HomeMy WebLinkAboutBuilding Permit #329-13 - 1041 FOREST STREET 10/22/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: 7i Date Received
Date Issue -L _ L—
IMPORTANT:Applicant must complete all items on this page
lie h
,t ,�
t'a7rty���ay ARM
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rL®C* �TION s _ exp{_ s � K » a
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W� J- P:Iht �'' Iii��yy r41tP" ".,!''�"�a •A<�+ its . 7947t'' r �"dY fi ��r ''' ' =.,.,xE -' ''S....t �t^rb #>: 'I�/NER
�� < f100 Year Old Str ctu a es
�MP�;PN®� ��.•�-' PARCE� � - �Z® ;ING D_ISS�RIC�Tt� �� -�Histor c-�®i rict �.,~��` }yes = riot ��3
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TYPE OF IMPROVEMENT PROPOSED USE
Resi ential Non- Residential
❑ New Building Xbne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
"a. "F 'Gf wfi"`,'� '- '�' •. -tea "''g.�F ry s�
�tSeptic *Well � ��, � ❑ F,,cl°°dp a � V R�tla� n i �# ® Watershed District r �
DESCRIPTION QF WORK TBE ERFORMED:
i
Iden fica nCt Please Type or Print Clearly)
OWNER: Name: i-- t ,`-� �� � Phone: 9�8 /9`4.01 f
Address: l Q ( ro rg� N 6?
.754
r.pZMA
� �.�" .�•, �.:, 4�a '�' , y r?'d ��.,
rCQ;NT;RCfiORName
F a ,one
tt,
y�. w rg+, •rx"°7f r+`.n r�,^s t j "'a. ."'2ns�'"vi " 'vim..'*xS°7'14 .,"n riF-.`r+�r.+.a .v7-17
'�s t ,lakr •� jc- ytp ' �,...-j .-r'R :aS' •t "''y�=5 ,�7ti'Sa gyp[* .;'?'may4 �_t"'n� ..� �• * rr+, �a¢ , �, ., y,J.* ,Ii -''ys ¢`
,y, ..F..�,.nA•.r,��;Y1w_ w a s �e.....`^�"' t�'t w ssxc�*� w rar. -+�,�,F+'p.'fr" ,�'r 1 y r� "�'�+,'}"us
Fs L, $'Q �t � �}}'t'�i`;'�' .. n �t >�`• ���.'f{�v,� t ip�i�k'4 u. j,,, ;_ g�x�`'21.A.�y T�� �r � " t'L x t � �� �¢
-orf. n; It 1 ]1- '- 1Y ',1� _t.r K y f�- t Lair r �C ` ,t, u S
k 7nwz- .yt� i 4 -r �r'x✓{M^s�"x�S ylY " a^�E ,}.4 S 'J iter f i<ft'tw 55''d'."k '�'wW ,yd
Supenr►sor's ,Construconcerlse� t } :1.57
-i"r^.:t` r..., r mry u`^2�"""�'"' r-' 5J' t: '�...�;+,�n. �Y... c "t''� 1"`a •t fc�f k�arhl!'.d k y� d z
ARCHITECT/ENGINEER Phone:
d
Address: Red.'No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Idi
Total Project Cost: $ -31? FEE: $
Check No.: S�U Receipt No.: 1
NOTE: Persons contracting with unregistered contractors do not have access Nhe guars fund
Signature of Agent/Owner .,.r.. :: Signature of conracto
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ S mped Plans ❑
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Old Structure yes no
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
i
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Location/ o /
No. Date v
® • TOWN OF NORTH ANDOVER
� ���►T.tU l�y�` e
Certificate of Occupancy $
• Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Check#-sQ`-'
25861 Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Drivewav Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
,Located at 124 Main Street
Fire-bepartment signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use
® Notified for pickup - Date
I
Doe.Building Permit Revised 2010
Building Department
The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
Li Building Permit Application
o Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
o Certified Surveyed Plot Plan
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
o Building Permit Application
o Certified Proposed Plot Plan
L3 Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: Doc.Building Permit Revised 2012
`AORTH
Town of .� t �� Andover
o -
No. 2W9u cz�_
*6*h ver; Mass,
COC NIC Nf WICK �1.
p°fOATE0 #kp��g5
S U
BOARD OF HEALTH
Food/Kitchen
PER T T L D Septic System
THIS CERTIFIES THAT .. .. .... ,
* . BUILDING INSPECTOR
............ ... ...... .. ................................ ..........
