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TOWN OF BARNSTABLE
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,639. MASSACHUSETTS
Solid Fuel Stove Permit
DATE OF APPLICATION ..... ....................1.�. .. ............... FIRE DEPT. ISSUING PERMIT
............................:..............................
NAME (owner) ...Fra.J.[...A......��O htR/►�l T�: elvi AC'.S � NAME (Installer) ........ �' ��rZ �� � �1�i�:�t.::.!................
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ADDRESS •.. ..
ADDRESS ..............................r..�........................................................... .................,:...:.:...........�........................;.........................;........ ................
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STOVE TYPE ,,,.Wand ,S�d� '(��5�1�TC ......................... CHIMNEY: NEW.......... EXISTING ........................
Manufacturer ��,,// n ` 4 '� CHIMNEY: Masonry
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�c Mass. Approval . .. .. ��..............(O:��..:..........:h:'w....... ��. ...N.4. SCHIMNEY: Metal AC. ......R C,5{.?....
...................................................
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 ..... ,.r..�a .., ,a• .r:.3`�......................... Date ...... ..a. ........................
Permit to install expires 60 days after issue date
Stove .: ..................................................................................................................:................
..........................................................................................................................................................
StoveClearance ..... . ................................ ............................................................................................................................................................................................................
Floor .. ............................................................................................................................................................................................................................ .....................................
Smoke Pipe .. .. :.......:...................................................................................
v......................................................................................................................
SmokePipe Clearance !1�.......................................................................................................................................................................................................................................................
Chimney . ............................................... . ........................................................................................................................................................................................................................
SmokeDetector ......c j� ..................................................................................................................................................................................................................................................................
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 .A:.......................................................:...........
i�
Installer
INSTALLATION APPROVED �t
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......................................... By:.....................................:.....`:.--:::::............................... Title: .................................................
` date
WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK: APPLICANT