46-050 v
CREOSOTE-FORMATION AND NEED FOR REMOVAL
When wood is burned slowly,it produces tar and other vapors,which combine with expelled moisture to form creosote.The creosote vapors may
condense on the inside of the chimney liner during slow-burning firing periods.As a result,creosote residue accumulates on the chimney liner.
When ignited,this creosote makes an extremely hot fire.
*To properly inspect the liner system it is necessary to gain access to the top and/or bottom of the chimney.To inspect the liner from the bottom
remove the connector pipe from the appliance and the chimney.Using a flashlight and a minor look in and up the liner to visually inspect for
soot and creosote formation.Note: if the chimney has offsets you may not be able to see all the way to the top or to the bottom depending on
your inspection location.In this case it will be necessary to inspect the liner from both the bottom and the top of the chimney.
*After inspection,if cleaning is required,use a plastic bristle brush the same size as the interior of the liner.Either push the brush up from the
bottom or down from the top using the appropriate number of extension pole for the height of the chimney.When cleaning from the top
remove the liner cap before inserting brush in the top of the liner.
8.)OPERATION
*FOR M-Flex liners,insulated with Premier Mix,used to vent a solid fuel burning appliance please note:
Solid fuel burning stoves can be used immediately after the installation is complete.However the flue gas temperatures entering the liner should
not exceed 500 degrees F.for a period of three weeks.A connector pipe flue gas thermometer will help monitor this procedure.
Fireplaces can also be used immediately after the installation is completed.A small to moderate fire should be maintained for a period of
.approximately three hours.After this time a normal fire can be established.
It is important that the operator not over fire the appliance during these initial periods.
PRODUCT INFORMATION:M-Flex 316L
M-Flex 316L Stainless Steel Flexible Chimney liner is designed to reline existing chimneys or used as a liner in new construction.Manufactured
in the highest quality,mill certified,316L grade alloy M-Flex Stainless Steel Flexible Chimney Liner has a high acid fighting capability.Listed
by UL Laboratories to UL 1777 standard for zero clearance installation.M-Flex can be used to vent wood,wood pellet,coal,non-condensing gas
and oil,making it the choice for venting all standard efficiency installations.M-Flex is available in 3"to 30"diameter to cover a wide range of
requirements found in the field today.
The unique manufacturing systems used to make M-Flex utilizes a continuous strip to stainless steel,interlocked and diagonally crimped to
produce a gas and water tight lining system of superior strength and durability.M-Flex can be bent to negotiated offsets in chimneys and can be
ovalized to custom sizes to fit most any installation. The corrugated construction allows for 1'"I :4
Wv
expansion and construction during the heat up and cool down periods,removing any stress on thef ;F '
system.
M-Flex can be insulated with either a Premier Mix or Thermal poured insulation or with a foil faced %h PIT t_ring t
ceramic wool blanket to meet Uf:1777 standards for chimney exteriors with zero clearance to e(�Fle lihec i'�, a car i
combustibles. amless tee,
iinpedto�
M-Flex can be shipped UPS in the following lengths 3"-50',4"-44',5"-38',6"-32',7"-26',8"-20'. V11 iingsystemof
All other diameters and lengths exceeding those above must be shipped road freight. ura6�l�ty�Th Flex{:y¢e a
ed`to�negocia e'�e ec e.
M-Flex Stainless Steel Flexible Chimney Liner carries a Life Time Warrantee for all fuels,with can ke evalize ;foucvsto'si
st mstallatiot
appliance efficiencies at 83 percent or lower.
corrugate constc'o
PRODUCT INFORMATION: M-FLEX 294C SS LINER ows for exp�?ansion .
M-Flex 294C Stainless Steel Flexible Chimney Liner is designed to reline existing chimneys or d contrach`o$nu mg;
used as a liner in new construction.Manufactured in the highest grade mill certified AL294C alloy
e heat u antl coo
M-Flex 294C has the greatest acid fighting ability to combat the acidic condensate produced by emoving any
todays high efficiency boilers.Listed by Underwriters Laboratories M-Flex 294C can be used to vent tress m.the liner
gas fired appliances with AFUE'S of 83%or greater.M-Flex 294C is available in diameters of 3" he M FI`ex tenet ,
to 24"to cover the wide range of appliance requirements found in the field today. an be insulated -P
The unique manufacturing system used to make M-Flex 294C utilizes a continuous strip of stainless remier Mixor with V
steel,interlocked and diagonally crimped to produce a gas and water tight lining system of superior n UL used 2remer5
rap Eiiher type.i.