. .. P .. ....
has permission to erectP4*#A^
.......... buildings on . Foundation
Rough
to be occupied as ........ ........T....... ! !.....,�� +M. 4C. AW�...... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
60bUNLESS CONSTRUCTI TIN=
Rough
Service
................. .....:.. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
SEE REVERSE SIDE
WARM TRADITIONS STOVE SHOPjPE
144 Pine Street P O Box 2081 Danvers, MA 01923
978-777-5562 FAX 978-777-5887
TO David Pease
..........................................................................................................................................................................................:........... DATE...._ .9.-.2.4..-.12.........................
93.8=294:7.240.9,
^�Q .... JOB NO........................................................
..........._10 41 Forest Street JOB NAME.........,l..A...SJ..-...7..9.�..-..240.�.......H.o.m.e......................................................
...................................................................................................................................................................................................
North Andover, MA 01845
.................................................-..................................................................................................................................... JOB LOEATION.........9...7...8..-.6..8.5..-.6..0.5..7_....._Work.....................................................
TERMS
4
> 1........... Q/,F 1.290. ,F/S. Pellet stove - All Black $2 , 529!00
............................................................................ ............................................................................................................................................1......................
I
....................................................................._L e_ss....... o u.p o.n.......................................................................................................................................................................................................................................... .$..........._l.o_o_L..00
_ ........
140" 4 � FlatPad ' De Desert rt �anyon......... . . .....X . ...... ....... ......_ . ...... _ . _ _ ................................................................ $............4301.00
1......................
...................1:......._Ap.p.l.. ance Ada.pt.e_r......................................................................° $ 25!00
.......... ..................................................................................................................................................................................1......................
......................................... .....T.... L•
..................6_.�....1.._�.�........
u nVent'
................................................-1.........3 .
..........X.....12
$................_3,5.L 00.........
1n 6n Vent
................................ .................. ........ ........ V .
I
145° .n a �
......................................._ ........_ . . ... .... ....._ p .............................................................................................................................................................. $ _59.-1................
1Tube of Silicone
. ............................................................. ..... 10o.................................................................................................................................................................. . t
............ . ..I. _ .........
Sales Tax .on . 3 ,086.00
._ $...........................................................................................................................................................................................................................:.$............_1.9. ..x..8.8.........
I
Installation ,Labor
.........................I....................... .. . . .........................................................................................................................................................................................................................................$..........._6 0.D_L..00.........
I
............................................................................................... ...........................................................$_3..i..$.Z.8_L._$.8.........
..............................................................................................................................................................................................................................
I
> I
..........................................................................D e.Po_S-itReceived 9- 4-12heck
. ......................................................_ .. . . . . ...... _ _ _ . . # 4............................. ............................................................. -$............
20_q._4._D_D........
............................................................................................................................................................................................................................................................................................................................ $_3; 6 7 8...-..8_$.
..............
...................................................
Building Permit Extra I
Or Propose hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
Three Thousand Eight Hundred Seventy-Eight and 88/00*** dollars($ 3 , 878. 88*** �.
Payment to be made as follows:
$200 . 00 at time of acceptance and balance due on installation .
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized
manner according to standard practices.Any alteration or deviation from above specifications Signature
involving extra costs will be executed only upon written orders,and will become an extra —_...._—
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control.Owner to carry fire,tornado and other necessary insurance.
Our workers are fully covered by Workman'compensation Insurance.
Acceptance of Contract —The above prices,specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature t
WARM TRADITIONS STOVE SHOPPE
144 Pine Street P.0 Box 2081 Danvers, MA 01923
978-777-5562 FAX 978-777-5887
TO David Pease
............................................................:........................................................................................... DATE
..... ..9......... .4......1.2......................... JOB NO.......................................................
1041 Forest Street
......................................_..................................................................................................................... ............................ JOB NAME . ..pp77p-19
4-24.0.9 . HOIe......................................................
........North Andover, MA 01845..................................................._............................................................ JOB LOCATION.........9..7...8..-.6..8.5..-.6..0.5..7.........W.Q.rk...._...............................................
TERMS
1 007 1-995334
....................................„.,,,,.....,1 F,....,12«0 O F S Re 11 e t Stove A 11 B l a c k
_.........................................................................._.........................................................................................................................«..................$.2..,._5 2 9..I...O ........
......................................................_...._........Le_ss......Coupo.n.......................__.......«...............................
.........,.$............100! 00
..................................................1....._..4.0."._...X...«4b".......Flat a d - Desert C a n.von.........._..................................................... �
............................................_.................................. $...........430,.0 0
l.....................
.1.:.......APP..1_ .an.ce......Adapt.e.r.........._ $ ?5.00
........................................................................................................................................................................................._.
.......................... .........1......................
1 Thimble '
....................................................................................................._.
6500
1 n X1?” Yent .... I
................................................ :......_ 3.....«... ..... .........._ . . . ..........................«..........................................._.................... ............ ............I............................
.
$.................. �L._ 0.........
. 3rX6n
vent...........: ..................... 1 . ............ ...... ........... . . . ............................................................... ........$..................25 t 0 0
.1.........4.5.°......E«n.... . .aP............................................. ........$.................5.9..�.0.0........
.................................................1.........Tube......o.f.....s. ..l,i«cone ........$.................1.8..x_ . .........
..............................................................._.....a1esTa xon3c086.00. « « ..... ...... . ....... ......... .... .. $ 192L $$
. . .. .. _ ........
«Install«a«t«ion.....«Labor $ 600L00
I
..........................«...........................................................
........................:.........................................................................................................................................................................3..:..8..7...8.x..$a.........
>
.........................................................................Dep...o.S.i.t......Re.c,e«i«ved.:....9..-2.4.-.1.2......Ch,ec.k................374
# ...............«....................................................................................-..$............2 0 0..4._O.O........
......................................«........................................................................
$.3..%_6.7 8...�_$8..............
1....
Buildin Permit Extra '
..................................................................................................-.9.............................................................................................................................._...................................................................................
Or Fropooe hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
Three Thousand Eight Hundred Seventy-Eight and 88/00*** dollars($ 3 , 878.88*** �.
Payment to be made as follows:
$200.00 at time of acceptance and balance due on installation _
A r
w
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized
manner according to standard practices.Any alteration or deviation from above specifications SI nature
involving extra costs will be executed only upon written orders,and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control.Owner to carry fire, tornado and other necessary insurance.
Our workers are fully covered by Workman Compensation Insurance.
Acceptance of Contract The above prices,specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
\
Date of Acceptance: Signature /
1
SAFETY LABEL
(FOUND ON BACK WALL IN HOPPER)
Modeb
Report No. Report Dow QU RA-FIRE
J9e0001D1e Febrvsry,1997 1200 FIS
Listed Solid Nei(pellet Type)Room Heater Also Suitable For Mobile Home Installation
This pellet burnin iePD eo wiM16lanOAR 9114>�00 tivough 61vie
i2"0&manufactured homes
WhmoCk Hettom/ Manufaetured W
��►. ALAQ Q-1 N
® X01 N.W to
Colville,WA99114
'PREVENT HOUSk FIRES'
Tested Te: ASTME1309-1695
Install and use only in accordance with ULCS627-M93
manufactursra Installation and Opera".
Instructions.Contact local building ofFOR USE WITH PELL.E717fD WOOD FUEL
fire officials about restrictions and ONLY.
inspection in your arae. Input Ratng:5.61b.fudlhour
wAftWNi3-FOR MOOILE HOMES:Do f
Install app0ance ih a slee Ing room.An Electrical Rating:
outside combustion air inlet must be 115 VAC,60 Hs,Start U Amps,Run 1.6
provided The structural intolp�rhhyy of the Amps.
mobile home floor,oelling field wall must Route power cool arway from unit.
be malttakted•
Components Required for Mobile Henna DANGER, Risk of electrical shook.
k,sls0sdon Partf16110660 tN 611-0`i10.. Disconnect power supply before
servicing.Raplaes glass only with Siren
Refer to manufacturers instructions and ceramic avallsblefrom Vow dealer.
local codes for pfeenulionb required for To start,sotthdrmostat above room
passing chimney through a combustible temperature. The stove will light
wait or telling.Inspect and clean vent automatically. To shut down, set
system frequently in sceordente with thermooM to below room tentperatore.
manulsetursrs Inetrvcdon& For further Instructions,refer to owner's
Do not Install a flue damper in the manual,
exhaust venting system 61 INS volt De Keep viewing and ash removal doors
not connect this volt le■chimney serving
anctMr appliance. tightly closed during opsrstleM
Install rent at elect»nose*pacified by the Use a 3"or 4 diameter type"L"of"PL"
vent manufacturer. venting eye%-
Mini nuns Clearances to Combustible Materials
e11COM aril WAL tLoas►soleCloa Use a non-combustible
n e e s door protector extending
or under unit 2"/50 mein to
+! sort[ each side of unit and
n01e �` e E 6"/150 min in front of •
feria as stow door.
- he'Irlew- �alentl0fle
(,Tnimnei 61
Installation Ceeneeter A. 9 C D
twb ontal 3"or 4'Pallet Vent 6 INiR can t wm mm WA 2 WW nes
Vertical 3'P*IM Vend t Inliq sea WAS
Wn sea 2 iM5o ran
Vertical Residential-NOTE 1 6 M47 mm WA 3 W/6 sen 2 W50 mm'
vertical Mobile Haas•NOTE! 6 I nf147 mn WA 6 kin utas 2 W O MM
Vertical �gi a Wdit Met Kit
M47 cess WA 3146 seri 2 WR eve .
Note h 1n ressdandd installatiouN,when using part 06114LMM(3"top vent),
24 gouge single wall Rue connector may be asod.
Note 2: In mobile horse Installetlem when wing part 6e11-0580(3"top vent).
use rioted double Vmn
Slt-0670)must be used WO mobile home,In$Olj*doOut connector.An outolde WrM 1 .0680 or
U.S.ENVIRONMENTAL pAMOTION AGENCY
Thls mpdel in mommpt from EPA (�c� 1 RatiC"F 40,631 by definition .
Do"of Maoufsoturr
199E 19992000 Jan. Feb.Mar.Apr. May June July As g.Sept.Oct.Nov.Dees
DO NOT REMOVE THIS LABEL Made in U.S.A.
r '
Page 3
PELLET STOVE 1
PerformanceTechnical Data
�� Weight Btu/Hour Burn Rate Hopper Convection Particulate
' Width Heighf Depth �, Capacity ' Blower Emissions
llbs( Input Ilbs/hrl (tbsl lcfm) (g/hr(
Mt Vernon AE 28-7/16" 32-5/16" 29-1/16" 429 14,620- 1.7-6.1 81 220 .9
52,460
Castile 24" 28-9/16" 24-7/8" 258 12'900 1.5-4.0 40+ 160 .7
34,400
Classic Bey 1200 28-1/2" 31-5/8" 27-5/8" 349 17'200 2.0-5.5 80 160 .9
47,300
Santa Fe 25-1/2" 28-11/16" 21-1/4" 240 1 ,40 0-
3 4 4,40 1.5-4.0 60 160 .7
`Btu/Hour Input calculated using premium wood pellets at 8,600 Btu/lb.Btu/Hour Output will vary,depending on the brand of fuel used.For best results consult your authorized Quadra-Fire dealer.
"Fuel density and pellet shape may affect hopper capacity.
Mt.Vernon AE n c A Back wall to appliance....................................2"
B Side wall to appliance.....................................6" ALCOVE INSTALLATION:
1We CORNER INSTALL Minimum alcove width.......................................40"
Vc C Walls to appliance...........................................2" Minimum alcove height......................................43"
WITH TOP VENT KIT: Minimum alcove side wall....................................6"
F G D Back wall to flue pipe......................................3" Maximum alcove depth......................................36"
E Side wall to cast top........................................6"
F Back wall to appliance....................................8" CORNER HEARTH PAD SIZE
e c CORNER INSTALL WITH TOPVENT KIT 38-3/4"w x 38-3/4"d
Advanced Energy
G Side walls to appliance...................................3'
Castile A Back watt to appliance..................................2"
B Side wall to appliance....................................6" ALCOVE INSTALLATION:
CORNER INSTALL
Minimum alcove width.......................................38"
® C Walls to appliance.........................................2"
WITH TOP VENT KIT: Minimum alcove height......................................43"
D Back wall to flue pipe....................................3"
Minimum alcove side wall....................................6'
E Side watt to cast to 6" Maximum alcove depth......................................36"
F Back wall to appliance..................................7"
CORNER INSTALL WITH TOP VENT KIT CORNER HEARTH PAD SIZE
Original Energy 34-1/8"w x 34-1/8"d
G Side walls to appliance.................................2"
H Side walls to flue pipe...................................3"
Classic Bay 1200 c A Back watt to appliance..................................2"
B Side wall to appliance....................................6' ALCOVE INSTALLATION:
B ` CORNER INSTALL Minimum alcove width................................40-1/2"
m C Walls to appliance.........................................2" Minimum alcove height......................................44"
WITH TOP VENT KIT: Minimum alcove side wall....................................6"
D Back watt to flue pipe....................................3" Maximum alcove depth......................................36"
E Side wall to appliance....................................6"
E F Back wall to appliance...........................7-1/2" CORNER HEARTH PAD SIZE
Original Energy
S O CORNER INSTALL WITH TOP VENT KIT 40-5/8"w x 40-5/8"d
G Side walls to appliance.................................2"
Santa Fe A Back wail to appliance..................................2"
c� B Side wall to appliance....................................6" ALCOVE INSTALLATION:
® CORNER INSTALL
e ® Minimum alcove width.......................................38"
C Watts to appliance.........................................2"
WITH TOP VENT KIT: Minimum alcove height......................................43'
C
3" Minimum alcove side wall....................................6"
D Back wall to flue pipe....................................
