HomeMy WebLinkAbout0006 BOB-WHITE RUN - Wood Stove Permit 01/16/81 TOWN OF BARNSTABLE
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116 9• MASSACHUSETTS
Wood Stove Permit
121
DATE OF APPLICATION .............................................................................. FIRE DEPT. ISSUING PERMIT ............................................................
4
NAME (owner) :.................:........... NAME (Installer) .......... ..............................
1
�nADDRESS .. � I............/( �� f �4�. � ...................... ADDRESS ��, r?r���•, 1r 1.�,�^r` 'I.......................!......... .................. ...... ....................
STOVE TYPE ...............:........................ :..:......... . .................................... . CHIMNEY. NEW .. . ............ EXISTING ...................
Manufacturer ..� ( CHIMNEY: Masonry ......................................................:...
.......:.:.................. ..........1:....^,...............:............................................ .. . ....................
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 .........:................. �i..'���... ............................................. 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 ..............
K22 ...,...
Permit to install expires 60 days after issue date
Stove ..... ..................................................................................................:.....................................................................................................................:..............................................................
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StoveClearance .................................................................................................................
Floor ........... ..
SmokePipe ......Rr' .......................................................................... ..................:............................................................................:.....:.......................................................:..........................
SmokePipe Clearance ..<.: 'r.....................................................................................................................................................................................:.....................................................
Chimney z
.................................................................................................................................................................................................................. .
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 . . . ........... By.-........... a ............................ Title: ..:. ....�..,
....... .
date
WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK: APPLICANT