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02-026 (5)
668 NORTH FARMS RD BP-2017-0195 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 02-026 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 s BP-2017-0195 Projects JS-2017-000328 Est. Cost: $4000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: const.Class: Contractor: License: Use Group: THE FIRE PLACE 99401 Lot Size(s9. ft.): 474411.96 Owner: FERNANDEZ TONY Zoning: RR(100)/WSP(99)/WP(50)/ Applicant: THE FIRE PLACE AT: 668 NORTH FARMS RD Applicant Address: Phone: Insurance: P O BOX 606 (413) 397-3463 0 WC WHATELYMA01093 ISSUED ON:8/15/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL HARMAN XXV PELLET STOVE 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 ft 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: FeeTvoe: Date Paid: Amount: Building 8/15/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner City of Northampton 0) a RECEIVED h' ,E, Massachusettsisz >> t(:iii ;lg.' 15 2016 ,12 Z..ITMEN 0 BUILDING INSPECTIONS ti r ,'� _,I _060 u___ NOTtli . ,as SINGLE- OR TWO FAiviILY SOLID FUEL A..PPLiANOE PERMIT FOR WOOD. COAL. PELLET.CORR. STYOF ..-'ES. _PL. CE_ =7093/ Ple Name of Applicant' )tibias t d 6CC 7-Ac n' ' ?Ater_ t I Address: /06 cYV'a/C cRO klia/c ty 04010?S-_.__ _ _ 51(3 .35'73V63 _ y Owner of Piopern, %oNCrCh anchZ. Address: 46 S 1✓orIA Farn,S /gyp Wonky-kip/4,n - .. F: 51(3 3P6 -.3/07 3 / . Status of Applicant : Owner 1"----Contracrc: Type or Brand of Stove : /-/a/mmn XY1,/ NS $74' 5 Estimated Cost : b. 5/000 00 .f applicant is not the homeowner:: Contractor name 5)O074.$ 14hhc Construction Supervisor's License Number 9 CVO/ Expca!'icn Dare /-C ./t Home Improvement Contractor Registration Number /e0s177 ExpiraiionDate /L'xY'/b All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a berme 6. Certification: I heathy certify that the information contained herein is true and accurate to the best of my knowledge. DATE: er101/4 APPLICANT'S SIGNATURE ...-------5't .----. DATE: tF'rf'/L HOMEOWNER'S SIGNATURE ....---"<" „..-.--.--e-.._ .APPROVED ) DATE: EUILD!NG OFFICIAL The Commonwealth of Massachusetts Department of Industrial Accidents 1.11 e 1 Congress Street,Suite 100 Boston, MA 02114-2017 wwwmass.gov/dia Workers'Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name:THE FIRE PLACE Address:106 STATE RD-P.O. BOX 606 City/State/Zip:WHATELY, MA 01093 Phone#:413-397-3463 Are you an employer?Check the appropriate box: Business Type(required): I.❑✓ I am a employer with 10 employees(full and/ 5. 0 Retail or part-time).* 6. ❑RestaurantBar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ID Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8. ❑ Nov-profit 3.0 We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152. 81(4),and we have 10.0 Manufacturing no employees. [No workers'comp.insurance required]*' 11.0 Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees.[No workers' comp.insurance req.] 12.0 Other *Any applicant that checks box 41 must also fill out the section below showing their workers`compensation policy information_ '4f the corporate officers have exempted themselves but the corporation has other employees,a workers'compensation policy is required and such an organization should check box I. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:MA RETAIL MERCHANTS WC GROUP INC. Insurer's Address:P.O. BOX 859222-9222 City/State/Zip: BRAINTREE, MA 02185 Policy#or Self-ins.Lie.#014005033601116 Expiration Date:1/1/2017 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 e. 152 can lead to the imposition of criminal penalties of a fine up to$I.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,,un er the pains an pena s of perjury that the information provided above is true and correct. Signature: 144. Date: a /0 (� Phone#:4138397-3463 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia Installation Installing Place the stove on a non-combustible floor protector that extends a minimum of 6 inches to the front (152mm), 6 inches to the sides (152mm)and 0"(152mm)to the rear,which is flush with the rear of the hopper. Front and side floor protection measurements are made from the firebox or window opening. Floor protection must also be positioned under horizontal flue pipe, extending 2"(51mm)beyond each side of the pipe. NOTE for Canadian installation only: Per ULC-8627-00, If installed on a combustible floor, the need to provide a noncombustible floor protector covering the area beneath the space heater and extending at least 17.72" (450mm) on the firing side and at least 7.87"(200mm)on the other sides. In Canada,you may follow smaller U.S.floor protection requirements ONLY if the user agrees to completely shut- down the appliance,and allow it to cool to where all fire is extinguished and the combustion blower and its indicator light shuts off, prior to opening the firebox door or ash door. The minimum floor protector material is 20 gauge sheet metal.Other floor protector materials are ceramic tile,stone,brick,etc. Place the stove away from combustible walls at least as far as shown in Figures 2 and 3. Note that the clearances shown are minimum for safety but do not leave much room for access when cleaning or servicing. Please take this into account when placing the stove. Tl 76mm __-- t d Sides 6 200mm 1 h' -3 © Front 6" 450mm ® w ElRear 0 200mm 3 3 Floor protector minimum:32"X 32"(873mm s i X 813mm) �'�� L .0. NOTE: Measurement lit Fig. 3 "K" is measured from f the glass in the US ONLYla 6.25" n 159mm USA_°� �� 1Canada N9"'''''<":' .ma " A _ r 569m .25 -1L Fig.2 Alternate floor protector dimension may be used as long as they satisfy the measurement requirements shown below. Minumum size floor protection for a corner installation hearth pad is 36"x 36". Clearance shown as 9' with optional side shields installed. 3-90-00684R22_04113 XXV Pellet Stove 6