Maximum alcove depth......................................36"
E Side wall to appliance....................................6"
s F Back wall to appliance..................................7"
CORNER HEARTH PAD SIZE
Original Ener a CORNER INSTALL WITH TOP VENT KIT
g Energy 38-7/8"w x 38-7/8"d
G Side walls to appliance.................................2'
H Side watts to flue pipe...................................3"
FL
1 1 • PROTECTION IMPORTANT- READ BEFORE
Use a noncombustible floor protector YOU I NSTALL
J. extending beneath heater and to the front/ Refer to the Owner/Installation Manual
sides/rear as indicated.Measure front dis-
tance IKI from surface of glass door. for complete clearance requirements
I............2" and specifications.The images and
® I .l'.........2" descriptions on this brochure are
K Must extend2"oeyondeach provided to assist you In product
'See owner's manual for exceptions side of plpe(shaded area) selection only.
............................................................................................................................................................................................................................................................................
WARM TRADITIONS
STOVE SHOPPE
A Division of
AQUA TERRA PROPERTYMANAGEMENT, INC.
Contractors License #105711 NIa,.achusett. Dcpilr[ntcnt 111 1'nllfic .alc(t
Robert Raucci Huard of 13(iddin- Rc:;ul:uiun. ;uul st:utdat"tl.
Construction Supervisor License
One- anu Ta,,,C,". Carlile �tr✓elUngS
License: CS 105711
ROBERT RAUCCI
123 NORTH BROADWAY
HAVERHILL, MA 01832
Expiration: 2/13/2014
„, ,,• r. 105711
Home Improvement Contractors License #170349
Aqua Terra Property Management, Inc.
DPS-CAt 0 50M-04104-13101216
Office of Consumer Affairs&B siness Regulation
VHOME IMPROVEMENT CONTRACTOR
Registration: ,170349 Type:
Expiration: 1113/12/2013 Corporation
ARTERRA PRQPE TT-Y t kP1AGEMENT INC.
ROBERT RAUCCi "
144 PINE STREET
DANVERS,MA 01923 Undersecretary
144 Pine Street, P.O. Box 2081 Danvers, MA 01923 978-777-5562
SEP-25-2012 15:59ennott Insurance 97EI 897 2,104 P.03%04
� •,�, �. �STM � __ __
LaD R 978.887.4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
and F. Sennott insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
L6 South Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
3. 0. Box 457
ropsfield, MA 019413 _ NSURER3 AFFORDING COVERAGE � �MAIC
SURER AquaerraTi�aperty Kanaiement, I-nc. II NJURERA. Acadia Insurance 31125
DBA Warm Traditions Stove Shoppe _INSURERS: Union Insurance Co.
P 0 Box 2081 INSURER 0: _-
Danvers, NA 01923 INSURER D:
INSURER E, .
OVERAGES _ —
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TER)a OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSUPANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCEO BY PAID CLAIMS.
a— .- - '7' ETIV9 'p-ML-1cY EItPIRATILIMMT5 _
R N6Rq _ TYPEOFINEWRANCIN POUCYNUM19A DAT£tMN1OWYyYYZ DATE IMIA/DOfYY7Y1k�
(JfNERAL LIABILITY CPA033 5 587 04/14/2012 04/14/2013 EACH OCCURRENCE_ I s 1,000.00
j X C-OMMIiRCIAL G eN€NAL LIABILITY FI MISES LFa p� +�b Z 100,08
I WIP.46 MADE IT]OCCUR 1 MED EXP(Any one person) II S10
PERSONAL&ADV INJURY S 16000,000
0ENERAL AGGREGATE_ $ _2 1000,00
GENL wGGRE,ATF.f IMIT APPLIES ezEa: PPRODUCT$•COMPIOP AGO S _ 2.000.000
PRC- __.
