29-321 (5) 405 ACREBROOK DR BP-2020-0063
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV.Block:29-321 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 P E RM I T
Permit# BP-2020-0063
Project# JS-2020-000099_
Est.Cost: $4500.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: THE FIRE PLACE 99401
Lot Size(sa. ft.): 14026.32 Owner: CHARTIER MAURICE J JR&SHEILA CASHMAN
zoning: Applicant: THE FIRE PLACE
AT: 405 ACREBROOK DR
Applicant Address: Phone: Insurance:
P O BOX 606 (413) 397-3463 O WC'
WHATELYMA01093 ISSUED ON.711812019 0:00:00
TO PERFORM THE FOLLOWING WORK:HARMEN PELLET 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# 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:
FeeTyae: Date Paid: Amount:
Building 7/18/2019 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton
" Massachusetts
DEPARTMENT OF BIIIZD
a 212 MainStr jou g F-..
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SINGLE OR TWO FAMILY S LIDDIF A CE PERMIT APPLICATION
FOR WOOD, COAL, PELLET,CO N,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check#_
J Please fill in all appropriate information
1. Name of Applicant : 6,u __,j 1 )1166 �/Ky_/�� ���c e-
�
Address: / SYLA '120 W/lck/I( PX01 0/6f_? Telephone: -5 ,5 f 34 S
2. Owner of Property : /71 av"cG 42A&rA%c('
Address: V05— �c/'c /'G 0 i� �l� Telephone:
Status of Applicant : Owner Contractor
4. Type or Brand of Stove : 1-7afr'/xrr) `/� S �l/�� i/?S�/ t. ��S fir/li'/�, do
.A 5s l�nc-- iA16
5. UL Listing
6. Estimated Cost : !�SOo
7. Email :
If applicant is not the homeowner::/
Contractor name �0W//tS L Aber— Email
Construction Supervisors License Number ?9f401 Expiration Date l -�20
Home Improvement Contractor Registration Number %80 Y 77 Expiration Date
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
8. Certification: I hearby certify that the information contained herein is true and accurate to the best of my
knowledge.. q
DATE: APPLICANT'S SIGNATURF�
DATE: 73—//� HOMEOWNER'S SIGNATURE f
APPROVED
j
DATE: / "f BUILDING OFFICI L
fri
aCl�cs�
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
l� Boston,MA 02114-2017
„j 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):
1.[E I am a employer with 10 employees(full and/ 5_ Q Retail
or part-time).* 6. Q Restaurant/Bar/Eating Establishment
2.0 1 am a sole proprietor or partnership and have no 7. Q Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers' comp. insurance required] g• F1 Non-profit
3.0 We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing
no employees. [No workers' comp.insurance required]** I I.Q Health Care
4.Q 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;: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#l.
Ian: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.Lic.#0140050336011116 Expiration Date.
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 certify, un r the pains and penal ' s of perjury that the information provided above is trite and correct.
Signature:. �� Date: 7 l�
Phone#:413-397-3463
Official use only. Do trot 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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gowdia
B. Clearances to Combustibles - Masonry or D. Minimum Opening for Masonry and
Manufactured Fireplace Manufactured Fireplaces
THE CLEARANCES SPECIFIED ARE FOR YOUR -
SAFETY! THESE CLEARANCES MAY ONLY
BE REDUCED BY MEANS APPROVED BY THE
REGULATORY AUTHORITY.
H
i
Mantel - -
Face Trim G
3 B v
D
Location Inches Millimeters
A — G Minimum Width 24 609
C H Minimum Depth 14-1/2 368
�s
_- I Minimum Height#1-70-774235 23-1/2 597
��
1 Minimum Height#1-70-774195 19-1/2 495
F E. Mantel Projections
Location Inches Millimeters J—�
A Insert to combustible sidewall 13 330
B Surround top to face trim 0 0
C Surround side to face trim 1 25
D Insert top to(max) 12"mantel 12 305
K
C. Floor Protection Requirements
Location Inches Millimeters
E Window opening to front 6 152 0 0
F Window opening to side 6 152
Hearth extension must be of a non-combustible material.
It must extend beyond the appliance according to the
measurements listed. o
Minimum Size Hearth Extension is 16" Deep By 32"Wide. ° 0
o �
- o @BB�999
The Maximum mantel depth (J) is 12" (305mm) with a
minimum vertical height(K) of 12" (305mm).
3-90-775 Harman® • P35i Owner's Manual R43 • 2010 • 11/16 10
w
D. Existing Fireplace Installation: Be sure to design the venting so that it can be easily cleaned.
When using a short run of venting (flex or rigid)the damper Check with your local authority having jurisdiction to
must be removed or locked in the open position and sealed determine if this venting method is acceptable. Some
with a plate constructed of steel or other non-combustible Provincial, State, or Local codes may require a full liner run
material. to the top of the chimney. Be sure and check your local
Kaowool, mineral wool or other non-combustible insulation regulations before planning the installation. In this method,
is recommended above the plate to reduce the possibility the proper flashing and rain cap are also required.
of condensation. You will also need to wrap the venting
section between the insert frame and the damper sealing A WARNING
plate. This is to prevent overheating of the fireplace cavity,
which may cause damage to the insert's motors and other Fire Risk.
electrical components. Inspect Chimney
The connector pipe should extend through the sealing plate JAC Masonry chimney must be in good
and smoke chamber and into, or beyond the first flue tile. condition
• Meets minimum of NFPA 211 standard
• Factory-built chimney must meet
requirements of UL103 HT
IN CANADA: This fireplace insert must be When venting in this configuration,a rain cap and proper
installed with a continuous chimney liner flashing must be installed on the top of the chimney to
of a minimum 3" diameter extending from prevent flooding and damage.
the insert to the top of the chimney. The
chimney liner must conform to the Class 3
requirements of CAN/ULC-S635, Standard a,
for Lining Systems for Existing Masonry or
Factory Built Chimneys and Vents, or CAN/
ULC-S640, Standard for Lining Systems for LL
New Masonry Chimneys.
Non-combustible
Insulation
Sealing Plate
When using single wall flex,this
section of venting must be
wrapped with non-combustible
insulation to prevent excessive
MUM 0 heat build-up in the cavity.
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15 Harman® • P35i Owner's Manual R43 2010- 11/16 3-90-775