HomeMy WebLinkAbout0057 LAKE STREET - Wood Stove Permit 09/29/80 ypf tp``
°"' °• TOWN OF BARNSTABLE
Z DAIL STABL
6 9 MASSACHUSETTS
Wood Stove Permit
DATE OF APPLICATION ..............`5 '....:'..Z..��............� ............ FIRE DEPT. ISSUING PERMIT ...�... ..�..�u......:..................
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NAME (owner) ..../ a..:..... Q............ .�C NAME (Installer) ... . ...f.. �-.......!....."..r:� .. .��..'r'..... .?�'`!FlG'. '`x�'�'
ADDRESS .3/ � ............. ¢ ADDRESS ..>.........../...........o.4........�...�....c..r.........�.�......�......................G.......t..,.�.....t....�.........f......V..v....�..
STOVE TYPE .................. .... .... ..G?-.... .................................................. CHIMNEY: NEW ........................ EXISTING ........
Manufacturer C..�... 0 C. ,N� ............. CHIMNEY: Masonry .........�...............................................................
................... ...........:..............................................................
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Mass. Approval ..................f.................................................................,...........�..... CHIMNEY: Metal ................................................................................................
This is to certify that the above installer has permission to install as wood burning appliance at the listed address
in accordance with an application on file with the �............!:t �........................:........................ Fire Department,
and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made
under the authority thereof.
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Issued By: ..........� ...............................Title �.� �r
....................... ......................................�..... .... ................. Date ,.............................................
Permit to install expires 60 days after issue date
Stove~ ... ................................................................................................................................................................................................................................................. ......
StoveClearance .....'"........................................................................................................................................................................................................................................................................
Floor .....✓.......................................................................................................................................................................................................................................................................................................
SmokePipe . .............................................................................................................................................................................................................................:.......................................................
SmokePipe Clearance A ..................................................................................................................................................................................................................................................
Chimney ..................................................................................................................................................................................................................................:...................................................................
SmokeDetector ......!......................................................:....................................................................................................................................:.............................................%.............................
The undersigned hereby certifies that the installation of wood burning stove and equipment made under author-
ity 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 SD..........� ..................... By: .................................................. ' Title:........ ...
date
WHITE: FIRE DEPARTMENT - CANARY: BUILDING INSPECTOR - PINK: APPLICANT