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38B-139
PRODUCT FEATURES SAFETY PILOT This heater has a pilot with an Oxygen Depletion Sensing (ODS) safety shutoff system. ODS /pilot shuts off the heater if there is not enough fresh air. PIEZO IGNITION SYSTEM This heater is equipped with an electronic piezo control system. This system requires AAA batteries (provided). THERMOSTAT HEAT CONTROL The control automatically cycles the burner on and off to maintain a desired room temperature. See page 17. DUAL FUEL CAPABLE Your heater is equipped to operate on either Propane or Natural gas. The heater is shipped from the factory ready for connecting to Propane. The heater can easily be changed to Natural gas by having your qualified installer follow the instructions on page 12 and the markings on the heater. State of Massachusetts: The installation must be made by a licensed plumber or gas fitter in the Commonwealth of Massachusetts. Sellers of unvented propane or natural gas -fired supplemental room heaters shall provide to each purchaser a copy of 527 CMR 30 upon sale of the unit. In the State of Massachusetts, unvented propane or natural gas -fired space heaters shall be prohibited in bedrooms and bathrooms. In the State of Massachusetts the gas cock must be a T- handle type. The State of Massachusetts requires that a flexible appliance connector cannot exceed three feet in length. LOCAL CODES Install and use heater with care. Follow all codes. In the absence of local codes, use the latest edition of The National Fuel Gas Code, ANSI Z 223.1, also known as NFPA 54". *Available from: American National Standards Institute, Inc. National Fire Protection Association, Inc. 1430 Broadway 1 Batterymarch Park New York, NY 10018 Quincy, MA 02269 -9101 This heater is designed for vent -free operation. State and local codes in some areas prohibit the use of vent -free heaters. 5 7. Always run heater with control knob at PILOT /IGN, LOW or HIGH locked positions. Never set control knob between locked positions. Poor combustion and higher levels of carbon monoxide may result. 8. Do not use heater if any part has been under water. Immediately call a qualified service technician to inspect the room heater and to replace any part of the control system and any gas control which has been under water. 9. Turn off and unplug heater and let cool before servicing. Only a qualified service person should service and repair heater. 10. Operating heater above elevations of 4,500 feet could cause pilot outage. 11. To prevent performance problems, do not use propane /LP fuel tank of less than 100 lbs. capacity. 12. This heater should not be installed in a bedroom or bathroom. 13. Do not use this heater as a wood- burning heater. Use only the logs provided with the heater. 14. To prevent the creation of soot, follow the instructions in Care and Maintenance (page 20). 15. Do not add extra logs or ornaments such as pine cones, vermiculite, or rock wool. Using these added items can cause sooting. Do not add lava rock around base. Rock and debris could fall into the control area of heater. After servicing, always replace screen before operating heater. 16. This heater is designed to be smokeless. If logs ever appear to smoke, turn off heater and call a qualified service person. Note: During initial operation, slight smoking could occur due to log curing and the heater burning manufacturing residues. QUALIFIED INSTALLING AGENCY Installation and replacement of gas piping, gas utilization equipment or accessories and repair and servicing of equipment shall be performed only by a qualified agency. The term "qualified agency" means any individual, firm, corporation, or company that either in person or through a representative is engaged in and is responsible for: a) Installing, testing, or replacing gas piping or b) Connecting, installing, testing, repairing, or servicing equipment; that is experienced in such work; that is familiar with all precautions required; and that has complied with all the requirement of the authority having jurisdiction. 4 IMPORTANT SAFETY INFORMATION IMPORTANT: Read this owner's manual carefully and completely before trying to assemble, operate, or service this heater. Improper use of this heater can cause serious injury or death from burns, fire, explosion, electrical shock, and carbon monoxide poisoning. , Only a qualified installer, service agent, or local gas supplier may install and service this product. A WARNING: Do not store or use gasoline or other flammable vapors or liquids in the vicinity of this or any other appliance. l ik WARNING: This appliance is for use with only the type of gas indicated on the rating plate. This appliance is not convertible for use with other gases. CARBON MONOXIDE POISONING: Early signs of carbon monoxide poisoning resemble the flu with headaches, dizziness, or nausea. If you have these signs, the heater may not be working properly. Get fresh air immediately! Have heater serviced. Some people are more affected by carbon monoxide than others. These include pregnant women, people with heart or lung disease, people who are anemic, those under the influence of alcohol, and those living in high altitudes. NATURAL AND PROPANE /LP GAS: Natural and Propane /LP gases are odorless. An odor - making agent is added to the gas. The odor helps you detect a gas leak. However, the odor added to the gas can fade. Gas may be present even though no odor exists. Make certain you read and understand all warnings. Keep this manual for reference. It is your guide to operating this heater safely. A WARNING: Any change to this fireplace or its controls can be dangerous. A WARNING: Do not allow fans or any other drafts that alter burner flame to blow directly into the heater. They create drafts that alter burner flame patterns, which can cause sooting. A WARNING: Do not use a blower insert, heat exchange insert, or other accessory not approved for use with this heater. Due to high temperatures, the appliance should be located out of traffic and away from furniture and draperies. Do not place clothing or other flammable material on or near the appliance. Never place any objects in the heater. Heater becomes very hot when running heater. Keep children and adults away from hot surfaces to avoid burns or clothing ignition. Fireplace will remain hot for a time after shutdown. Allow surfaces to cool before touching. Carefully supervise young children when they are in the room with the heater. You must operate this heater with the heater glass panel in place. Keep the heater area clear and free from combustible materials, gasoline, and other flammable vapors and liquids. 1. Do not place Propane /LP supply tank(s) inside any structure. Propane /LP supply tank(s) must be placed outdoors. 2. This heater needs fresh air ventilation to run properly. This heater has an Oxygen Depletion Sensing (ODS) safety shutoff system. The ODS shuts down the heater if not enough fresh air is available. See Air for Combustion and Ventilation, pages 7 through 9. If heater keeps shutting off, see Troubleshooting, pages 21 through 23. 3. Keep all air openings in front and bottom of heater clear and free of debris. This will ensure enough air for proper combustion. 4. If heater shuts off. Do not relight until you provide fresh, outside air. If heater keeps shutting off, have it serviced. 5. Do not run heater: • Where flammable liquids or vapors are used or stored. • Under dusty conditions. 6. Before using furniture polish, wax, carpet cleaner, or similar products, turn heater off. If heated, the vapors from these products may create a white powder residue within burner box or on adjacent walls or furniture. 3 TABLE OF CONTENTS Important Safety Information 3 Air For Combustion and Ventilation 7 Installation 10 Operation 16 Care & Maintenance 20 Troubleshooting 21 Replacement Parts 24 A WARNING: READ THE INSTALLATION & OPERATION INSTRUCTIONS BEFORE USING THIS APPLIANCE. IMPORTANT: Read instructions and warnings carefully before starting installation. Failure to follow these instructions may result in a possible fire hazard and will void the warranty. PRODUCT SPECIFICATIONS MODEL QD250T Input Rating 25,000 BTU /Hr 25,000 BTU /Hr Gas Type Natural LP /Propane Ignition Piezo /Automatic Piezo /Automatic Manifold Pressure 4 in. W.C. 9 in. W.C. Inlet Gas Pressure ( "For purposes of input adjustment ) Maximum 10.5 in. 14 in. Minimum * 5 in. 11 in. Dimensions, inches (H x W x D) Heater 25 in. x 32 1/4 in. x 13 in. Carton 24 4/5 in. x 34 1/4 in. x 13 in. Weight, Ibs Stove 56.5 Shipping 67.5 2 1 --- RO OM 7 WARNING: This appliance is ,i equipped for (Natural and Propane) gas. Field conversion is not permitted other than between natural or propane gases. VENT —FREE GAS STOVE MODEL # QD250T ----------- _ i a , , 1 0 a o��o. x x..w�e� ( i �.,., o, D -T L a.x.. �,a —� us f i ff omx*e4 , eo.mmm, rc. A CAUTION - FOR YOUR SAFETY A WARNING: IF THE INFORMATION IN THIS MANUAL IS NOT FOLLOWED EXACTLY, A FIRE MAY RESULT CAUSING PROPERTY DAMAGE, PERSONAL INJURY, OR LOSS OF LIFE. — Do not store or use gasoline or other flammable vapors and liquids in vicinity of this or any other appliance. WHAT TO DO IF YOU SMELL GAS • Do not try to light any appliance. • Do not touch any electrical switch; do not use any phone in your building. • Immediately call your gas supplier from a neighbor's phone. Follow the gas supplier's instructions. • If you cannot reach your gas supplier, call the fire department. — Installation and service must be performed by a qualified installer, service agency or the gas supplier. This is an unvented gas -fired heater. It uses air (oxygen) from the room in which it is installed. Provisions for adequate combustion and ventilation air must be provided. Refer to Air for Combustion and Ventilation section on page 7 of this manual. INSTALLER: DO NOT DISCARD THIS MANUAL — LEAVE FOR HOMEOWNER'S FUTURE REFERENCE. This appliance may be installed in an aftermarket, permanently located manufactured (mobile) home, where not prohibited by local codes. This appliance is for use with the type of gas indicated on the rating plate only. This appliance is not convertible for use with other gases. Questions about installation, operation, or troubleshooting? Before returning to your retailer, contact our customer service department at 1- 877 - 886 -5989, 8:00 a.m.- 4:30p.m., EST, Monday- Friday or e-mail customerservice @usaprocom. com PC- QD250T -0805 01/08/2012 10:45 413-527-8991 PANCIONE ASSOC. PAGE 01/01 Maksacisue&ts DepailMent ni Public SA* Board of Building Retorlatinns and Standards i,j ' Construction Supervisor License License: CS 38821 • mia-tAn. J'1OANCIONE 73 PERRY 4UL RD GRANBY, MA oi 013 Expiratickt: 12/1912013 CommkAirilitOr A. • TM 7107 I "" • "A 4 4re' 5 7- 7Z. a t iel ; c'hae-1 14/40`d/C / * 510/4-7-4-e TABLE OF CONTENTS Important Safety Information 3 Air For Combustion and Ventilation 7 Installation 10 Operation 16 Care & Maintenance 20 Troubleshooting 21 Replacement Parts 24 !! WARNING: READ THE INSTALLATION & OPERATION INSTRUCTIONS BEFORE USING THIS APPLIANCE. IMPORTANT: Read instructions and warnings carefully before starting installation. Failure to follow these instructions may result in a possible fire hazard and will void the warranty. PRODUCT SPECIFICATIONS MODEL QD250T Input Rating 25,000 BTU /Hr 25,000 BTU /Hr Gas Type Natural LP /Propane Ignition Piezo /Automatic Piezo /Automatic Manifold Pressure 4 in. W.C. 9 in. W.C. Inlet Gas Pressure ( `For purposes of input adjustment ) Maximum 10.5 in. 14 in. Minimum * 5 in. 11 in. Dimensions, inches (H x W x D) Heater 25 in. x 33 1/2 in. x 13 in. Carton 24 4/5 in. x 34 1/4 in. x 13 in. Weight, Ibs Stove 49.8 Shipping 60.4 2 9. VALIDITY: This instrument shall be valid unless specifically revoked by me, regardless of how long ago it was executed. Dates at i art, g1A this day of t \o'emtx \ ,2008 • Signature of OWNER ~` tit: 9r� Si pature of OW R v Acknowledged before me this 5 day of ,4 J - ,-- 2008 Notary Seal: m eo r�r /Ss) ,, i,/6 � 3 4. CONTRACTS - GENERAL: To enter into, make, sign, execute and and deliver, acknowledge and perform any contract, agreement, writing or other document that may, in the opinion of my AGENT, bf necessary or proper to be entered into, made or signed, sealed, executed, delivered, acknowledged or performed. 5. CLAIMS: To demand, sue for, collect, recover and receive all goods, claims, debts, monies, interest and demands whatsoever now due, or that may hereafter be due, or belong to me ( includinc the right to institute any action, suit or legal proceeding for the recovery thereof), and to make. execute and deliver receipts, releases or other discharges therefore, under seal or otherwise. 6. SETTLEMENT: To defend, settle, adjust, compound, submit to arbitration and compromise all actions, suits, accounts, reckonings claims and demands whatsoever, that now are, or hereafter shall Ir e pending between me and any person, firm or corporation in such manner and in all respects as my said AGENT shall deem fit. 7. REAL ESTATE: To enter into, on my behalf, any agreement to rent, or lease any real estate in which I have an interest including, but nt �t limited to, signing leases and broker's agreements, leases. My AGENT shall have authority to sign in his or her own name, identified as .my AGENT and to have their signature acknowledged by a Notary Public. 8. GENERAL: Without in any way limiting the foregoing, generally to do, execute and perform orgy other act, deed, matter or thing whatsoever, that ought to be done, executed or performed of every nature and kind whatsoever, as fully and effectually as I could do if personally present. It is my specific intent that my said AGENT shill! have the power and authority to undertake all and any manner of activity regardless of whether such activity or a category of activitie has been specifically mentioned in this Durable Power of Attorney, and all persons dealing with my said AGENT may rely upon this provision as providing him or her with authority to act in authority. •/ POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENT, THAT nov1rls C V tvt.frA_ irtuic - N nmr,th f �1 1. kik/ k 1 (Name) 4 Pine Island Streetlo.cated at (state whether 6Iividuaprtnership or corporation) 170 South St. Northampton, MA. 137 North Main St. Florence, MA. 141 North Main St., Florence, MA.has made, (Address) constituted and appointed, and, by these present does hereby make, constitute and appoint Michael J. Pancior }e, a resilient of the United States, whose address is: 120 Union St., Easthampton, MA. 01027 , its true and lawful attorney for it in its name, place and stead. The Power of Attorney shall be governed by the Uniform Durable Power of Attorney Act, pursuant to the provisions of Massachusetts General Laws, Chapter 201 B, Section 1.b) 1. GRANT OF POWERS: I hereby grant my AGENT the following general powers, intending by this enumeration to enlarge rather than limit his or her ability to do in my behalf anything which I might do for myself in regards to the following properties: 170 South Street Northampton, MA. 137 North Main Street Florence, MA. 141 North Main Street Florence, MA. 2. DEBTS AND EXPENSES: To pay all sums of money at any time or or times that I may hereafter owe upon any check, draft or note made, executed, endorsed, accepted and delivered by me, or for me, and, in my name, by said AGENT. 3. BANKING: To make, execute, endorse, accept and deliver any and all checks, notes, drafts, and other instruments; to deposit or withdraw any funds belonging to me in one or more savings or or checking accounts or in certificates of deposit and to open or close any such accounts in my AGENT'S discretion. 1 • City of Northampton Massachusetts fi DEPARTMENT OF BUILDING INSPECTIONS a toy �fr 212 Main Street • Municipal Building � d Northampton, MA 01060 srj‘ INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he /she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and /or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location • The Commonwealth of Massachusetts 11 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information ,Q Please Print Legibly Name (Business /Organization/Individual): /l ( /t} � � al 4 / /V G Address: ( ? C Pl //1/ -a / 7 l (161/ City /State /Zip:_ , S) , f L n O /0 Phon #: q7 3- `.7 3 6 Are you an employer? Check the appro fate box: Type of project (required): am a YP ° p (req ed): 1. ❑ I am a employer with 4. I general contractor and I ❑ g employees (full and/or part- time).* have hired the sub - contractors 6. New construction 2. l I am a sole proprietor or partner- listed on the attached sheet. 7. 11] Remodeling These sub - contractors have ship and have no employees 8. Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance. required.] 5. n We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. 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. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation 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: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: 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 $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 certi under the pains penalties of perjuty that the information provided above is true and correct. ✓vl Z..1 l Signature: � �� y iC/ � Date: � Phone #: / 'Z 3 6 7 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 #: • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable Name of License Holder : License Number Address Expiration Date Signature Telephone .- r tl �' a NotA licable" ` 9: mRegisteredme,.Impr actor. � 1 4-10 4 4. 1 02.t,617,.. : pp f� Company Name Registration Number Address Expiration Date Telephone SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M G L c 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ❑ No ❑ :` aiwn�r t einptio The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 1083.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside; on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature r • J SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) . New House LI Addition n Replacement Windows Alteration(s) n Roofing n Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [O] Other N Brief Description of Proposed Work: //f C. L L -71 /_L> 6',47 Si-z, Ve'= / / / z-/i/24/c Iceotho Alteration of existing bedroom Yes )(-- No Adding new bedroom Yes 'No Attached Narrative Renovating unfinished basement Yes _ No Plans Attached Roll - Sheet 041t; . e w' =hous and.,or addition to e xistin4 housing,: c omplete the.; following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? . d. Proposed Square footage of new J ru« on. Aft Dimensions r e. Number of stories? 