HomeMy WebLinkAbout0011 STAYSAIL CIRCLE Vie Town of Barnstable Q , Building
Post This Card.So That it is Visible From the Street-Approved Plans Must be Retained`on Job and this Card Must be Kept
M" p Posted Until Final inspection Has Been Made. z S Permit
Where a Certificate'of Occupancy is Required,such Building"shall Not be Occupied until a Final Inspection has been made.
Permit No. B-18-3087 Applicant Name: Roland Langevin Approvals
Date Issued: 09/25/2018 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 03/25/2019 Foundation:
Location: it STAYSAIL CIRCLE, MARSTONS MILLS y _Map/Lot: 058-016-002 Zoning District: RF Sheathing:
Owner on Record: Julie Veres , Contractor Name'.,ROLAND LANGEVIN Framing: 1
Address: 11 STAYSAIL CIRCLE Contractor License: C-103861 2
MARSTONS MILLS, MA 02648 i Est. Project Cost: $4,077.00 Chimney:
Description: Air sealing,weatherstrip door, kneewall:2" rigid board:6";fiberglass Permit Fee: $85.00
R19. attic: R-19 unfaced fiberglass,ventilation chutes,vent bath fan, ' Insulation:
insulate bulkhead door,attic hatch:seal and Insulate, basement ,� Fee Paid: $85.00
sills: R19 FG Batt. Date: ;f 9/25/2018 Final:
Project Review Req: �r Plumbing/Gas
r
Rough Plumbing:
Building Official
Final Plumbing:
Rough Gas:
j[ Final Gas:
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.
All work authorized by this permit shall conform to the approved application and the'approved.construction documents for which this permit has been granted.
Electrical
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Service:
work until the completion of the same.
} _ _ Rough:
The Certificate of Occupancy will not be issued until all applicable signatures by the Building re Offic and Fiials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Final:
1.Foundation or Footing
2.Sheathing Inspection Low Voltage Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final:
S.Prior to Covering Structural Members(Frame Inspection)
6.Insulation Health
7.Final Inspection before Occupancy Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
ik�
TOWN OF BARNSTABLE Permit No. . 34255
BUILDING DEPARTMENT
TOWN OFFICE BUILDING Cash
� Yl
ew. N/A
'�>o,,,r►� HYANNIS.MASS.02601 Bond
CERTIFICATE OF USE AND OCCUPANCY
Issued to JOHN J. McSHANE
Address lot #2 11 Staysail Circle, Marstons Mills
USE GROUP FIRE GRADING OCCUPANCY LOAD'
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL'NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETT_S STATE
BUILDING CODE. "I
May 20 91
'4.......................... 19................. ........... :in
....Buil Inspector .
IY
� TOWN PF BARNSTABLE, MASSACHUSETTS
BUILDING PERMIT
- A=058.016 Aril 8 9i }� ,q
IlcShanE> Construct on
P MIT NO _NQ 3`i 915
APPLICANT 4�i rraZmOUth E'oad CO UYT
( ADDRESS
INO.I (STREET) (CONTR'S LICENSE)
j PERMIT TO gild dwelling (12 1 STORY S•� j' XX Single family dWNUMBER OF 1,
I
I (TYPE Or IMPROVEMENT( N0. (PROPOSED USE( DWELLING UNITS
AT (LOCATION) .Lot 11 Staysail Circiel:;, ttElrstOnb :Hills ZONING RF
IN0.) (STREET) DISTRICT_
i_
' BETWEEN AND
( -ROSS STREET) (CROSS STREET)
I
SUBDIVISION LOT
LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
` Sewage #$96r (TYPE)
I REMARKS:
1
r
j AREA OR 768 sq. ft. 45;000 PER 'NO FEE
VOLUME ESTIMCTEO COSTS FEE MIT
(CUBIC/SO DARE FEET( e d1
OWNER John J. McShane ?
464 Fallout Road, COtu t BUILDING DEPT. cr_ADDRESSBY
L""`FR'OM"'fFi "'DEPAi7TK1EFJT"OF`PUBLTCW`bKS. THE ISSUANCE OF TH1$ PERMIT DOES NOT RELEASE~THE APPLICANT FROM THE CONDITIONS
OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE
INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN
ALL CONSTRUCTION WORK: ELECTRICAL. PLUMBING AND
I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS.
2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL
MINAL INSPECTION
TI TO LATHE FINAL INSPECTION HAS BEEN MADE.
3, FINAL INSPECTION BEFORE
OCCUPANCY.
POST THIS CARD SO IT IS VISIBLE FROM STREET
�j BUILDING INSPECTION APPROVALS PLUMBING NSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS
3 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT
2 L�l/� F HEAL
BOARD OTH
�•/�/j VT�q 7,
OTHER SITE PLAN REVIEW APPROVAL
WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT 'N!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARO CAN,t;E
TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONL OR wRIrrEN
CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION.
i
II. s, Gocal Cr-ntributions, e: W.
,a
::A. Which of the following contributions has the community made ..to' the:
project? Please check: <'
o Land Donation
o building Donation:
o ,Marketing Assistance- x
o Other Work of Local Staff
o �;iq rehensive Permit C*MMx —X— Applied for I
` c ID-insity Increase
Q �.,,:a.l Funds (Cash) .
o Amount ti $ 15 ,000- value
W: fiver of Permit Fees for Affordable Units only:
B. Has the community contributed to the project in ways other than
t~,: •. isted above? If so, please indicate:
III Local ro v as l s: -- COMMUNITY-SUPPOR M APPLICATIONS ONLY: , : �}
'If th_s application is•,community-supported. please complete this. .'x1� YI
sect_c ,t. (F,y. 110P definition, a. community-supported':application is..
suppo:>:-i.J both by. the chief elected official and by the local.housing . .. i; . ...,
if .one exists. )
A. Le ..ers of support-
lose a letter of support for your project from the'chief
C.e _d official.
tt E::.close a letter of support for your project from the local'
nartnershi. ., p (if one exists) .
B. Sid .... :ur„s cf Support '
V•'C
Prti':; e :e signatu es. requested below:
6 Official cal using Partnership
_&Ecufm
OFFICE OF
COMMUNITIES &
DmoPmmT
' Michael S. Dukakis,Governor
Amy S.Anthony,Secretary
December 1.0, 1990
Mr. John McShane
McShane Construction
4464 Route 28'
Cotuit, MA 02635
Re: Prince Cove Highlands HOP Project - 11yannis
Dear Mr. McShane,
I
We have received your request for approval of a unit mix change at
the Prince Cove Highlands HOP project in Hyannis. This change
will increase the number of HOP units from two to six making all
units at Prince Cove affordable under the Homeownership
Opportunity Program guidelines.
After consulting with MHFA Single Family staff, we agree to approve
your request. The amount-..-:of 'subsidy set aside for Prince Cove
Highlands will be $78,000: We understand that many first-time
homebuyers have expressed interest in the HOP units at Prince
Cove. We look forward to hearing about the successful marketing
of all six homes in this development.
If you have any questions, please contact Lionel Julio of my
staff.
Sincerely
C therine Racer, Director
Homeownership Opportunity Program
cc: Marcia Lamb
Tom Gleason
Peter May
Lionel Julio
I
i
100 Cambridge Street
Boston, Massachusetts 02202
r
lJ' 11 V.G .. ..... . .....
"OFFICE OF
COWUIVITIES &
DMOPMMT .
Michael S.Dukakis,Governor
Amy S.Anthony,Secretary
December 1.0, 1990
Mr. John McShane
McShane Construction
4464 Route 28
Cotuit, MA 02635,
Re: Prince Cove- Highlands HOP Project - Hyannis
Dear Mr. McShane,
We have received your request for approval of a unit mix change at
the Prince Cove Highlands HOP project in Hyannis. This change
will increase the number of HOP units frow two to six making all
units at Prince Cove affordable under the Homeownership
Opportunity Program guidelines.
After consulting with MHFA Single Family staff, we agree to approve
your request. The amount,.-:of 'subsidy set aside for Prince Cove
Highlands will be $78,000; We understand that many first-time
homebuyers have expressed interest in the HOP units at Prince
Cove. We look forward to hearing about the successful marketing
of all six homes in this development.
If you have any questions, please contact Lionel Julio of my
staff.
Sincerely
C therine Racer, Director
Homeownership Opportunity Program
cc: Marcia Lamb
Tom Gleason
Peter May
_Lionel Julio
100 Cambiidge Street
Boston, Massachusetts 02202
! IZ:i� Goca_2_Cr__ntributions. ^ 'p ;tl`• ' -.
..
