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1 �_y TOWN OF YARMOUTH
� MATTM, � 5l; Applic fon for a Permit to Build No. __
UPON FINAL APPROVAL /Ota-14–aS___.--MAP I t% LOT 4 –19 q-'
FEE MUST ACCOMPANY THIS APPLICATION. DATE Az V 6 19 IS
The undersigned hereby applies for a permit to build �0,/a//"9 3
according to the following specifications • /%//f3
1. Name of property owner V•A•Nowick_�� la�aoe AewiCl-v.., Tel.%2•b5-33
Address 300 5 - 4 70*e,! Lrs ct1.+J In, .
2.Name of Architect(if any) Tel.
3. Name of builder & e? Address
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel.
7. Construction address 9t) & 1EE,f)Gl-.<A D 044 ity-- I MR_ . 02670
Food District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE
Type of room No.
10. Multi family 0 I- 280.00
11. Commercial 071.4.t.st ' Kitchen
12. Other 0 Dining Rm.
13. No. of stories - Living Rm.
Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath
15. Materials — Wood 0 Cement 0 Other 0 Deck
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
Family Rm.
17. Garage — 1 0 2 ❑ Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
20. Stove — Wood 13/Coal 0 v2eD Alterations
21. Size of lot: No. of feet front No. of feet rear No. of feet deep
22. Size of building. No. of feet front No. of feet side No. of feet rear
23. Distance from nearest building: Front Ft. side Ft. side Rear
24. Distance back from line or street Fr•m rear lot line Side line
25. H.I.C.R. No.
LOT RELEASED BY Signature .
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PLANNING BOARD Ade ess •o "".,, el
Datejs // ,2Z _8675'
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::WOOD STOVE INSTALLATION CHECKLIST
• Permit
A building permit is required for the installation of any solid fuel burning appliance. The building permit and
installation inspection are limited to the stove installation and not to the stove construction.
Stove
A. New Used Y
B. Type/radiant BAD wuT Circulating
C. Manufacturer Lao.No.
Name/Model No. 5orUL )IS Collar size
Dimensions;Height "An 'r Length z9 t' Width PI "
Chimney
A. New Existing
B. Size(flue area)
C. Other appliances attached to flue(Number and flue size) NOAIF
D. Prefab(Manufacturer—name and type)
E. MasonryiLined X Flue liner TIL r
Unlined (type a manufacturer)
F. Height(refer to diagrams) cap
0 .
•
4
cvez to I ! orE^< to T ( 12" M!,4.
'1Nlty 2 Mi�. I
3 mlrtl, to, IC' - 3 MIN. •—r
z'
MIN,
18"!AIN.
(FUc I.L4i
In Cl H EARTH
FPIP7Os X43
CHIMNEYHEIGHT p /a�22/93
A. arthMat rials moustible) $KtCie t moire Cara,ra, g L'�3
ilt
A. Materials
B. Suo-flcor construction AJOOP ' c,q p. t--- f/,tc.Diti[. P.f-JD
C. Minimum dimenscns(refer tociacram)
Clearances and Wall Protection isee stove,rstailancn clearances chart) .
A. Type cf wail protection proviced e y1 V
B. Clearances(refer to diagrams)
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FIREPLACE CORNER WALL/CENTER
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To Whom It May Concern:
l' The purpose of this memorandum is to communicate that I have given
permission to my brother, David E. Nowicki, to install an approved wood
burning stove in my lime at 90 Eileen Street, Yarmouth Port, MA.
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