1 f. Method of heating? ", A . or Woodstoves Number of each ' I g. Energy Conservation Com. - - . sch •ck Energy Compliance form attached? h. Type of construction i. Is construction within 1 r s ft. of wetlands? es No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a :OWNER AUTHORIZATION„ TQ BE COMPLETED WHEN OWNERS AGEN T OR CONTRACTORiAPPUES FOR'BUILDING PERMIT 1, 1710 07 /9 ,5 C. / \ ,/ /7JQ 7 ?/ C-/( , as Owner of the subject property hereby au o ize A -/ _ P7Y---iiic_ /0 r� �d AA e` to act o • . h. f, :II , _ ers relative to rk authorized by this building permit application. s // � ,� 94 C,l Mf rR / c am / .- p Signet. - of Owner Date I, Ai& - L_ 4--- .1 , , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 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Permit Can Be Denied Due To Incomplete Information b Existing Proposed Required by'ZoningM This column to be filled u n 49 r - ; Building Department Lot Size ' i i 4 1 Frontage Setbacks Front i _ ! i Side L: R: 1 L I R: : ' Rear 1- Building Height i i I Bldg. Square Footage I 1 1 s Open Space Footage (Lot area minus bldg & paved t I 1 t I parking) i 4 # of Parking Spaces Fill: _ __-__ __ _ ._ ..__ 1 _ _._ ___ . .. I _._ _.� .. __._ _ ____ - _ (volume & Location) I 1 A. Has a Special Permit /Variance /Findin• ever been issued for /on the site? NO 0 DONT KNOW a=1 YES IF YES, date issued: I IF YES: Was the permit recorded at the Regi try of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book Page ( and /or Document #' B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: 1 1 D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO *r IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading ex ation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO A IF YES, then a Northampton Storm Water Management Permit from the DPW is required. _�,,��-- Z. r► £�" DepartlTtet us2 dry " RECEIVED � , 4 , .. � 6 City of Nort �'' . o e rrrlr "�° d '1� Building Depart ment �y tt,� � � � JAN - 92012 2 Main Street S � ; � � , � - ilabtT� H° � � Room 100 W e er elAalle �:.� ,--. �. _ OFBUItDINGINSPEcIIONg rthampton, M 01060 Twos sEo tru er PCans . � ' w NppTHANI N "'^ - 587 -1240 Fax 413 - 587 -1272 1. r5 ans� Other S z �, }F APPLICATION TO CONSTRUCT, ALTER, REPAIR, R OR DEMOLI SECTION 1 • - SITE INFORMA 6-,--‘--- ✓ i f This section to be complete y,office 1.1 Property Address: , `70 �bz17 - 1 - I r �'1 ( 1 la Lot Unifi 1 F �f -17) n q '-4, t t n', dig s - ia c 4 4 7 + fr o � A/1 1 1 4 61 � Zone Overlay Distri . Etm St. District ' ^. ' CB District- �'' SECTIO 2 = PRO PERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: c6 /- Li 9"/ ✓! e3-1-e'-'. YO C . C c �� P,�, rz r...- U 6-71-77-77/- .�.1 l 4 /' 2 7 Name (Print) Curren Mailing Address: Telephone 9/3 S�- __/7 / 0 Signature , 2.2 Authorized Agent: ,/ /' /" / G / v 111 !`c e/,4/ /t./ ,— 4- �I C I �Li� L - � Name ( / Current Mailing Address: ,/ / j�/f 6 U � 7 / /// 9/ 5_,.?_ 7 / /io /.' Sig -,,_.,,r7,, " Telephone SECTION Item 3 =:EST A CON COST Estimated ) to Official U se Only completed byo Cost per m (Dollars it a be t 1. Building�� (a) Building P erm it F 2. Electrical (b) Estirriated T Cost of, `- `Constr f r o m : .(6) 3. Plumbing % 649 , ,� Buildmg Permi Fee 4. Mechanical (HVAC) 5. Fire Protection t ./.;1-, 6. Total = (1 + 2 + 3 + 4 + 5) '57- � L) Ch Number Th is Section For O ffici Use Onl . Building Per Number Date _ Issue Signature +� Bu ilding C /Inspect o f B Date 170 SOUTH ST BP- 2012 -0663 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B - 139 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Non structural interior renovations BUILDING PERMIT Permit # BP- 2012 -0663 Project # JS- 2012 - 001103 Est. Cost: $570.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MICHAEL PANCIONE 38821 Lot Size(sq. ft.): 6272.64 Owner: KIRKPATRICK THOMAS C & ROBBIN K Zoning: URB(100)/ Applicant: MICHAEL PANCIONE AT: 170 SOUTH ST Applicant Address: Phone: Insurance: 73 FERRY HILL RD (413) 527 -1110 GRANBYMA01033 ISSUED ON :1/18/2012 0 :00 :00 TO PERFORM THE FOLLOWING WORK :VENT FREE GAS 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 # 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 1/18/2012 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner