HomeMy WebLinkAbout0121 LEWIS POND ROAD - Wood Stove Permit 01/06/81 1
TOWN OF BARNSTABLE
AUL
1639. .� .1 MASSACHUSETTS
�•0 Y�Y k� i
Wood Stove Permit
'ter
DATE OF APPLICATION ........ ......'���... . .��.....f.............................. FIRE DEPT. ISSUING PERMIT ...........-...J...... 1 t ..................
NAME (owner) /�h. " � �J.���/r�t.= /�f' (Installer) ..sF ..�?......
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ti
NAME Installer �- ...
ADDRESS ............................ ADDRESS .... ..... ....... .... .. .................
...... .......
STOVE TYPE .......................... .........................................:...................................... CHIMNEY NEW EXISTING
Manufacturer ...............� ....................................................:. CHIMNEY: Masonry I1��rK
............ .......................................................................................
Mass..-Approval ..... :..../` •! ............................................................... CHIMNEY: Metal
This is to certify that the above installer has permission to install�a wood 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.
IssuedBy .................................Title ........................,,.................................................... Date ................................................
Permit,to install expires 60 days after issue date
Stove . ``......................................................................................................................................................................................................................................................................................................
Stove Clearance
.................................................................................................................
Floor ................................................................................................................................................................................................................:.........................................:...................................................
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SmokePipe .. . .................................:.............................................................................. ...........................................................................................................:...................................................
SmokePipe Clearance ..!-'` ......................................................................................................................................................................:......................................................................
Chimneyt:�`.............................................................................................................................................................................................................................................................................................
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
INSTALLATIONAPPROVED . � ��' � • 17 �/-�•-�+�r-� r�s ✓�...........................e.................. By.,..................................................................,................ Title. ,..........................................{.........
date y � d
WHITE: FIRE DEPARTMENT - CANARY: BUILDING INSPECTOR - PINK: APPLICANT