31A-186 (3) 55 WASHINGTON AVE BP-2016-1053
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 A- 186 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-2016-1053
Project# JS-2016-001787
Est. Cost: $1500.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BERNARDSTON FARMERS SUPPLY 99401
Lot Size(sq. ft.): 11804.76 Owner: VOLKMANN STEPHEN E&ELIZABETH
Zoning URB(100) Applicant: BERNARDSTON FARMERS SUPPLY
AT. 55 WASHINGTON AVE
Applicant Address: Phone: Insurance:
43 RIVER ST (413) 648-9311 O WC
BERNARDSTONMA01337 ISSUED ON.•2/29/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL HARMAN P38 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# 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 2/29/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton
� F �tP` M3SSdChU3ettS �� f`
LQl6 D P TMENT OF BUILDING INSPECTIONS w ,
FEBEB Gilt 12 Main Street • Municipal Building �,, ,
Northampton, MA 01060 �`py >< ��°�
DEP 1_ !,vS�TL Tft7NS
N'�Fi; 'A:YIPT0N,h9A 01"33
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD,COAL, PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check# i
// Please fill in all appropriate information
1. Name of Applicant : %r`l� rlt fA-� /�C 1/oU�IAS L .19b
1,2
Address: /0� � t l/1/�afc�y 0167-3 Telephone; Vl_- -377-
2.
772. Owner of Property
Address: 67.- W-(3AiA c)'1a rI Aub n/drv� M f �r� Telephone: ./!-S
3. Status of Applicant : Owner Contractor
4. Type or Brand of Stove ; P1lnrnAr,1 `P3,
5. Estimated Cost : OD
If applicant is not the homeowner::
Contractor name
Construction Supervisor's License Number �`� �'� Expiration Date
Home Improvement Contractor Registration Number /�' 4 x'77 Expiration Date_ �j t
All Applicants must complete a Workers Compensation Insurance 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: � '!C APPLICANT'S SIGNATURE -
--sj DATE: a'1 t ' HOMEOWNER'S SIGNATURE X
APPROVED
DATE: BUILDING OFFICIAL
The Commonwealth of Massachusetts
- — Department of Industrial Accidents
tl Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): THE FRE PLACE
Address:106 STATE RD
City/State/Zip:WHATE LY, MA 01093 Phone #:413-397-3463
Are you an employer? Check the appropriate box: Type of project (required):
1.9 1 am a employer with 10 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have
8. F-1 Demolition
working for me in any capacity. employees and have workers'
9. E] Building addition
[No workers' comp. insurance comp. insurance.+
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑ 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#tl must also fill out the section below showing their workers'compensation policy information.
_l 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. Lic. #:014005033601116 Expiration Date:
1-1-17
Job Site Address: ��S ltJoes�iinXV I 4tm City/State/Zip: Ao/t A rXPY'f n
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 5250.00 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 under the pains and penal s ofperjury that the information provided above is true and correct.
Si nature: Dat c: ,-5•
Phone#: 413-397-3463
Of 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#:
Installation
Installing
Placode stove on a noncombustible type floor or floor protector dimension may be used
that extends a minimum of 6 inches (1 52mm)to the front of the as long as they satisfy the
load door opening, 6 inches (152mm) to the sides of the door measurement requirements 9"(228mm)
shown below
opening, and 6 inches to the rear. Floor protection must also Minumum size floor
extend 2 inches(51 mm)beyond each side of any horizontal flue protection for a corner I
pipe. The minimum floor protector material is 20 gauge sheet installation hearth pad is
36'x 36"�Clearance shown
metal. Other floor protector materials are ceramic tile, stone, as 9' with optional side
brick, etc. shields installed.
NOTE for Canadian installation only: Per ULC-S627-00,
If installed on a combustible floor, the need to provide
noncombustible floor protectornuveh the area beneath theco
space heater and extending at least 17.72"(450mm)on the firing
side and at least 7.87" (200mm)on the other sides. Fig.3
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 2"(51mm)
light shuts off,prior to opening the firebox door or ash door.
Place the stove away from combustible walls at least as far as 10"(254mm)with
shown in Figures 3 and 4. Please note the difference in side wall
side shields
clearance with and without side shields. i � 10-(254mm)
Note that the clearances shown are minimum for safety but donot
leave much room for access when cleaning nrservicing. Please
take this into account when placing the stove. without side shields
Connect the power cord to a 120 V.A.C. GOHz grounded
receptacle.
circuit board.)Also be sure that the polarity of the outlet that the
stove is plugged into is correct. 36"(914mm)
Prior to installing the flue pipe, connect a draft meter. (The Fig.4
draft meter must have a minimum range of 0 - .5") Record the
first reading. Connect flue pipe to stove and be sure all doors Minimum Size floor protection (USA) is 32`11" wide By
and windows in the home are closed. Record the second draft 33"deep(826mm X838mm).
reading |fthe second reading iamore thon05" |mwer °
' Floor protection dimensions for the front and sides
than the first reading check' are measured from the appliance door opening in
for outside air(see page 1U) For� The United States. In Canada'
the side dimension is
test refer hoPage 1Q.
measured from the widest part ofthe appliance.
Mobile Home Installation
When installing this unit in umobile home,several requirements
must befollowed:
1.The unit must bebolted tothe floor.This can badone with 1/4" j Sides 6" 200mm
lag screws through the 2 holes inthe base plate.
2.The unit must also beconnected tooutside air. See page& K Front 6" 450mm
3. Floor protection and clearances must be followed as shown.
4. Unit must begrounded tothe metal frame of the mobile home,
CAUTION: This appliance must bevented tothe outside.
Due tnhigh temperatures,the stove should beplaced out nftraffic NOTE:
and away from furniture and draperies. Measurement"L"
Children and mdu|Lo should be alerted tuthe hazards of high iomeasured from
surface temperatures and should stay away to ovoid burns to the pedestal base
skin and/or clothing. in the US ONLY L
Young children should becarefully supervised when they are in
the same room aathe stove. NOTE:
Clothing and other flammable materials should not beplaced on Measurement"K"
ornear this unit. iumeasured from
the glass inthe
WARNING US ONLY
THE STRUCTURAL INTEGRITY OF THE MANUFACTURED /
cAmAox
HOME FLOOR, WALL, AND CEILING/ROOF MUST BEDO NOT INSTALL IN SLEEPING ROOM. J
USA
Venting
q"D
L B C)r";4
=Vent Terminal =Air Supply Inlet =Area where termination is not permitted
Requirements for Terminating the Venting i The clearance bzservice regulator vent outlet must boa
WARNING: VVentingm\nimumof6��
Venting terminals must not be nocnaaed into .
wall orsiding. J. The clearance toanon-mechanical air supply inlet 0othe
NOTE: Only approved pellet vent pipe, wall poso-througho. building nrthe combustion air inlet hoany other appliance
and fire stops should be used when ventingmuatbeaminimumof48''
through .
combustible materials. K. The clearance k/a mnoheniom!air supply inlet must bee
NOTE: Always take into consideration the effects of the minimum of 10 feet. (with outside air installed, Gfemt )
prevailing wind direction or other wind currents that may L. The clearance above a paved sidewalk or a paved
cause Oyuahand/or smoke when placing the termination cf driveway located onpublic property must beaminimum
the vent. of7feet.
|naddition,the following must baobserved: KA.The clearance under overanda, porch, deck orbalcony
A. The clearance above grade must beeminimum of12.. must beaminimum of12inches, (B.also applies)
B. The clearance tnowindow ordoor that may baopened NOTE: The clearance 1ovegetation and other exterior
oumbuaUb/assuch aa mulch ia3G'' ay measured �umthe
must b* a minimum of 4D" 0o the nide, 48^ below the
�
conarnftheouUot or cap.This 3S''radius oondnueutograde
window/door, and 12'' abuvethevxindovx/doo� (with '
outside air installed, 8"to the side mrbelow) #raminimum uf7feet below the outlet.
C� A 12" clearance to a permanently dosed window is Certain Canadian and/or Local codes or nayu|abonn may
recommended toprevent condensation nnthe window. require different clearances.
O. The vertical clearance Uuaventilated soffit located above Aventshall not terminate directly above aside-walk orpaved
the terminal within ahorizontal distance nf2feet(6Ocm) driveway which islocated between two single family dwellings
from the center-line nfthe terminal must beaminimum and serves both dwellings.
of 18". Only permitted if veranda, pornh, dmok, or balcony is fully
E. The clearance toanunventilated soffit must bmaminimum open onaminimum of2sides beneath the floor.
of12" See NFPA211for more installation clearance reductions
F The clearance ioon outside corner is 11"from center of when using outside air.
pipe. NOTE: Where passage through a xxa||, or partition of
�urn�umtib|� construction is desired,' the installation
shall conform tpCAN/CSA-B3$5. (if inCanada)
H. Avent must not beinstalled within 3feet(0Ocm)above
agas meter/regulator assembly when measured from the
hohzmntal center-line of the regulator.
7 ppxa+Pellet Stove 3-e0'0e422n36�05/14