BLD-90-596 O2t
ac tor, :So TOWN O RMOUTH
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MATTALM[TE -
�,:nE,A fl/ Application for a Pea /0, -90rmit to Build No. ,°
UPON FINAL APPROVAL MAP <oP LOT C-1051 .
FEE MUST ACCOMPANY THIS APPLICATION. DATE fa/i 19 v •
The undersigned hereby applies for a permit to build
according to the following specif;>ations / / 7 /!
1. Name of property owner an' at .. ' Tel 397 ^1'`/?7
Address a7' eii2 f �"),--e � A' V7
2.Name of Architect(if any) / Tel.
a Name of builder 4-2.0-7u4 _ Address
4. License No. Tel.
5. Name of Mason _Address
6. License No. Tel.
7. Construction address _.2 y 04-0•17A/c<24
A/
rlood District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated Cost DO NOT WRITE IN THIS SPACE.
10. Multi family 0 . (5-6-0 . ereType of room No.
11. Commercial ❑ Kitchen
12. Other 0 Dining Rm.
A & Living Rm.
13. No. of stories d 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 ❑ 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size ' _ 6 Shed
20. Stove —Wood �oal ❑1- �— 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 Signatu iia- ' ` C ;
PLANNING BOARD Address a) /, �-�Z
Date 1„i-- ;.L:,�o-e,t2,v'�
WOOD STOVE INSTALLATION CHECKLIST
. c,. L.. /ye-
.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 construe /990
/990
Stove ��L(/����1
A. New - Used
B. Type/radiant v/ Circulating
C. Manufacturer MaahiER 6Onewb,4 Lab.No.
Name/Model No. Collar size e ce
Dimensions/Height 1'O Length p fir Width j' Cl
Chimney rA. New Existing
B. Size(flue area)
C. Other appliances attached to flue(Number and flue size)
D. Prefab(Manufacturer—name and type)
E. MasonryiLined Flue liner
Unlined (type 8 manufacturer)
F. Height(refer to diagrams) cap
a
1 °vel lo' I
NAT�� !O I 112° MIN.
I
2 MIN. 2 Mi�•
I �I2
3'4iµ 4ci IC' 'MIN.
I _ .1. IL
I
MINI.
• 18"
5 MINI S
i CFAt.JA
II
HEARTH
_S a raw_
_ _1
CHIMNEY HEIGHT /
Hearth(non-comoustible)
A. Materialsa'��t •
B. Sue-floor construction
C. Minimum dimensions(refer to ciaeraml
Clearances and Wall Protection i see stove installation clearances cnart)
A. Type ��)of wall protection provided �ie 1-4--•/ •//7 'n
6. Clearances(refer to diagrams)
•
—44 --I ...–. I
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FIREPLACE CORNER WALL/CENTER
I 13