POLICY J;CT LOC I _
�AUTONORILELLABLITY MAA0335589-12 04/14/2012 ( 04/14/2013 COMBINED SINGLE LIMIT
ANY AUTO -
(Ea etaideni) s 1�000�0
'
I
i ALL OAWEO AUTOS BODILY INJURY S
SCHECULEDAUTOS j (Perpww)
X HACD AUTOS
BODILY INJURY S
I X NON-OWNW AtITOS (Per Qvi4aN)
PROPERTfDAMAGE
(Per wgideml)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 31
i - I ANY AUTO OTHER THAN
AUTO ONLY: AGG S
EXCE33IUMDRELLPLIASWT'Y i� CUA03357641,04/14/2.012 04/14/2013 �EACI—I=VRRENCE S 1„0!)0,00
X OCCUR C�CLkIMS MADE I I AGGREGATE $ 11000,000
DEDUCTIBLE
I RETENTION $
WORKERS COMPENSATION 014/20132 4/1 L --T-A-T—fI- R�
AND EMKQYHRS'UABLIT'e YIN
ANY PROPRI[TORtPARTNER/EXECUTIVEN E.L.EACH ACCIDENT m 500,00
IM
A OFFICEREM13ER EXC,IUCEO7 Q I F
tMandatary In NH) j El DISEASE-EA 6NIPLOYREt 5 500,Od
H yyes,describe ttndv.
3PiiCLAL PROV161DNS habvE.L.D13EA3E-POLICY I,p�31T S 500,00
- I OTHER
E80MPTION OF OPERATIO01 .00ATIPNS I VEHICLES I EXCLUSIONS ADDED BY FW CORSPUENT I SPECIAL PROVISIONS
:ERTIMATE HOLDER CANCELLATION
..— SHOULC ANY OF THE ABOVE DESCRIBED POLICHIS BE CANCELLED BEFORE TME EXPMATON
GATE THEREOF,THE ISSUING INSURER WILL BNDQAVOk TO MAIL ld DAYS LMRITTEN
NOTICE TO THE CRATIFICATE HOLDER NAMED YO THE OFT,BUT FAILURE TO DO 00 CHALL
David Pease IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
1041 Forest Street REPRESENTATIVES _
North Andover. MA 0184S AVTNORIZE0 REPRESIENTAME
Peter Sennott/AAM
KORO 25(2009101) C 1988-2008 ACORD CORPORATION. All rights reserved.
The ACORD name alLd logo are registered marks of ACORD
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www:massgov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
FCQt:t:� 1'e'"C� 1'clrt>( t,Marc i111r'n�`• mr .
Name(Busincss/Organiration/Individual):_ �klSPi r (tem
Address: 1 �A it e—
City/State/Zip; �1� w ; I��I� Q I�1,�. Phone
Are you an employer?Check the appropriate box: Type of project(required):
1.® I am a employer with 4-�:: — 4. 0 1 am a general contractor and 1 6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2.0 I am a sole proprietor or partner- listed on the attached sheet.t 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9, 0 Building addition
[No workers'comp.insurance 5. ❑We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work right of exemption per MGI. 11 T1.Plumbing repairs or additions
myself.[No workers'comp. c.152,§1(4),and we have no 12.[]Roof repairs
insurance required.]t employees.[No workers'
comp.insurance required.] 13.K Other �' ��5ictllt�l
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
rHomeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:_- A e'cld'CA, 1-)Sofan e, ,
Policy#or Self-ins.Lie.#:i -_ Expiration Date:
C)
Job Site Address: f/±1Fo� 1 City/State/Zip: `oe NA—
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited 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 DTA for insurance coverage verification.
J do hereby cert n er the aim an penalties of perjury that the information provided ab ve is tr to and correct.
Date:
Phone
�7
Signature:
Phoneft:
`17CJ 777 � ,7ct�i �
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):
1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Department of Code Enforcement
Debris Disposal Affidavit
In accordance with the provisions of GL,c.40, sec,564,a condition of permit 0 is that the debris
resulting from this work shall be disposed of in a properly licensed solid waste disposal facility a;definSd by
aL,c, 111, Sec. 150A.
The debr;s will,or has been disposed of at:
144 4�3 Y Y1l° 't+`e -�-- .t �11h"t ? r'tom l3 l l ti r
r
Location of Facility
pr , , ;__-- '—„�__. ry)( .� 1
Location of action/jobsite (Street Address)
Signature at' contracto�� �� Date