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01-001 (8) BP-2022-0033 710NORTH FARMS RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 01-00 l-oo l CITY OF NORTHAMPTON Permit: Solid Fuel Appliance PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE,GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0033 PERMISSIONISHEREBYGRANTED TO: Project# WOODSTOVE Contractor: License: Est. Cost: DOUGLAS L'ABBEE 99401 Const.Class: Exp.Date:01/06/2024 Use Group: Owner: BRIERLY-BOWERS KEITH W&PATRICIA E Lot Size (sq.ft.) Zoning: RR/WP/WSP Applicant: THE FIRE PLACE Applicant Address ) Phone: Insurance: PO BOX 606 (413)397-3463 014,005033011 16 WHATLEY, MA 01093 ISSUED ON: 01/12/2022 TO PERFORM THE FOLLO WING WORK: WOODSTOVE • 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: Gas: Final: Final: Rough Frame: Rough: • Fire Department • Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: • Smoke: Final: THIS PERMIT MAY BE REVOKED By THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: p ' 114) r Fees Paid: $40.00 • • • • • 212 Main Street, Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner City of Northampton . Massachusetts , 0>' c'�c14 =E � • w ,,};0,5 DEP&RTMENT OF BUILDING INSPECTIONS "` fit s t � ' ' 212 Main Street • Municipal Building !�ti • 1 . Q�, .1 Northampton, MA 01060 "-�1^' ?U 'N APPI ICATION 'FOR SOLID FUEL APPLIANCE INSTALLATION c -- � Property Information Owners Name: k 1-h %3y«r/ci Address: 7/a /(/oritA, Frr 7 (No.) (Street Address) Phone:4)°) y51'- 77'77 Cell: Email: Owners Signature: Date: // zT Contractor's Information (If Applicable) Name:7 oo7/eks I Ahk-- i 1/re?/„t e� Phone: i1Y.3 s 7'9' Construction Supervisor's License #: 9 9 5O/ Expiration: /- 6 - Home Impr. Contractor License #: /roc/77 _ Expiration: /7 /8'a 71at/(n9 ink) i S / rna.s anry ditent/Lrey. Stove Information eAipnnti rs aiern ant) irk •ycO ecn.49f'(earn • Type of Fuel (check all that apply): Wood Pellet Coal Location: t '/5Y /Lxr Freestanding )( Insert Manufacturer: /-v' n/o Model: -rivzol • FOR BUILDING DEPARTMENT USEj�_____ Permit# ���'3 '> Date Applied: Total all Fees: $ 4 Building Official: 1k 11 Joss Date Issued: 1- 12-ZOZZ Signature of Building Official: The Commonwealth of Mlassachusetts . �� ••. ,-;! Department of Industrial Accidents _j ;' Office of Investigations I --, i_t :�;. - g`:�i Lafayette City Center• J : ` •2 Avenue de Lafayette, Boston,1fL4 02111 1 750 . `"._. °" www.rriass.gov/dia Workers' Compensation Insurance Affidavit: General usinesses Applicant Information Please Print Legibly - Business/Organization Name:THE FIRE PLACE Address:100 STATE RD City/State/Zip:INNATELY, MA 01093 #:413-397-3463 Phone Are you an employer?Check the appropriate box: Business Type(required): l. I am a employer with 10 employees (full and/ �- ❑ Retail orpart-time).' 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I 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] 8. ❑Nor-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]" 4.❑ We are a non-profit organization,staffed by volunteers, 11. Health Care with no employees. [No workers' comp. insurance req.] 12.0 Other Any applicant that checks box g I must also fill out the section below showing their workers-compensation policy intbrmation. "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 I. - I art 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 Polio\ =or Self-ins. Lic.#01400503301116 Expiration Date: / I'�� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under§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 S250.00 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 cordf-, under the pains and p rallies of perjurh that the information provided above is true and correct. Siunature: • Date: Aa 3l Phone-: Vl. L5 rt 3 51C 3 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# - issuing Authority(check one): ).❑Board of Health 2.0 Building Department . 3.0 City/Town Clerk 4.0Licensing Board 50 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.aov/dia Stove Dimensions 28 3/4" 28 3/4" 21 5/8" [730 mm]— 21 5/8" _ ~[730 mm] [549 mm] 23 7/8" [549 mm] 23 7/8" [606 mm]— [606 mm]— I Y I I I I I 1 . 28 1/8" di 261/4" �'l 1 28 1/8" 28 1/8" 261/4" �'I 281/8" [714mm] [667mm] - [714mm][714mm] 667mm] [714mm] , 1 ' Lr I j j1-1 coo— Figure 1: TN2OB Dimensions. Residential Installation Warning: Under no circumstances is this heater to be installed in a makeshift or "temporary" manner. It may be fired only after the following conditions have been met. • DO NOT CONNECT THIS UNIT TO A CHIMNEY FLUE SERVING ANOTHER APPLIANCE. • DO NOT INSTALL IN A SLEEPING ROOM. • THIS ROOM HEATER MUST BE CONNECTED TO: 1. A CHIMNEY LISTED TO: UL 103HT(USA) or ULC-5629 (CANADA) or 2. A CODE APPROVED MASONRY CHIMNEY WITH A LISTED FLUE LINER. • DO NOT ATTEMPT TO CONNECT THIS HEATER TO ANY AIR DISTRIBUTION DUCT. • The services of competent installer are strongly recommended. • Outside combustion air or fresh air into the room may be required in your area, consult local building codes (see Combustion Air section). NATIONAL We recommend that our products be FIREPLACE installed and serviced by professionals INSTITUTE NFI who are certified in the U.S.by the 6 National Fireplace Institute(NFI) or in Canada by Wood 0 Energy Technical Wood Energy CERTIFIED Training(WETT) Technical Training `www.nflcertiried.org wwwwettlno ra / 110618-28 TN 20B ©PACIFIC ENERGY FIREPLACE 11 PRODUCTS LTD. A, - Crate Removal 1. Carefully remove wood top and supports. 2. Remove plastic cover. 3. Remove all screws holding the Legs or Pedestal, to the Pallet. Residential Clearances • BOTH CHIMNEY SYSTEM AND CONNECTOR MUST BE 6"(150mm) DIAMETER AND LISTED TO: CANADA - CONNECTOR - LISTED to ULC S-641 and CHIMNEY LISTED to ULC-S-629 USA- CONNECTOR AND CHIMNEY LISTED to UL-103 HT 1. Residential Clearances to Combustible surfaces and materials; This heater may be installed using a single-wall connector(smoke pipe) as per local and National fire and Installation codes. see Single wall Connector in figue 2. Clearances may be reduced with various heat shielding or insulating materials. Consult local and national fire codes and authorities for approval For close clearances, use a listed double-wall connector, See (Figure 2). "Double Wall Connector Mobile Home installation see "Mobile Home Installation"Figure 8 on page 19. Minimum Clearance to Combustibles Single Wall Connector-Residential 12" % / - 8" 18 3/8"467mm 305mm j I 19„ _203mm / 12" 483mm r 305mm✓ / /0. _ 22 3/4" , 8„ -I a>° , ' 578m— 203mm Double Wall Connector- Residential 113/8" 5" 11 3/8" 5" 28•mm 127mm 289mm 12r ',/ / / r7mm r r A 8" % % 8" j 1 p 355mm 76mm 81111 203mm 0 pp203mm!� 203mm I / 18 3/4" j 18 3/4 j g.-\,] i ' 476mm r 476mm9 al°_ 1 .Z. 3„ i Alcove: Min.Height 7' [2.13m] 76mm Max.Depth 3' [915mm] Figure 2: TN2OB clearances.ai 12 ©PACIFIC ENERGY FIREPLACE TN 20B 1 110618-28 PRODUCTS LTD. - - -- -''--'-------------�---- --- --- - _-_-_-- ' ~' ---'---' -�� ----- ��(�^�3 ___-__-__--_'__-______'_-___--_--_�__.--__^_____� ~z � � � � � � - . . ~