22B-038 *-
1
' 10'
' N. VV , O
U
NOTE:
WE ARE NOT USING A HEAT SHIELD ON WALLS
BEHIND STOVE.
"PLEASE VERIFY AND CONFIRM CLEARENCES.
ALSO PLEASE TELL ME IF WE ARE ALLOWED TO
USE A
SINGLE WALL PIPE ON ONE FLOOR AND A DO LE W
WALL PIPE ON ANOTHER. / z
'PLEASE CREATE A INSTALLATION MATERIALS LIST ill
FOR THE JOTUL 3CB USING MY DIAGRAM.
INCLUDE IN YOUR PRICING ALL MATERIALS IN N
(FIGURE A) ROOF PITCH: 9 K
'PLEASE PROVIDE THE QUOTE FOR THOSE
MATERIALS (MINUS THE STOVE , OUR CLIENTS
\ W ' W
ALREADY PURCHASED IT FROM YOU.)REFERENCE
JOB NAME: CHRISTINA GREER J K
THANK YOU.
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SECOND FLOOR USE DOUBLE WALL PIPE v > d
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FIRST FLOOR USE SINGLE WALL PIPE
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ry IIIi' 1st Floor
--
DATE:
9/2'1/2012
SCALE : 1 /4" = 1' -0" SCALE:
Cross Section 1 SHEET:
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C `�"`'�y�� DEPARTMENT OF BUILDING INSPECTIONS - ---7--1E IS
212 Main Street • Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION MISURANCE Aleie.WAVIT
I-, A/2 o Af sib iG1%‘_-Eii T !/ y /-/z2 .1- r'» r r, 1 c
(lipermittee)
with a principal place of business/residence at:
3 `fo ! _6 2_ v/1-i✓ / /f/0,�27Wg7,7 ;,M (phone #) F3� -ZZ
(street/city!s'.atel ip) c1 /O6 0
do hereby certify, under the pains and penalties of perjury, that:
I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Acadia Insurance Company WCA5029908 2/1/2013 "
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company /Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE: please be aware that vehilo homeowners who employ persona to do maintenance, construc. or repair work on a dwelling of
not more than three units in which the homeowner resides or on the grounds appurtenant thereto ars not generally considered to be
employers under the worker's compensation Ad (GL152,ss 1(5)), application by a homeowner for a lice cc permit may evidence the
legal etatus of an employer under the Worker's Compensation Act.
I undarstand that a copy of this siatcment may be forwarded to the Depert oust of Iadusiri al Accideutd Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 51,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against me.
Signed this / 51 day of jam 20/4 For use only
` Permit Number
• . Ai AiSf . / Maprt Lot #
Signature of L` 40 •ermittee
. ----Ci y of Northampton
4TH - _. \ ♦ i ,, .,,
9 f _ o RECEi\i _.- .- _ S,,
'' Massachusetts
((++ _ n 02 D =PAR I NT OF BUILDING INSPECTIONS y
i .a v ' 4i o U � '1 2 2 in Street • • Municipal Building
-^! ' Northampton, MA 01060 y u �
NspECTIO
- ..oFBOM 1�AA
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check # 3 b 3 /1q
PLEASE TYPE OR PRINT ALL INFORMATION r ,M
1 . Name of Applicant: 1 0 5) �- 4' @bl V j 1 1 )/ N1 :1!e 1' 10 i v�f'r' col
Address: 3 9 o 121,e rS, cL £ Y . NC v P it Telephone: 5 - 753"-
2. Owner of Property: CAC isTNI G `` S Os 6 TH
Address: 1k COO I ce1 l 1 St Telephone: C9'16, )/ l� , 6 q tr 6 g! o
3. Status of Applicant: Owner Contractor j� p /y ��-y�
4. Type or Brand of Stove: 1 \UL— I 3 V VVCJ J I V\
If applicant is not the homeowner: aa ^ q 724 Construction Supervisor's License Number !� 077 i� ` l Expiration Date 6 M f
Home Improvement Contractor Registration Number 13 I q L I 5 Expiration Date I 0 11 3 /7n12
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
5. Certification: I hereby certify that the information contained her•' is true an accura the best
of my knowledge.
DATE: 10/ l Z APPLICANT'S SIGNATURE /l// /1 1 ,,,
DATE: Vr HOMEOWNER'S SIGNATURE _ 44 P ' ` '
APPROVED
DATE: BUILDING OFFICIAL
26 CORTICELLI ST BP- 2013 -0409
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22B - 038 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit # BP- 2013 -0409
Project # JS- 2013 - 000653
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 11020.68 Owner: PLAUT DAVE M & T M LIEBERMAN C/O SAMUEL K ROBERTS JR
Zoning: URB(100)/WP(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 26 CORTICELLI ST
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584 -7522 Workers Compensation
FLORENCEMA01062 ISSUED ON:10/10/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL JOTUL F3 CB WOODSTOVE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/10/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner