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�wce ' "wg " Application for a Permit to Build No. 5 5a _
UPON FINAL APPROVAL9 _ 0-90 MAP r LOT 6 7
FEE MUST ACCOMPANY THIS APPLICATION. VDATE n /p
0
The undersigned hereby applies for a permit to build 9 /
90
according to the following specifications
✓1. Name of property owner DAN ti.I Jf- 1f1arjItJh 61 `' ran/ Tel. 36a-g30f7
Address sect 1'r'P�mgn) (R41. 'YA"r-vr,owlpnr C p'Th- .
2.Name of Architect(if any) Tel.
3. Name of builder nIII,>Pr- Address
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel. n
t77. Construction address R'9 Cre_eimign) Rich , rarimgw r± VYlA- ,
Flood 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 1 i Q S, Q a
11. Commercial 0 Kitchen
12. Other 0 toss) 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 ❑ Deck
16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
17. Garage — 1 0 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
(20. Stov9- Wood liCoal IBV 4-IMA) 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 ' on4jn / . 0:41/
'
PLANNING BOARD Address C '7 -p-,..evnD
AT I�c
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Date [ -vvI tm ,IP'`pa r4'I in0 A- •
WOOD STOVE INSTALLATION CHECKLIST
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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 - Coat S+nue„ cow ) Used
B. Type/radiant Z'rov,i-FBuc•r_..• Circulating 1--***--
C. Manufacturer Lao.No.
NameiModel No. Afrraras+Ipt� RA/ya. Collar size %ii Ir
Dimensions/Height ;Pt Length ,Rfl Wic:h R2
Chimney.
A. New Existing
B. Size(flue area) D if"t4
`` �_--
C. Cther appliances attached to flue(Number and flue size) UP
D. Prefab(Manufacturer—name aryl type)
E. Masonry/Lined I/ F:ueliner •
Unlined pype 3 manwac:urerl
F. Height(refer to diagrams) cap
over Ic' 1 I C:t.c 'Ci I T I I2" MN.
2 NCL 2 M' .�/�
1 �'NIN.
3'�.ti,u. � IC' :,,IMIN.
V. , iv
=, —' MIN.
s l
18'I!AIN.
ry��A,S-I
ISti
FZZ
r
o� hEARTH
CHIMNEY HEIGHT/
/V9�90
Hearth(non-compusnble) El:re C ...-
A. lo s a
CI. a*
-
1141
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S. 3uo-fup-,'Icorcpnsrucpon Kt-O�d.D
C. Minimum cimensicns(refer tociacraml ppp
Clearances and Wall Protection,see stove Irstaile:I clearances crart
� i
A. Type cf wall prctec icn provlced .3r,r Li'— F-I ICS l7rrn l,e e1- Ref.
B. Clearances(refer to ciagrams)
I •
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1
FIREPLACE CORNER WALL/CENTER
13