:A. which of the following contributions has the comID unity"made;to:`:the;,; 1 .•.i. - .*;,1,
project? Please check: t + `
o Land Donation :
o Building. Donation
o S.arketing Assistance . x
o Other work of Local Staff
o k-.:inprehensive Permit C*KXMx 'fit—' Applied for i
' c Density Increase
x !�•
. .. .--r;-::.,-ivrr-of-PE='�L""FeES � .' `•'
v 1...t:u1 Funds (Cash)
o Amount ti S 15 ,000 value
Waiver of Permit Fees for Affordable Units only.
.B. Has the community contributed to the project in ways other than
listed above? If so please indicate: :!' •�� ` '
3 :
• bi;
No
t :.. ftj .:6Ae4
III. 'Local _o rr_a l s: -- COMMUNITY-SUPPORTED APPLICATIONS ONLY i i)i77
;-If th_s ap,�li-cation is community-supported. please complete,this• . �`: ••eL' ' <
sect:c:i. (B . }i0P definition, a, community-supported•:application:is•,. .:.'; : F!''•.
: sup;�_.:'tod bo_}i by the chief elected official and by the local.housing
part:•:&rrs:rip -- if .one exists. ) °.
o c::close a letter of support for your project from the chief
�!c,ted'official. i
VE::.close a letter of support for your project from the locale
",'�'• sin- partnership (if one exists) .
16.
-B. Sid.:::: :.ures of Support
signatu es- requested below:
-� .•.. : .:?r;c �d Official cal using Partnership
A;,
:re D e
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'III_ :I�--. .• �.I
wwon SKP4
Z14(�W I I I INO ROOF SHINC.LES OR EQUAL. .-_ --
2A WO►1
• I ALUM.GUTTER. - ---
_.I.^_ %MAIM CLMR 1NINGLlj I — _
OPt10NALCaUMNLY YNE — - _ -—
I �I I=r— y{4cw I Iww tMl.Vf u Z,I"
• -I-I r-:- I I I I 1.1 —
L�.-.,LL.__.'110 war 16MINftLL� AWM ON.bPWI JT`1R) _
I 'PaceAST.eanc..cTL.es
LEFT ELEVATION FRONT ELEVATION.
32K24C/>PE•'306EnR'11./UNFINISHEI7UP.usoyrluVsuchk5A ING090H.A .
un.r•o MAr woo FtvlsloNs: Rb Irsl CONSTRUCTION
MCSY LANE CONSTRUCTION
4464 Route A CotuiL,MA 02635 (508)42"500
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MCSHANE CONSTRUCTION
4464 Route 28,Cosuis,MA 02635
TIR FLOOR PAN.
(508)42"500
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McSI•fANE CONSTRUCTION
4464 Route 20,Cotuit,MA 02635 (508)42"S00
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FpUNDATI 3
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v 32. 10 In
3 4.
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z LOT 2
10, 262 SF.
108.66
N31 '31 '05"W
PLOT PLAN OF LAND
"TO THE BEST OF MY KNOWLEDGE, THE FOUNDATION L OCA TED IN
SHOWN ON THIS PLAN IS AS IT ACTUALLY EXISTS BARNS TABLE MASS.
ON THE GROUND.
cpf , PREPARED FOR
DATE:APR. 4, 1991
Mc SHA NE . CONS TPUC TION
1.. y
P
c A
�f� • t..��,R.L.S. DA TE.•APR. 4, 1991 E.•SCAL 1 'a 30 FT.
"1r=�•Y�L(% ���''ryC..�_(.�y/� .Q �UL(T�� V,��
c i[{," ' ''� CAPE F ISLANDS SURVEYING
FLOOD ZONE C (NON-HAZARD) FALMOUTH — MASS,
r �
Assessor's office(1st Floor):
Assessor's map and lot number ►� .��£� d. S $ 61 .: SEPTIC SYSTEM M
Board
Permit numbs or): a 9 -�J3��j INSTALLED IN CO
,. WITH TITL
'r Engineering Department(3r"d floor): i }�• E��IRON�ENT��, N e l
y, House number
Definitive Plan Approved by,Rkowi%Boar ;rs 1. )�} 19 d . ��f!` ��r�r d•
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
� APPLIC Y
TOWN OF BARNSTABLE
` BUILDING INSPECTOR
1 J n ll
APPLICATION FOR PERMIT TO C i7/I S U(/4 Sj Q I L J 19 M / [J wei/� �►
TYPE OF CONSTRUCTION
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information: /
Location �OT JT04y.Sr9! '
Proposed Use S�n�9�. �r¢ �f/y /f esd N���C �g�2o0 L�
Zoning District Fire District
Name of Owner a 4.l Address
t �
Name of Builder S 4 GaK� Address
Name of Architect eEU I' r 41c Address
Number of Rooms 4 Foundation �Oy2fi� G(�H G11 e
Exterior I!f C� 614145 U�. Sy �"1 /e 5 Roofing i�&P h* fGi� `�c Y ep
Floors G y Interior
Heating /� _ � � Plumbing / Q", S
Fireplace /v Approximate Cost
Area
Diagram of Lot and Building with Dimensions Fee
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Construction Supervisor's License
S'
i
MCSHANE, JOHN J..
f
No 34255 permit For 112 Story
Sinqle Family Dwelling
Location Lot #2, 11 Staysail Circle
Marstons Mills
4
Owner John J. McShane
Frame _
Type of Construction
Plot Lot
Permit Granted April 8, 19 91
Date of Inspection pp 19
Date Completed o�020-7� 19
1
r � ,^p^c..�^gg��g�vg4pJp:�pi��vn
p�.� 6o�JCy1�"I.Y/�iVb6�o.
Assessor's office(1st Floor), , �.��q'('�-rL9 5
Assessor's map and to number — �� �pE TwE To
E�9�6 ®NMEN�TAL
Conservation S Z- T®viN nEGUL ATIAN
Board of Health(3rd floor): q
o
Sewage Permit number �. f � �yant !
IL
Engineering Department(3rd floor): � ` ��'6��'
House number / r'•is a tr�r
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO v 1 Q L 5-Ap LW-,
TYPE OF CONSTRUCTION _ `
�' 19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location
Proposed Use�/L v-r ,10 A 1
Zoning District [• f Fire District
Name of Owner )Die— U: A•`'i^G Address—,4z
_ Lam•
Name of Builder * Address
Name of Architect Address
Number of Rooms Foundation - w)-o v .• } �'
Exterior Roofing
Floors �� Interior
Heating Plumbing
Fireplace Approximate Cost o
Area
Diagram of Lot and Building with Dimensions Fees t
L oZ�
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Construction Supervisor's License Qf 0 1
D. DeBARRO' S
No 35041 Permit For BUILD DECK.
Single Family Dwelling
Location 11 Staysail Circle
Marstons Mills
owner. D..• DeBarrows
Type of Construction Frame
Plot Lot
Permit Granted May 7 , 19 9�
Date of Inspection 19
CV
Date Completed 19
a,
S!y
.�y -'""b� y '.Y�6,� ._: ;.. ,u.., .- ...s4T"tia` .` �;e�4, ... `j.•';...:.1. .� ,Jf ^r v.-�..� .:;�, _: .: .. S
.-+�;r�ix:.� �� �-:i+-w.r�,y;;r � s f ;., � +.�• v `t , w �.• "-; w .s fi...,.. .�SrfR�+��' �`�w��•irww'aT :,. r
`OF THE Town of•Barnstable
•BARNSTABLE. Regulatory Services
MASS.
0,59. Building Division pFFO h1P'�A .
200 Main Street,Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
Pr-fi@a- _____tion Notice
Type of Inspection- �L
Location -��`4 �iSa ���lc/p Permit Number
Owner \ lie ��l /M�Jt 7 Ai Su Ye l e
One notice to remain on job site, one notice on file in Building Department.
The following items need correcting:
D X6 OAJ6 LL � � C.' S 7�
/GN �x r
-1 f-r /S
r Loci nut) aht c— B& R —fi4esv t--�s
A
Please call: �508--862-4!03 'for re-inspec
titi
ioon.
Inspected by / e`er'' %P*C"/�C-7
Date �O ( � /07
�FTM�Tti The Town of Barnstable �.
Department of Health, Safety and Environmental Services
annlvsrrnHr.E. t Building Division
1639. .0� 367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph M.Crossen
Fax: 508-790-6230 Building Commissioner
Home Occupation Registration
Date: 3-0
Name: L Phone#:(s�t) (�12
Address: C rd � Village:.jb�gL� a]I 1 Lis
Type of Business: l=l .n�l�f�l��l I Map/Lot: \o
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and
there is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
1,the undersigned,have read and agree with the above restrictions for my home occupation I am registering.
Applicant: Date:
Homeoc.doc
TOWN OF BARNSTABLE
t sesasr
MASSACHUSETTS
�`•0 MAY�` ,
Solid Fuel Stove Permit
DATE OF APPLICATION ............................:�....,,( R FiftH ^^nP-T-,-ISSUING PERMIT .............
NAME (owner) :. ... ..... �1..] .C.... -?.. .... NAME (Installer) CL... 'U. , ............l...Jl/�(t...l.. .....
- . ADDRESS nfL0ADDRESS .....` ..... ............ ..................................1...: ..:.. .... ..... .. ...... .... /,�
STOVE TYPE .............................. ... ..... ......... ......... ....................... ............... CHIMNEY: NEW ....... EXISTING ........................
I
Manufacturer ................. ..... .. ....... ..... . . . . . .. ........... CHIMNEY: Masonry .............................................................................................
Mass. Approval ..� G .................... CHIMNEY: Metal ...................................................................................................
This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed
address in accordance with an application on file with the ................................................................................................... Fire Department,
and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made
under the authority thereof.
Issued By: ............. ........ ....... ..... ... ... .........................................................Title L� ,................ Date
—�
Permit to install expires 60 days after issue date
Stove . ..... ..... .1................. ............�.1............. .......................
i
StoveClearanc ...rr.................5�%. .... .......... ........ '.. ..... ...... ......... .. .. ... ..c
Floor .C `,r ....... .. ..........................................................................................
SmokePipe .. ......... ....................................... .............................................................................................................................................................................................
4&4-
Smoke Pipe Clearance ....................:...�--
..... . ...............................................................................................................................................................................................................
Chimney .................................. ..............................................................................................................................................................................................................................
Smoke Detector ................................
e'....�.........'...........................................................................................................................................................................................................................
The undersigned hereby certifies that the installation of solid fuel burning stove and equipment made under au-
thority of permit dated ...................................................... has been made in accordance with provisions of the Commonwealth
of Massachusetts State Building Code now currently in effect and pertaining thereto ........................................................................
Installer
:.
INSTALLATION APPROVED G.............. By:........................................ .................. ........................... Title. .................��r...........
....................date..... .... 7.
WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK: APPLICANT
He
TOWN OF BARNSTABEE
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2039. MASSACHUSEM
Solid Fuel Stove Permit
DATE OF AP"PL'ICATION .............. r�.' ... ................. FIRE-DEPT:ISSUING PERMIT .. .:. ..�....
� f-.CC)7 NAME (Installer)Ej0-r1X'0(NAME (owner) ................... ...... . ....�� �I �........—.....-...�....
....
ADDRES / "�- ADDRESS 4J
�................. ................. ........_. 'c............................... ..................
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STOVE TYPE ............................' �J....... ......................................... CHIMNEY: NEW ........................ EXISTING ........................
Manufacturer ......................� .......... .... ........... CHIMNEY: Masonry .............................................................................................
Mass. Approval lQ.. CHIMNEY: Metal ..................`'�.................................................._............
This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed
address in accordance with an application on file with the ................................................................................................... Fire Department,
and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made
under the authority thereof.
Issued By
—�
*� .1� .........................................................Title -................ Date ! ��
Permit to install expires 60 days after issue date
� 1 J! ....................................................U .... a.7..........................................
Stove � ��� -............... .... ........................... ......... ........ ..... w
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Stove Clearanc QGYQ�i '�l � P�K�� �..........
............................................................ ........... ,...
Floor ,. .........11r................. ............. .....................�..................................................................................................................................... ..........................................I............
SmokePipe ................... eie...... ............. ..........................................................................................................................................................................................
SmokePipe Clearance ........................ y ....................................................................................................................................................................................
Chimney / ..........................:...............................................................................................................................................................................I....................
qaw
SmokeDetector .................................. ..........................................................................................................................................................................................................................
The undersigned hereby certifies that the installation of solid fuel burning stove and equipment made under au-
thority of permit dated ...................................................... has been made in accordance with provisions of the Commonwealth
of Massachusetts State Building Code now currently in effect and pertaining thereto ........................................................................
Installer
INSTALLATION APPROVED ............. By: .................................................................................. Title: ...................
date ....................�..
WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK: APPLICANT