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No.
Av4)
Application for a Permit wild
'Fee must accompany this appli ion ��AA,,
Yarmouth .(//- 3 19.G.Y
,s-a 5-p
TO THE BOARD OF SELECTMEN ''t I
The undersigned hereby applies for a permit to build, according to the following specifications:
L Name of Owner fr/l1C Pn t J' e n it o N Address 3 3.r greet /o°if ,/iZ�1
�
C/au�le de/7e W yarl�r°u i.
2. Name of Architect (if any) ( / M/ f/c e//e ./10-0,6 a,1-1
u//el�llU
3: Name of guilder Q/4 f r
4. Precinct No. // Lot No. n Plan: Name or No.
5: Name of Street 3, rgrea SI/C ti( �L 1 M LIC 508
6: Purpose of Building ta}Yj!!/k - C410/ f71te., AgCLLt
7. Material CCc/nit
8. Estimated cost of building- 5ZU Cee
9. Dwelling at „Silky •
10. Cottage 0 4 14)
11. Heat Co'!
12. Basement lid
13. Garage yei
14. Store
15. Shop
16. No. of stories 0--
17. Is there to be a Store in the lower storey N 0
18. Size of Lot. No. of feet front //4Q No. of feet rear .,.../6 0 No. of feet deep •171°Q
19. Size of building. No. of feet front d No. of feet side ..:7-41 No. of feet rear
20. Distance from nearest building: Front ft.; side T ft.; side ft.; rear
21. Distance back from line or street yQ from rear lot line .../.00 , side line
Show by diagram the location of propsed building with relation to distances from adjoining lots, on reverse side.
Name,..y...L ./11 Ca'w b J 61/4 N k
Address 3 3.1- fie(e7 -2r/eke ce
Stove 14 /lug gal /r( / 1St Cf/ , r<rritgafl
uwi'e/ /k Ca / Y7 th//yK<fu/e- 1
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Street Name
-a
p Left Side Depth of Lot
1
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z
z
Fro:/
y O
z 07
m 0
r
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0
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i.
1
l
L7 le
V
Right Side Depth of Lot
1 _
t
F
Street Name T
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WOOD S'iOV2 I dSTALLA`i'i0/1221LIST app
. 1/P�t'mit � ��� ,, � a ✓ 9
A building permit is required for the installationofany' solid l burning
appliance. The building permit and installation inspection are limited to the
stove installation and not to the stove construction.
Stove
A) slewUsed-
_._.
B) Type/radiant te, Circulating
C) Manufacturer cat ei4C Lab. label
Name/Model No. Collar size if 1
Dimensions/Height -f Length )r — Width 1sr.p
Chimney
et
A) New Existing
B) Size (flue area) ex-so
C) Other appliances attached to flue (Number and flue size) t1tuir
D) Prefab(Manufacturer—name. and type)
E) Masonry/Lined rig
. Unlined Flue liner
(type & manufacturer)
i
F) Height (refer to diagrams) ktt.° g 44v cap
over to I I osee lo L ,lemin.-
•
min.
. ...+-. 4 X
/B
man
(fo.i/nsh
CLCC eft Sail)
.1 HEARTH . -.
CHIMNEY HEIGHT
Hearth (min. 1 hr fire resistance) A) Materials r' tf ' e ?c
B) Sub-floor construction - Aj,,,,,,n
C) Minimum dimensions (refer to diagram)
Clearances and Wall. Protection(see stove installation clearances chart)
A) . Type of wall protection provided b R i aK -_.
B) Clearances (referto diagrams) ..-.. ; --•
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..—.16 __
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FIREPLACE CORNER , WALL/CENTER