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Applin for a Permit to Build No. 32-5
UPON FINAL APPROVAL %.,• I MAP LOT
FEE MUST ACCOMPANY THIS APPLICATION. DATE 6,.1-'�7 19 9 0
The undersigned hereby applies for a permit to build Wad9°
accordjng to the following specifications
1-1-:"game of property owner J n IN N., Z'.+ L r- y Tel.77/- a76 8
Address CC i Q o a o c is IS l u cL
2.Name of Architect(if any) Tel.
L.2.'flame of builder c-Rarbe J Address
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel.
!Construction address ��� _72-c-.i_ �t
Flood District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling ❑ Estimated CostDO NOT WRITE IN THIS SPACE
,/ Type of room No.
10. Multi family ❑ " / a 6 C. .- ani)),tlrzzlSt/
11. Commercial ❑ Kitchen
12. Other ❑ . Dining Rm.
ab Living Rm.
13. No. of stories 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 ❑ Closed porch
Family Rm.
17. Garage — 1 ❑ 2 ❑ Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
20. Stove — Wood VCoal 0 /720 (A) 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 From rear lot line Side line
LOT RELEASED BY Signature ac_� 4J -p e a ea�-
PLANNING BOARD Address •--6-3- c-�?' ,
Date
WOOD STOVE INSTALLATION CHECKLIST
U. 1.. r /si9 ez
Permit •
A building�oermit is required for the installation cf any solid fuel burning appliance. The building permit and u
installation inspection are limited to the stove installation and net to the stove construction. • 3f-,S- 70 er
Stove 7 �--
A. New & 00 cl air0d - Used
B. Typeiradiant '"-- Circulating
C. Manufacturer 4 VT in- Lao.No.
Name/Model No. 3 r A Collar size -c'- Our l.et-cc
Dimensions;Height JG `r Length ' X11 Wicth aiifr
•
Chimney
A. New Existing 1.-------
B.
B. Size(flue area)
C. Other appliances attached to flue(Number and flue size)
D. Prefab(Manufacturer—name and type)
E. Masonry/Lined Fiue liner
Unlined t :u
,type a manutacren
F. Height(refer to diagrams) cao
a
I cve� Ici I i c�F< IC'
I —4- Ile MIN.
j . MINI. Z M.I.
S Mu. IC' .,'`AIN. .
c' IZ
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MIN.
L',; 1 Lel !.
- , AC__--oma
FIB) 0X I HEAARTH
I
CHIMNEY HEIGHT ®i 62 P-00 LL
Hearth(ncn-ccrncusadle) D ' / AP ,
A. Materials .�j 6Pd%
B. Suo-floor construction
C. Minimum cimensicrs;refer tociacraml
Clearances and Wail Protection isee stove installation clearances chart)
A. Type of wail protection proviced
6. Clearances(refer to diagrams)
7 11
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FIREPLACE . ' CORNER WALL/CENTER
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