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08-058 192 COLES MEADOW RD BP-2017-0149 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:08-058 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-2017-0149 Project# JS-2017-000245 Est. Cost: $2600.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group BERNARDSTON FARMERS SUPPLY 99401 Lot Size(sq. ft.): 32408.64 Owner: MALINOWSKI JAMES E Zoning: RI(100)/RR(78)/SR(22)/ Applicant: BERNARDSTON FARMERS SUPPLY AT: 192 COLES MEADOW RD Applicant Address: Phone: Insurance: 43 RIVER ST (413) 648-9311 O WC BERNARDSTON MA01337 ISSUED ON:8/2/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPUBLIC LOPI 1750 INSERT 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 N 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: FeeTvpe: Date Paid: Amount: Building 8/2/20160:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner City of Northampton • 4-- -.144;:: RECEIVED Massachusetts ts. p� �1 AtE _ 2 2OI6DE=ART + NT OF BUILDING INSPECTIONS Y.^." 2 M.in Street a Municipal Building Northampton, MA 01060 _. • moi/_ 4EPr OF BUILMNG WSPECTIO NOMBAMPTON,MA OICSpN$ SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION FOR WOOD,COAL, PELLET, CORN,STRAW OR SIMILAR STOVES.OR FIREPLACES Check# IV Lal Please fill in all appropriate information 1_ Name ofApplicant (7) oflp LA)2,6cc J (s['cr Address: /C'( Sinicft) b//aicki o/O i? Telephone: ` '3 7.::;97 .5/4 3 2. Owner of Property : V &/ S /Pf 0-1 J3/Cy Address: /9 �c> S ' Ltoo ffteapPerdw ne: • 3. Status of Applicant : Owner ✓Contractor 4. Type or Brand of Stove : �-cpon&/C L02i /7S6 /✓rser+ 5. Estimated Cost : k,(P CV-- If applicant is not the homeowner:-. -� `�b - �.✓"� r/rcct)/der; Contractor name //oog Construction Supervisor's License Number y7t(6( Expiration Date /_6 ? Home Improvement Contractor Registration Number / J 'V77 Expiration Date N-19-4- 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: 71Q-/� APPLICANT'S SIGNATURE DATE: 723-/Io HOMEOWNER'S SIGNATUREX //LQ�yt,d7,aA 4 ' APPROVED DATE: BUILDING OFFICIAL The Conemonwealth of Massachusetts Department of industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.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.❑✓ [am a employer with 10 employees(full and/ 5. 0 Retail or part-time).* 6. ❑RestaurantBar/Eating Establishment 3.0 1 am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl_real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] R. ❑Noti-profit 3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing no employees.[No workers' comp.insurance required]** 11.0Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees_[No workers'comp_insurance req.) 12.0 Other ^Am}applicant thm checks hox=l must also fill out the section below showing their workers'compensation policy information. "If 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=1. I ant 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:1/12017 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 SI,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, under the pa' s an:I senalties of perjury that the information provided above is true and correct yZp— Sienamre: 1�� ' r"'- Date: / � Phone ii: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): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.alassgov/dia Stove Installation (for qualified installers only) 9 Sack Wall Top View - p Straight Installation m 24'smmm O —TT 5-3/4"taemm O O 23-1?59� Measure rear and sltle clearances from the nearest edge of the stove top. NOTE vent diameter may very depending on brand and model. Measure front clearances from the face of the stove (unibody). Floor Protection Figure2 Top View - Corner Installation 24^510mm 0 IL44r4'146mml e '23-1/21597mmI Measure rear and side clearances from the nearest — — edge or the stave top. NOTE'.vent diameter may vary depending on brand moddel. COan Measure front clearances from the(ace of the stove (unibody). Floor Protection Figure 3 ©Travis Industries 100-01433 4151217 16 Stove Installation (for qualified installers only) Exterior Factory --' Follow the chimney Built Chimney Chimney Cap manufacturers (See the section"Chimney Iinstructions and Termination Requirements" L clearances for roof NOTE: ) y `, penetrations. A storm for more details • Exterior chimneys are collar and flashing are Chimne Sections required(some subject to greater moisture and creosote Minimum Air Space to require a radiation accumulation due to the Combustibles(See — - IP J shield). lower temperatures. An Chimney Manufacturers Wall Bands p Instructions) and ty Minimum 15'(4.57M) insulated chase will lJ Maximum 33'(10.05M) reduce these Asupports (`7 accumulations (the Min. 18" �� ®y lJ Insulated Tee proper clearances to the (457mm) _/ 1 illi (with cleanout) chimneymust be clearance tolk \ ,. l�/ Follow the chimney maintained). ceiling — ,ids ✓ manufacturers i� r i instructions and Seimoes Connector e Sections clearances forwall penetrations. ations.. A wall radiation shield Floor Protection r (thimble)is (See Floor I required. Protection IStove Clearances Requirements Ii (See the section"Stove Optional for details) -- ii Placement Requirements" insulated afor more details) chase Figure 12 Hearth Stove -*--___ Cap and flashing � Positive : -----_ prevents water from Connection NOTE'.The entire fireplace and I t' entering chimney must be dean, undamaged, / U NOTE: and meet all local building codes �� (UBC,etc.). Damage must be I Most factory-built repaired prior to installation. The1--- + 1 chimney manufacturers chimney must be 15'(4.57M)to 33' make stainless steel (10.05M)tall The liner must be chimney liners,either 1 '- — stainless steel connector flexible or rigid. This F i -- or flexible vent. Follow provides a wide variety A f �i the liner manufacturers of installation options. Ti andsupport instructions for installation Make sure to follow the Combustible manufacturer's MantleJ instfUehOns for M°' 18 Airtight Insulated installation and support. (457mm) �1�+ - Clean-Out '8-- 1 —I t Remove damper �1 or wire it open Floor Protection ��...-1i (See the section "Floor Protection 1�') See the section .,, . Requirements" r� Il ^Stove Placement for more details) H- 1j— Requirements"for p , minimum clearances I I iLI I 4. rsqulred- I gyp/ Figure 13 ©Travis Industries 100-01433 4151217