HomeMy WebLinkAboutBLD-90-627 k POSTED �3G% i�/F/gyp
; � 4 o TOWN OF • MOUTH
"' ... 60 Application for a Permit to Build No. Ga?
' Or r0el9 qo
. UPON FINAL APPROVAL MAP /a 3 LOT % a/7
FEE MUST ACCOMPANY THIS APPLICATION. DATE Ce-ti? 19 %d
The undersigned hereby applies for a permit to build /%7/90
/. /./,/9s/according to the following specifications
1. Name of property owner '. o5EPN C! 54674 Tela 3ef'8535-
Address 3 5 r7,e,q,c s: L/A,P�nuu M 61 i-,7,7.
2.Name of Architect(if any) - �/ Tel.
3. Name of builder j - - Address
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel.
7. Construction address -7S - -eaeE Si V (5T •
Flood t District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling CAEstimated Cost DO NOT WRITE IN THIS SPACE
' 10. Multi family ❑ /A ad — Cop
S�vC Type of room No.
11. Commercial 0 - Kitchen
12. Other 0
cf
0 'cro Dining Rm.
13. No. of stories.
Living Rm.
Bed Rm.
14. Foundation — Full 0 Half ❑ 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 �� • Shed
20. Stove - Wood 0 Coal ®' L/Y\11 i 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 / ' / tele--
PLANNING BOARD Addri -✓ __i •
Date
1V00D -10\1E INS INSTALLATION CH7rK1 lv l
• Permit .
A bui!cicg ;armlt is recuirec for the instailation cf any solid fuel burning aoctiance. The building permit and
instaila::cn ins:ecton are limits,:to the stove installation anc no:to the stove constrL'ctcn.
Stove
A. New C6 1- Usec /
S. e/raci 1.7.........-
/
C. Manufa_urer `�rd OH eiouCie Sile- Lc.No. •
Namei Model No. NMciCpSTt-F Ccuar size A N
Dimer..siens;He!Cn: fa Lenctn _ •r
'Niethlk" p
" Chimney /
A. New Existing L/
3. Size(flue area) 1 LX 1 2---
Nom/
C. Cthera
_oliana
oes aaonEC to flue(NUmoer and flue size)
D. Prefao(Manufacturer—name anC type)
E. MascnryiLiined I/ Fiue liner CL-4Y.
t)nilnec IIYP•s manwac:urer)
F. Heignt(refer to ciacranis) a cap
_I cv�i !c' I,.. -. I c to 1
1 I IZ" MIc4.
,3'MIN. \ p i NIN. ..I
�• i — UIN.
IS' !AIN.
(FUEL/ASH
1
FIZt cam,---- . HEARTH
. '�' I • r/ 6�7/96
, ..
C:Ih1NEY HEIGHT eihk
Hearth(ncnazus•%CE tits/ •CXTriv520A/ 9:krg/wao,fL A.c1�ET
A. Matanas '
S. Suo-ticcrconstruct:on
C. Minimum cimensions i reter to ciacram) -
Clearances ane Pall Protection see stove Installation clearances chart)
A. Type ct'.vall prc:ectton o cvlcec
S. Clearances (refer::c!agra...$)
Ker-riii
ref„ /Z �� IXl to i X
IIf I / j , II \
i 54. 437 21)14
FiREFL.ACE CORNER WALL/CENTER
•
13