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23A-147 i Montpelier Medium Insert A B s E D,J �–►H. �I Measure side trim I B C D,J !i clearan i } ®i from her AI --1 C E -- ------ --- —1I ■ C FP1085 X �\ Fireplace Clearances 3"Extended Fireplace Minimums FP1084 Flush Mount Mount 3"Extended A. Mantel 471/2"(1207 mm) 441/2`(1130 mm) Flush Mount Mount B.Top Trim(11/2") 471/2'(1207 mm) 361/2'(927 mm) A.Width at Face 27"(686 mm) C. Side Trim* 21"(533 mm) 21"(533 mm) B.Width at Dimension"C' 221/2°(572 mm) 221/2"(572 mm) *where side trim extends more than 1112"(38 mm)from the fire- C. Depth' 171/2'(445 mm) 141/2°(368 mm) place facing,the side clearance must be no less than 261/.°(673 D. Height at Face 211/2"(546 mm) 211/2"(546 mm) mm);this is also the required side wall clearance. E. Height at Dimension'C' 211/2'(546 mm) 211/2'(546 mm) Measure the side clearance(C)from the exact center of your fire- place opening on the hearth(X).Measure the top trim(B)and/or Fireplace Maximums mantel clearances(A)from the finished hearth surface.Measure H. Lintel depth 81/2"(216 mm) the front clearance(to furnishings,etc.)from the fireplace face. I.Width 411/2"(1054 mm) Fig.4 Observe these clearances to combustible trim. J. Height2 281/2" (724 mm) 1.The minimum depth must be maintained from the floor of the fireplace Unless the fireplace and hearth are constructed over a to a height of 211/2°(540 mm) completely non-combustible surface(such as unpainted 2.Though the Montpelier Medium Insert will fit into larger fireplaces,the concrete over dirt), a thermal floor protector must be decorative optional MHSC Surround Panels will not completely cover the used in front of and to the sides of the door as protec- fireplace opening if these dimensions are exceeded.Custom made trim pieces may be used. tion against spilled coals and embers and heat radiated from the front of the insert.Floor protectors must extend Fig.3 Use these measurements to confirm that the Montpelier Medium Insert will fit into your masonry fireplace. at least 8"(203 mm)from the side of the insert, making the protector 443/4" (1137 mm)wide. Requirements Clearance In addition, the floor protector must extend from the front After confirming that your fireplace is the right size, check door opening a minimum of 16" (406 mm) in the United the clearance to combustibles.First mark with tape the exact States and 18" (457 mm)in Canada. (Fig. 5) center of your fireplace opening on the hearth. Measure The approved construction of a floor protector calls for a the side clearance from this point. Measure the top trim minimum of 24 gauge galvanized sheet metal or equivalent, and/or mantel clearances from the finished hearth surface. and the equivalent of 1.25" (32 mm) of a material with k- Measure the front clearance(to furnishings, etc.)from the value of 0.84 or less. fireplace face. (Fig. 4) Custom-made floor protectors may be used if they offer Hearth Requirements the same protection. Millboard has a standard k value of 0.84 and thus 11/4" (32 mm) of this material is adequate In some fireplaces,the hearth in front of the fireplace open- thermal protection. Custom-built floor protectors must ing is brick, stone, slate, or some other non-combustible have a k value equal to, or less than 0.84, meaning that material that is in direct contact with concrete poured over heat will transfer at the same rate or more slowly than the earth. These are the only hearths that are considered tested standard. noncombustible. In other fireplaces, the brick or concrete Determine hearth in front of the fireplace opening is supported by • • heavywooden framing.Because neither brick nor concrete • • Acceptable- has good insulating properties,heat radiated by the fire will All floor protection must be noncombustible (i.e. metals, pass downward through the hearth to the wooden framing. brick,stone,mineral fiber boards,etc.).Any organic materi- Such hearths are considered combustible. als (i.e. plastics, wood paper products, etc.)are combus- 6 30004403 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 y'v www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): AFS d/b/a THE FIRE PLACE Address:106 STATE ROAD City/State/Zip:WHATELY, MA 01093 Phone#:413-397-3463 Are you an employer? Check the appropriate box: Type of project(required): 1.W I am a employer with 10 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp.insurance comp.insurance.+ required.] 5. E] We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[:] Roof repairs insurance required.]t C. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compepsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. '*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees_ If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:MA RETAIL MERCHANTS WC GROUP INC Policy#or Self-ins. Lie. #:014005033601114 Expiration Date:1-1-16 Job Site Address: /P o? �i`nc S f City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u r the pains and per�lties of perjury that the information provided above is true and correct. Si attire: t.7 7'� Date: . 5-- Phone#: 413-397-3463 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts ` A.— EP T OF BUILDING INSPECTIONS ya VARQ5212 in Street • Municipal Building '., .? N rthampton, MA 01060 S eCWns ping& 01260 Electric,Plum ton,MA Northam 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 # PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 0 q� /E J L Ab F <c Address: /676 ',5/f i-v! '-?V�) f/✓/G4fc1V a'/C& Telephone: 5�� 3 f j 3 fCG� 2. Owner of Property: --� �C�. L��-;�`�� ��Q.� ` Address: /aa /"�/1c Sj r/Cf«1r•,C- 01-�� Telephone: y/3 93Y^ 3. Status of Applicant: Owner --­—Contractor 4. Type or Brand of Stove: �/T C:aS �•1 rZ� lYt�n� c//cY _l i,� &j/ fail /i rrrn ;S W-fv ! If applicant is not the homeowner: ,` Construction Supervisor's License Number ��1 6 Expiration Date Home Improvement Contractor Registration Number i67 Expiration Date All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit 5. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: v� . APPLICANT'S SIGNATURE DATE: t:5- HOMEOWNER'S SIGNATURE . APPROVED DATE: BUILDING OFFICIAL 122 PINE ST BP-2015-0833 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A- 147 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-2015-0833 Project# JS-2015-001615 Est. Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BERNARDSTON FARMERS SUPPLY 99401 Lot Size(sq. ft.): 49222.80 Owner: FLORENCE CONGREGATIONAL CHURCH Zoning: URB(100)/SI(0)/ Applicant. BERNARDSTON FARMERS SUPPLY AT. 122 PINE ST Applicant Address: Phone: Insurance: 43 RIVER ST (413) 648-9311 O WC BERNARDSTONMA01337 ISSUED ON:31312 01 5 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL VT CASTINGS MONTPELIER WD INSERT W/FULL LINER 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 3/3/2015 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner