BLD-90-563 POSTED 9
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TOWN
WN O ARMOUTH
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%,–.° "6 Applica nfor
a Permit to Build No. 56 3
UPON FINAL APPROVAL g'I , MAP L
FEE MUST ACCOMPANY THIS APPLICATION. DATE 19 p
The undersigned hereby applies for a permit to build g/ii 96
accyrding to the following specifications
"1. Name of property owner :Mlles e Ti;D4N TR . Tel. -710-303a_
Address % F Ski 0/ R. Dri;ie. So, pi(moot, ni4
2.Name of Architect(if any) Tel.
Lei:Name of builder OZ-0-w? ) Address
4. License No. Tel.
5. Name of Mason _Address
6. License No. Tel.
L.716Plistruction address #g 5111 Rc-5T Or. S,• yrcrN,aih MA• o2LG y
Flood District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost — DO
of room No.DO NOT WRITE IN THIS SPACE
10. Multi family 0 aoo
11. Commercial 0 o1@0-° Kitchen
12. Other 0 Dining Rm.
Living Rm.
13. No. of stories f 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
17. Garage — 1 0 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
2'
20. Stove — Wood Coal ❑ Z..(42-1Wzra 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 ,---- 0,9471,0-19 le ,
PLANNING BOARD Address F 52a St
Date So.y Av'tino 1 MR. 0260
WOOD STOVE INSTALLATION CHECKLIST
C/. L.:1r.
Permit
A building pejmit is required for the installation of any solid fuel burning appliance. The building permit and �1
installAioninspection are limited to the stove installation and not to the stove construction. 05
h1P01D
Stove / ✓
A. New Used V/
B. Type/radiant ✓ Circulating
C. Manufacturer P41-t-(6t' Mak e- /f Mj Lao.No. u L 'I 4$& '
Name/Model No. Mo 0P I �' ' Collar size Air
Dimensions/Height e?S" Length r24 " Width 16"
Chimney `
A. New Existing V
B. Size(flue area) 1 )t la.
C. Other appliances attached to flue(Number and flue size) N D
D. Prefab(Manufacturer—name and type)
E. Masonry/Lined Flue liner Ye S
Unlined (Woe a manufacturer
F. Height(refertodiagrams) cap
a
! cvER 10 I ! ovER 10 � _ I lei MI,M.
�2 MIK 2 Mi'�•
3'miN, }to, - lc - 3r,MIN- . —.
! _ _ I`e
ma
I
u
1 Le MIN.
(Fue_%A.4+
�75 HEARTH
CdT
CHIMNEY HEIGHT
Hearth(non-ccmcustible)
A. Materials
B. Sue-floor construction
C. Minimum dimensions(refer to diagram,
Clearances and Wail Protection Isee stove installation clearances chart)
A. Type of wall protection proviced
B. Clearances(refer to diagrams)
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FIREPLACE CORNER WALL/CENTER
13