strength and durability.M-Flex 294C is extremely flexible and can negotiate offsets in chimneys M
rnsultaion r W
with ease.It can also be ovalized to custom configurations to fit most any installation.The corrugated I meet UL 1 ,3
construction allows for expansion and contraction within the liner removing any stress on the liner 7 standards :,z
system. o himriey exten_' t ''
ero'�cl`earance� ��
For best performance of the appliance and the venting system,M-Flex 294C can be insulated with bustibles
either Premier Mix poured insulation or Premier Wrap ceramic wool blanket. Insulation shouldby
always be used on exterior chimneys. d
a
M-Flex 294C carries a Life Time Warrantee for all installation venting condensing gas appliances. ctwn"will,uaranl2e�t Q
Flex 294C can be shipped UPS in the following lengths: 3"-50',4"-40',5"-38',6"-32',7"-26', beventing safelyfor_trla y
8"-20'.All other diameters and lengths exceeding these above must be shipped road freight.
of smoke chamber.At this point hold liner in place by pushing 2x4 tee up through damper and across bottom of liner.Install top hardware at
top of chimney as described in previous section.
*To install the base plate through the face of the fireplace will require more work and masonry skill.Start by removing two to four bricks in
either the face or the back of the fireplace at the level of the top of the smoke chamber.If the smoke chamber is constructed correctly there
should be approx.eight inches of masonry to go through.Once this opening has been accomplished slide the base plate into the hole over the
top of smoke chamber.Slide the liner down from the top of the chimney and through the hole in the base plate.Secure with stainless steel
rivets,stainless steel screws,or place a support clamp on the liner above the base plate.This will keep the liner from sliding down through
the base plate until the top hardware has been installed.Once this is complete install top hardware as described in previous section.Seal hole
in masonry with like material.
6.)INSULATING M-FLEX STAINLESS STEEL CHIMNEY LINER
A note about insulating stainless steel chimney liners: Not all situations require insulation of the chimney liner.The UL1777 Standard for
installing stainless steel chimney liners require insulation because the non-code conforming chimney has zero clearance to combustibles or some
other defect.Thus the UL 1777 Standard is in place for fire protection.The definition of a code Conforming chimney is one that meets or exceeds
N.F.P.A.211 for construction of chimneys,ie:proper clearances to combustibles,intact 5/8 fireclay flue liner or equivalent,minimum four inch
(nominal) solid chimney wall. If the chimney meets the requirement for code conforming the only reason to reline would be for appliance
performance.In case of relining for high efficiency gas or oil fired appliances(over 83%)no insulation may be required.However,regardless of
existing chimney,insulating the chimney liner will improve the performance of the appliance that is connected to it.Because the insulated liner
will stay warmer the flue will not cool as quickly and will not condense as rapidly.In wood burning appliances this will reduce the amount of
creosote that will form in the liner.In oil and gas burning applications the likelihood of condensation,especially on start up of the appliance will
greatly reduce.While fire protection is the main concern,insulating liners even if not required will pay dividends by increasing performance and
efficiency.
* Please Note: For the installed liner system to meet UL standards,all UL listed components used must be installed with proper clearances.
THERE ARE TWO METHODS OF INSULATING M-FLEX STAINLESS STEEL LINERS
Method#1-Insulating with Premier Mix
•Premier Mix is poured into the chimney around the liner after the liner is installed.Premier Mix is premixed and water is added to the mix at
the job site.To determine the amount of Premier Mix needed to insulate a specific liner please call National Chimney Supply,Inc..
•No minimum thickness of Premier Mix around a liner installed in a code-conforming chimney is required.The required clearance between
the liner and the interior of the masonry chimney is 1"inches.In a non-code conforming chimney,ie:zero clearance to combustibles,no flue
liner,etc.the minimum recommended thickness of Premier Mix is One inch.The required clearance between the insulation and the interior
wall of the masonry chimney is 0"inches.
•Premier Mix is mixed with two to three gallons of water in a mortar pan or wheelbarrow.When mixed correctly the Premier Mix will have a
grainy consistency and little or no water will come out when squeezed in your hand.Once mixed the Premier Mix is poured into the chimney
around the liner.The liner should be vibrated during the pouring process to help the Premier Mix settle around the liner.Continue to pour
Premier Mix until the chimney is full to the top.Install top hardware as described in previous section.
*A Premier Mix insulated M-Flex liner can be used after the installation is complete.Curing of the mix will occur over approximately 28 days,
with approximately 70% of the curing process occurring in the first week.Drying time of the Premier Mix will depend on the thickness of
the mix and the absorption of the masonry chimney.Drying time will be accelerated by using the heating appliance.
Method#2-Insulating with Premier Wrap
Premier Wrap is installed around the liner before it is installed in the chimney.
•Premier Wrap is one half inch thick and one quarter inch thick,eight pound density,ceramic wool blanket with a three mil aluminum foil face.
Aluminum tape,retractable wire mesh,and mesh clamps will be needed to complete the installation.Premier Wrap is available in four widths,
24"to fit liners 4"to 6"diameters,30"to fit 7"to 8"diameters,36"to fit 9"to 10"diameters,and 48"to fit 11"to 14"diameters.
• In a code-conforming chimney no Premier Wrap insulation is required.In a code-conforming chimney that must have the tiles removed a
single one quarter inch Premier Wrap is required.In a non-code conforming chimney a single one-half inch Premier Wrap is required.The
required clearance between the insulation and the interior of the masonry chimney is 0"inches.
•To install Premier Wrap onto the liner,lay the blanket open with the foil side down.Cut blanket length wise so that it will overlap approx.one
inch.Place liner on blanket and wrap around liner.Run foil tape the complete length of the seam on the blanket,next cut pieces of foil tape
approx.eight inches long,and tape across seam about every foot.Next place liner into retractable mesh sock.Using mesh clamp,clamp at
end.of liner just above tee body.Pull retractable mesh sock to top of liner,continue to pull until mesh sock has retracted tightly around the
liner,clamp mesh at top and cut off excess mesh.Install liner as described in previous section.
7.) INSPECTION AND MAINTENANCE INSTRUCTIONS
Should you have any questions concerning inspection and maintenance of the M-Flex liner
Please contact:
National Chimney Supply,Inc.
Corporate Headquarters
3 Green Tree Drive
South Burlington,VT 05403
(800)897-8481
* Inspection of the M-Flex liner should be done in a minimum,once per year,at no more than 12 month intervals from date of installation.If
the liner is used to vent a solid fuel burning appliance,inspections should be done at intervals of every 2 months during the heating season.
Upon inspection,if soot or creosote accumulations have reached a 1/4"or more the liner should be cleaned.This inspection and cleaning should
be carried out by a nationally certified chimney sweep,or other qualified chimney professionals.
U
3.)DETERMINE IF THE CORRECT SIZE LINER WILL FIT INTO THE CHIMNEY
The M-Flex,Stainless Steel Chimney Liner can be installed with in the existing flue tile or the flue tile can be removed. It is extremely
important that the correct size liner will fit into the chimney.Certain factors,such as chimney construction and offsets in the chimney,may
change the size of the interior of the chimney.It is best to prove the interior of the chimney before trying to install the chimney liner.This can
be done by lowering a short piece of the.intended size liner down the chimney to see if it will pass all the way to the bottom.You can also use
a liner guide cone to accomplish this.If the chimney liner will need to be insulated this will effect the required dimensions needed to install
the liner.If the round configurations needed to vent the appliance will not fit the liner may be formed to an oval configuration to fit,however
ovalizing the liner will change the cross sectional area.Please call National Chimney Supply,Inc.with any questions.
4.)INSTALLING M-FLEX STAINLESS STEEL CHIMNEY LINER
• Make sure the thimbles to be used in the installation are in the proper chimney to maintain the required clearance to combustibles for the
connector pipe from the appliance.If the clearances are not correct reconstruct the thimble to the proper position.
•Determine the length of the liner by measuring from the bottom most thimble to the top of the chimney.To this measurement add approx.six
inches to accommodate the crown and top hardware.Cut liner to length.
•Remove the snout from the two part tee and attach the tee body to liner with either stainless steel pop rivets,or stainless steel screws.If the
liner is going to be insulated with a ceramic wool blanket,install the blanket now.If a tee cap is going to be used,attach it to the body now.
*Take the tee snout that was removed from the tee body and extend the draw band completely,slide the tee snout into the thimble with the draw
band centered in the flue. Lower the
liner down from the top of the chimney, Mimimumchimneyclearan
to brick and combuatibles
and feed the tee body through the draw 2in.(51mm) Mimimum clearance System
12 in.(305 mm) A Minimum 3.5 in.(90 mm)thick brick masonry wall framed
band on the tee snout.You may have to of brck
Y r info combustible wall with a minimum of 12 in.(305 mm)
rotate the liner to align the hole in the brick separation from clay liner to combustibles.Fireclay
liner(ASTM C 315.Standard Specification for Clay Fire
Chimney body with the snout.Once you have y y Linings,s,equivalent),o minimum surface e o mm)wall
hue �� connector thickness,shall run from outer surface of brick wall to,but
aligned the tee,tighten the draw band Fireclay not beyond the inner surface of chimney flue liner and shall
Minimum 12 n.(305 mm) Masonry chimney liner be firmly cemented in place.
to secure the snout to the tee body. to combustibles constructed to NFPA 211
Clearance:12 in.(305 mm)
* Seal the area around the tee snout with
B Solid-insulated,listed factory-built chimney length of the
mortar to form an airtight seal. Minimum chimney clearance from same inside diameter as the chimney connector and
* masonry to sheet steel supports and _ having 1 in.(25.4 mm)or more of insulation with a ombustible2-in.(61 mm) minimum 9 in.(229 mm)air space between the outer wall
At the top of the chimney there are 2 c
Mimimum deamnce
Nonsolude �g;n.(z2g mm) of the chimney length and combustibles.
Options to seal and support the liner: Fa°,°ry a in refractory cement The inner end of the chimney length shall be flush with the
chime length ••.
Option 1 is to install a to kit.This is °r g Chimney inside of the masonry chimney flue and shall be sealed to
P P Chimney length /conneclor the flue and to the brick masonry penetration with non-
accomplished by first removing the I l flush 4h inside use chimney water-soluble refractory cement.Supports shall be securely
fastened to wall surfaces on all sides.
rain ca onion of the kit b loosening •rotas.pans to Fasteners between supports and the chimney length shall
P P Y g Arspace Chimney attain connector PP Y 9
'gin.(229 mm)min. gue ` securely not penetrate the chimney liner.
the top worm drive clamp a few turns. \,.. solid-insulated. Clearance:9 in.(229 mm)
Mason chimney -1 . listed factory-built
Next, install the plate assembly over Masonry y chimney length
constructed to NFPA 211 C Sheet steel chimney onnector,minimum 24 gauge 0 024 in.
Sheet steel supports y 9 9 [ -
the liner,tighten the worm drive screw (0.61 mm)]in thickness,with a ventilated thimble,minimum 24
until snug, attach the late t0 the gauge[0.024 in.(0.61 mm)]in
g P Minimum chimney clearance to sheet thickness,having two 1 in.(25.4 mm)air channels,separated
masonry ith silicone or to cons.Cut steel supports and combustibles from combustibles by a minimum of 6 in.(152 mm)of glass
Y P 2 in.(51 mm) fiber insulation.Opening shall be covered,and thimble
Two air channels supported with a sheet steel support, g g
the liner flush with the to of the .�- PP minimum 24 gauge
P each t in.(25.4mm) [0.024 in(0.61 mm)]in thickness.
assembly and reinstall the rain cap chimney Supports shall be securely fastened to wall surfaces on all
CA-." connector sides and shall be sized to fit and hold chimney section.
portion of the top kit. ! J Fasteners used to secure chimney section shall not penetrate
Option 2 is to install a to late to Chimney `Minimum 6in. chimney flue liner.
P P plate, P Two ventilated air flue [ (152 mm)glass
• Clearance 5 in.(152 mm)
fiber insulation
support clamp,and storm collar.Place channels each I > l
in.(25.4 mm); Masonry chimney D Solid-insulated,listed factory-built chimney length with an
the hole in the top plate around the liner construction of constmded to NFPA 211 Sheet steel supports inside diameter 2 in.(51 mm)larger than the chimney
sheet steel connector and having 1 in.(25.4 mm)or more of insulation,
and center the liner and top place on serving as a pass-through for a single wall sheet s!eel chimney
Minimum chimney clearance to sheet steel supports and connector of minimum 24 gauge[0.024 in.(0.61 mm)]
to of the chimney, to chimney combustibles 2 in.(51 mm)
P Y+ Y thickness,with a minimum 2 in.(51 mm)air space between the
top with masonry screws, Silicone or - Sheet steel supports Mimimum clearance 2 in.(51mm) outer wall of chimney section and combustibles)
Minimum length of chimney section shall be 12 in.(305 mm).
mortar. Attach the support clamp Chimney 1 in.(.25.4 min)airspace Chimney section concentric with and spaced 1 in.(25.4 mm)
sedion to chimney length away from connector by means of sheet steel support plates
around liner and secure. Place a bead on both ends of chimney section.Opening shall be covered,
f Chim and chimney section supported on both sides with sheet steel
of silicone around top of storm collar i c.rm eor supports of minimum 24 gauge[0.024 in.(0.61 mm)]thickness.
to seal.Install rain cap on top of liner Chimney connector Supports shall be securely fastened to wall surfaces on all
/ sides and shall be sized to fit and hold chimney section.
and secure. Air space 2 in.(51 mm) , chimney length Fasteners used to secure chimney section shall not
* Masonry chimney Sheet steel supports penetrate chimney flue liner.
To facilitate inspection and cleaning, constructed to NFPA 211 Clearance:2 in.(51 mm)
wall penetrations shall not be placed
directly behind the heating appliance. Additional requirements:
1.Insulation material used as part of wall pass-through system shall be of noncombustible material and shall have a
5.)INSTALLING M-FLEX STAINLESS thermal conductivity of 1.0 Btu-in./hr-W-°F(4.88 kg-cal/hr-m2-'C)or less.
STEEL LINER FOR A FIREPLACE 2.All clearances and thicknesses are minimums;larger clearances and thicknesses shall be permitted.
3.Any material used to close up an opening for the connector shall be of noncombustible material.
•When installing a liner for a fireplace 4.A connector to a masonry chimney,except for System B,shall extend in one continuous piece through the wall pass-
application no tee is used on the bottom through system and the chimney wall to the inner face of the flue liner,but not beyond.
of the liner.Instead a base plate is used
to seal the liner at the top of the smoke chamber.The base place can be installed by working up through the damper opening or by removing
bricks in the face of the fireplace at the level of the top of the smoke chamber.
• Installing the base place from the damper opening is accomplished by sliding the liner down into the smoke chamber from the top of the
chimney.Put the base plate up through the damper opening and around the bottom of the liner.Secure the base plate to the liner with stainless
steel rivets,stainless steel screws,or a support clamp below the base plate.Once base plate is secured pull liner up and seat base plate on top
50`7- I i 4/o 'Ac-, �� Dee F
National Chimney Supply,Inc.#MH25531 "'Y' �
3 Green Tree Drive 21470 Fletcher Ave. 2601 Elmory Road Bldg.#4 4219 Howard Ave.
South Burlington,VT 05403 Indianapolis,IN 46203 Finksburg,MD 20895 Kensington,MD 20895
INSTALLATION INSTRUCTIONS FOR M-FLEX MODEL CB,SW,&AL STAINLESS STEEL CHIMNEY LINERS
M-Flex Stainless Steel Chimney Liner are manufactured by National Chimney Supply,Inc.This lining systems is designed and listed to be in-
stalled within masonry'chimneys used to vent the products of combustion produced by heating appliances that burn oil,gas,or solid fuels.
This liner should be installed by a nationally certified chimney sweep or other qualified chimney professional.
Each installation must be planned for the best performance of the appliance being installed.Refer to appliance manufacturer's instructions to
determine any special venting requirements for specific appliance.
The installer must contact the local building and fine code officials to determine any installation and inspection requirements.Building permits
may be required before installation.M-Flex CB and AL liner must be installed within.the local building codes.Please remember,regardless of
national codes,the local building inspectors have ultimate jurisdiction.
Do not use any materials or components other than specified in these installation instructions.
