18-034 D. Existing Fireplace Installation: Be sure to design the venting so that it can be easily cleaned.
When using a short run of venting (flex or rigid)the damper Check with your local authority having jurisdiction to
must be removed or locked in the open position and sealed determine if this venting method is acceptable. Some
with a plate constructed of steel or other non-combustible Provincial, State, or Local codes may require a full liner run
material. to the top of the chimney. Be sure and check your local
Kaowool, mineral wool or other non-combustible insulation regulations before planning the installation. In this method,
is recommended above the plate to reduce the possibility the proper flashing and rain cap are also required.
of condensation. You will also need to wrap the venting
section between the insert frame and the damper sealing A WARNING
plate. This is to prevent overheating of the fireplace cavity,
which may cause damage to the insert's motors and other Fire Risk.
electrical components. Inspect Chimney
The connector pipe should extend through the sealing plate • Masonry chimney must be in good
and smoke chamber and into, or beyond the first flue tile. condition
• Meets minimum of NFPA 211 standard
• Factory-built chimney must meet
requirements of UL103 HT
IN CANADA: This fireplace insert must be When venting in this configuration,a rain cap and proper
installed with a continuous chimney liner flashing must be installed on the top of the chimney to
of a minimum 3" diameter extending from prevent flooding and damage.
the insert to the top of the chimney. The
chimney liner must conform to the Class 3
requirements of CAN/ULC-S635, Standard v
for Lining Systems for Existing Masonry or
Factory Built Chimneys and Vents, or CAN/
ULC-S640, Standard for Lining Systems for LL
New Masonry Chimneys.
Non-combustible
Insulation
Sealing Plate
When using single wall flex,this
section of venting must be
wrapped with non-combustible
ihnsulation to prevent excessive
eat build-up in the cavity.
e o .
0
�eo
Save These Instructions 3-90-775R39 12i15 15
B. Clearances to Combustibles - Masonry or D. Minimum Opening for Masonry and
Manufactured Fireplace Manufactured Fireplaces
THE CLEARANCES SPECIFIED ARE FOR YOUR
SAFETY! THESE CLEARANCES MAY ONLY
BE REDUCED BY MEANS APPROVED BY THE
REGULATORY AUTHORITY.
H I
I i
G
Face Trim
i
A B
I
d
D
Zft
K Location . Inch *llU et rs
A -� C G Minimum Width 24 609
it H Minimum Depth 14-1/2 368
Minimum Height#1-70-774235 23-1/2 597
-F 1 Minimum Height#1-70-774195 19-1/2 495
E. Mantel Projections
Location Anches
Al
A Insert to combustible sidewall 13 330 J
B Surround top to face trim 0 0
C Surround side to face trim 1 25-7/16
D Insert top to (max) 12" mantel 12 305 ��
C. Floor Protection Requirements
Location Inches
E Window opening to front- USA 6 152 — r
E Window opening to front- CAN 18 450
I,----1,�
F Window opening to side - USA 6 152
F Window opening to side - CAN 8 200 /
Hearth extension must be of a non-combustible material. d0 \�
It must extend beyond the appliance according to the
measurements listed. C_-
Minimum Size Hearth Extension is 16" Deep By 32"Wide.
The Maximum mantel depth (J) is 12" (305mm) with a
minimum vertical height (K)of 12" (305mm).
10 3-90-775R3912/15 Save These Instructions
l The Coinmonwealth of Massachusetts
Department of Industrial Accidents
- Office of Investigations
1 Congress Street, Suite 100
' Boston, MA 02114-2017
www mass.govldia
Workers'Compensation Insurance Affidavit: Builders/Contractors/ElectricianslPlumbers
Applicant Information Please Print Legibly
Name (Business/Oreanizadon/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):
L. i❑ I am a employer with 10 4. ❑ I am a general contractor and I 6_ New jest(required):
employees(full and/or pact rime)* have hired the sub-contractors
2.❑ 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 an y capacity. employees and have workers'
9. ❑ Building addition
[No workers' comp_ insurance comp. insurance
required.] 5- ❑ We are a corporation and its 101-1 Electrical repairs or additions
❑ ffi
ocers have their Plumbing repairs or additions
�. I am a homeowner doing all work ave exerc r I L❑
myself. [No workers' comp. tight of exemption per i GL 12 ❑ Roof repairs
insurance required] t c. 152, §1(4),and we have no
employees. [No workers- 13.M Other
comp.insurance required]
*Any applicant that checks box#1 must also fill out the section belon,showing their Nvotkets'compensation policy information.
+Homeor hers who submit this affidavit indicating they are doing all work and then hire outside contric%FA must submit a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the sub-eontmetors and state whether or not those entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
I ani an eittplo}yer tlrat is providing workers'compensation fnsrtrance for my employees Below is the policy and job site
information.
Insurance Company Name:MA RETAIL MERCHANTS WC GROUP INC
Policy T or Self-ins- Lie. a:014005033601114 Expiration Date:
Job Site Address: 60 Z`/n?i/V City/State/Zip: cVl arj-)XArnf::��,J MA
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 Iead 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 S250.00 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 rider the pains and ,. allti�es ofperjury that the information provided above is true//and correct.
Signature: Date:
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#:
. -C ,y of Northampton
ti�C Sr
�e Massachusetts `-
f v D P MENT OF BUILDING INSPECTIONS
� y y 12 in Street • Municipal Building
--��' ,Northampton MA 01060
OF BUILDING INSPECi10NS
NORTHA� iA 01060
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACES
Check#- d6 6y
Please fill in all appropriate information /
1. Name of Applicant :�/S2 ) '19b b c e. ��c � ,re /,c C e
Address: j"d� '5/azc 7r:-� k1h,-1c(y At) Telephone: 77 3�14
2. Owner of Property : ///47;kC
Address: (,0 L-dn, ✓Vgi-p,-ernpT�N PA Telephone:
3. Status of Applicant : Owner ''Contractor
4. Type or Brand of Stove : IyQ/'rnrr)
� CV
5. Estimated Cost
If applicant is not the homeowner::
`� .�✓ l fhb
Contractor Home
Construction Supervisor's License Number �`I 'J� Expiration Date
Home Improvement Contractor Registration Number / 01`0 77 Expiration Date //-0�"
All Applicants must complete a Workers Compensation In_surance Affidavit before we can issue a permit
6. Certification: I hearby certify that the information contained herein is true and accurate to the best of my
knowledge.
DATE: IZ'2-I� APPLICANT'S SIGNATURE - -__
DATE: IZ 'I� HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
60 EMILY LN BP-2016-0931
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18 -034 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit# BP-2016-0931
Project# JS-2016-001574
Est.Cost: $3900.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BERNARDSTON FARMERS SUPPLY 99401
Lot Size(sq. ft.): 32757.12 Owner: KESTEN MICHAEL
zoning: Applicant: BERNARDSTON FARMERS SUPPLY
AT: 60 EMILY LN
Applicant Address: Phone: Insurance:
43 RIVER ST (413) 648-9311 O WC
BERNARDSTONMA01337 ISSUED ON.112112016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL P35 INSERT 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 1/21/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner