HomeMy WebLinkAboutBLD-90-694 o 04-<64714
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�o!°...AT�`"6"-,% Application for a Permit to Build No. �`i
hi 7-9D
UPON FINAL APPROVAL ii , MAP LOT/
FEE MUST ACCOMPANY THIS APPLICATION. DATE "I f A.7 19 go
The undersigned hereby applies for a permit to build 11/e 7 96
according to the following specifj�a/ I- .--
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1. Name of propert ner L � Tel.3 yb'-J /45
Address O qv '/zh /? tem) S,yg%/ia✓el oz6Gy
2.Name ofArchitect(ifany) / Tel.
a Name of builder 0-UrY(0/?=,) Address
4. License No. Tel.
5. Name of Mason Address
6. License No. Tel.
..4 construction address g4 QVn1X�/jl /' Eos S ot.
l Flood District
a 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
oo
11. Commercial 0 Kitchen
12. Other 0 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 0 a0 6-° Deck
16.Type of heat — Oil 0 Gas 0 Electric 0 Other ❑ Closed porch
17. Garage — 1 0 2 ❑ Family Rm.
Sun room
18. Swimming pool - Size Garage
19. Storage shed Size Shed
20. Stove —Wood O'Coal 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
2a Distance from nearest building: Front Ft. side Ft. side Rear
24. Distance back from line or street From rear at ine Side line
LOT RELEASED BY Signature –/ J./ /J.k
PLANNING BOARD Address
Date
WOOD STOVE INSTALLATION CHECKLIST
IMIZIOWS
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Permit
A buitaing-permitis 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. . 2 (D/
Stove
A. New Used X
B. Typeiradiant Circulating 1/
C. Manufacturer tet a SSr5 Lao.No. /96Tr 7 7/ 3
•
NameiModel No. a 100cA/EOQ I Collar size 6
Dimensions/Height Length Width 2
Chimney
A. New Existing X
B. Size(flue area) 9X fa
C. Other appliances attached to flue(Number and flue size) OA+
D. Prefab(Manufacturer—name and type)
E. MasonryiLined YC, Flue liner 9K) C1Ay
Unlined hype i manurac:urep
F. Height(refer to diagrams) cap
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3'may 'to. �� IC' " 3',tilN. a
12
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CHIMNEY HEIGHT /// �/�
A. (non-comous:tie) (7 �/ 4 [C� ;fri ,
A. Materials K
E. Suc-floor construction
C. Minimum cimen.sicns ireferto ciacraml
Clearances ana Wail Protection isee stove instailaticn clearances cnart)
A. Type of wail protection provicec
E. C:earances;refer to ciagrams)
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FIREPLACE CORNER WALL/CENTER
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