MATERIALS NEEDED TO INSTALL M-FLEX STAINLESS STEEL LINER:
316L - A1294C
316 Two piece or one piece tee AL Two piece or one piece tee
Tee Cap Tee Cap
90 Deg.or 45 Deg.elbow: 90 Deg.or 45 Deg.elbow:
Coupler Coupler
304 Top plate 304 Top plate
Top Support Clamp or Top Kit Top Support Clamp or Top Kit
Storm Collar Storm Collar
Liner Rain Cap Liner Rain Cap
INSULATION MATERIALS(if applicable)
Part# Description
PW4 Premier Wrap 114"Foil Faced Ceramic Wool Blanket
PW2 Premier Wrap 1/2"Foil Faced Ceramic Wool Blanket
PM Premier Mesh Protective Wire Mesh Sleeve
Foil Aluminum Foil Tape
FAIS40(large/small) Mesh Clamp
PRMIX Premier Mix
1.)INSPECTION AND PREPARATION OF CHIMNEY
The existing chimney must meet the following codes for proper construction and compliance requirements before the liner can be installed:
*The chimney must be a minimum of ten feet high,and a maximum of one hundred feet in height.
*The chimney,must have the proper wall thickness,ie:minimum of 4 inches(nominal)solid masonry units.
The chimney must extend at least three feet above the highest point where it penetrates the roof structure,and at least two feet higher than
any portion of the building or adjoining structures within ten feet.
If the chimney is constructed inside the structure,a minimum of two inches of unobstructed air space must surround the chimney Lg_anv
combustible material.If the chimney is constructed on the outside of the structure,one inch of unobstructed air space must be maintained
between the chimney and all other combustible materials.
*When the chimney passes through an floor,ceiling,or other horizontal or vertical structure,are stops of a non-combustible material must be
used.
**WTHE PROPER CLEARANCES LISTED ABOVE CANNOT BE DETERMINED THE LINER MUST BE INSTALLED WITH A ULMSTE3D CHIMNEY INSULATION**
*Do not connect any appliance that bums a liquid fuel to a chimney liner used to vent a solid fuel burning appliance.
*The connector pipe used to connect the appliance to the chimney liner must meet proper clearances to combustibles as determined by the
appliance manufacturer's installation instructions,the national building code,or the local building code,whichever is in force.
Before the liner is installed the chimney must be cleaned thoroughly to remove all deposits of soot,creosote,or glazed creosote.A proper
inspection must be done to determine that the-chimney is structurally sound.It the s c ral integrity o e chimney is found to be in question,
ie:missing,loose,or cracked masonry or mortar joints,repairs must be made before installation of the chimney liner.
2.)SIZING THE PROPER LINER DIAMETER
•For solid fuel burning appliances,the cross sectional area of the liner shall not be less than the cross sectional area of the appliance outlet collar.
The cross sectional area of the flue shall not be more than three times the cross sectional area of the appliance outlet collar.For solid fuel burning
fireplaces,the liner should be at least one-tenth the square inches of the square inches of the fireplace opening.Please note that this formula
can vary based on height of the chimney and other determining factors.Call National Chimney Supply,Inc.should you have any
questions.
•For liner sizing of gas and oil burning appliances please refer to N.RP.A.54 for gas and N.F.P.A.31 for oil.Also refer to appliance manufacturer's
instructions.Incorrectly sized liners for these appliances can lead to performance problems and condensation with the lining system.
Please call National Chimney Supply,Inc.should you have any questions. CBIN•001(Rev.05110)
y ,. .. .'
4
7
l
RECE1VE
OCT 2 2015
DEPT OF BUILDING INSPECTIONS
�^ j� NORTHAMPTON,MA 01050
The Commonwealth oj'Massachusetts Print Fore
W5) Department of Industrial Accidents
Office of Investigations
600 Washington.Street
Boston, MA 02111
www.ma.ss.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization Name:" 1_W___ _.�(�yf ___ _1�pX Q. _�1 t` `�'t _ Y L�- ._7,1L
Address: S 3
(J
1. ��r_
City/state/zip: I horse fit:
�— Are you an employer?Check the appropriate box: Bu,iness Type(required):
1.' ---1 am a employer with employees(full and/ 5. ( Retail
f - - -
or part-�tirne).* 6. [] Rcstaurant/Bar/Eating Establishment
2.❑ 1 ani a sole proprietor or partnership and have no 7. Office and/or Sales(ones. real estate,auto,etc.)
employees working for me in any capacity.
No workers' comp. insurance required] 8. Non-profit
3.,N We are it corporation and its officers have exercised 9. ❑ Entertainment
their right ofexemption per c. 152. §1(4),and we have I0.❑ Manufacturing
no employees. INo workers' comp. insurance required]*
I L Health(,,are
4.❑ We are a non-profit organization,staffed by volunteers,
with no employees.f No workers'comp. insurance req.] 12.0 Other
'Any applicant that checks box#1 must also fill out the section Ixla v showing tl.teir workers'compensation poncy intumration.
**If the corpoatte officers have exempted themselves,but the corporation Ims other employees,a workers'compensation policy is required and such an
organiiwion should check box 01.
1 um an employer that is providing workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name: _I rQ-V-Q tom __-_ - -LL_y_'LlvnC_(2 __
Insurer's address: D_' 60/, ,�} 1
City/state/zip: tJ IPAzyo J C, `9�Lfq'-
Policy It or Self ins.Lic.# z - _..--------tsxpira[iotr
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
I ailure to secure coverage as required under Section 25A of M, (;L c. 152 can lead to the imposition of criminal penalties of a
fine tap 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 ccrtij,,under the pains and penalties(J'perjury that the information provided above s true.and correct.
-
Si �nattlre:_�����-�-� Date,:--�-...?_L
QfOcial use only. Do not write in this area,to he completed by city or town offrcial
City or"Down:� Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building llepartment 3.City/Town Clerk 4. Licensing;Board 5.Selectmen's Office
6. Other
Contact Person: Phone#:
r4�',rv.mus.ttov/dia
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSI.) 16 t6 3q 6`
BY 110 P. T&y (�— License Number Expiration Date
Name of CSL Holder
I �
List CSL Type(see below)
SC�rj (' ��
No.and Str et Type Description
����� 9- d t 610%11S R Unrestricted(Buildings gs u el 35,000 cu.ft.)
if K Restricted 1&2 Family Dwelling
Crty/Town,State,ZIP M Masora
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
LiM- I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registratfon NILATer xpir ion l3ate
HIC Company r Ht Pegistrant Name
NQ.and Sir Email address
6)y1 G 4-N-�;A-611/S�r
Cif own,State,ZIP Telephone
SECTION 6: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...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authoriz n k(.j ��Jev,d cki,kn ���
to act on my behalf,in all matters relative to work authorized by this bu�iP ing piFrmit applicatiot . ry-)�;&Cfw-,/J'�Qc.
U6,6 Ntj( n Zr, kt sk'L
Print Owner's liame(Electronic gnature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest raider the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
ktcf hr�l n Kow Sk$
rint Owner' r Authorize gent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/tier own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the IIIC Program can be found at
�N»' >> sS.-N/uca Information on the Construction Supervisor License can be found at v,
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
lIo1�A pT0 INM`OtWONB
1,13U The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 ��gprerty Add es ' c � 1.2 Assessors Map&Parcel Numbers
6�J'
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2. O of' Recor
its uer r U n
Name(Print) U City,State,ZIP
qq IsJ&nd Vc4d -
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:_
Brief Description of Proposed Work 2: Z1,S
e- Kzo '
i
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
L Building $ 1. Building Permit Fee:$ Indicate how fec is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $ s
Su ression) Total All F es:$
Check No Check Amount: Cash Amount:
6.Total Project Cost: $Ca'r1 r6, ❑Paid in Full ❑Outstanding Balance Due:
File#BP-2016-0561
APPLICANT/CONTACT PERSON BRUCE FARIA
ADDRESS/PHONE 19 SPRING ST WESTFIELD01085 (413)568-6488
PROPERTY LOCATION 99 ISLAND RD
MAP 46 PARCEL 050 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiny,Permit Filled out
Fee Paid
Tyneof Construction: REBUILD CHIMNEY ABOVE THE ROOF&INSTALL STAINLESS STEEL CHIMNEY
LINER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 106039
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
De n Delay
Signature of Bui ding Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
99 ISLAND RD BP-2016-0561
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:46-050 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: chimney rebuild BUILDING PERMIT
Permit# BP-2016-0561
Project# JS-2016-000929
Est. Cost: $2780.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRUCE FARIA 106039
Lot Size(sq. ft.): 3484.80 Owner: ZAJOWSKI KATHRYN
Zonine: Applicant: BRUCE FARIA
AT. 99 ISLAND RD
Applicant Address: Phone: Insurance:
19 SPRING ST (413) 568-6488 WC
WESTFIELDMA01085 ISSUED ON.1012612015 0:00:00
TO PERFORM THE FOLLOWING WORK.-REBUILD CHIMNEY ABOVE THE ROOF &
INSTALL STAINLESS STEEL CHIMNEY 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 10/26/2015 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner