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Application for Alternative Heating Appliance

Property Location and Information

Owner Information

Installer Information

Manufacturer Information

If you are unable to upload the Installation Manual when submitting this form, a copy must be provided to the Building Department before your application can be processed.

By clicking Submit application is hereby made to the Building Department for the issuance of a Permit pursuant to the New York State Uniform fire Prevention and Building Code for the construction or installation of a solid fuel burning appliance. The applicant agrees to comply with all applicable laws, ordinances and regulations. The undersigned hereby certifies that the above statements are true to the best of my knowledge and belief, and all work will be completed as specified with the manufactures’ installation instructions.

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Application Number ____________________

Permit Number ____________________

Permit Fee ____________________

Received on ____________________

Approved ________________________________________

Paid on ____________________

Issued on ____________________