TOWN OF TISBURY
BUILDING INSPECTION & ZONING ENFORCEMENT
POST OFFICE BOX 1239
VINEYARD HAVEN, MA 02568
OWNER’S NAME:_____________________________________DATE:________________
MAILING ADDRESS:__________________________________PARCEL ___-___-____
PROPERTY LOCATION:_______________________________PHONE#:_____________
SIGNATURE OF APPLICANT:__________________________FEE: $25.00
PERMIT
As required by 780 CMR 3610, a permit is required for the installation of any solid fuel- burning appliance
STOVE
A. New _____ Used _____ B. Type-radiant _____ circulating _______
C. Manufacturer _______________ Lab. No. ______________
D. Name/Model No. _____________ Collar Size ___________
E. Dimensions: - Height ________ Length _______ Width __________
CHIMNEY
A. New _____ Existing _____ B. Size (flue area) _________
C. Other appliances attached to flue ( number & size ) _____________
D. Pre-fab (manufacturer name & type) __________________________
E. Masonry/lined ___________ Flue liner ___________ Unlined _________
F. Height: ________________ cap ________
HEARTH
A. Materials _____________________ B. Sub-floor construction _____________
C. Minimum Dimensions ____
Permit # __________________
__________________ Kenneth A. Barwick
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