Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Building Permit #540 - 776 DALE STREET 1/11/2012
I Permit NO: Date Issu TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION IMPORTANT: Date Received must complete all items on this LOCATION -1-ILP DAuE STRE..ET t J . A.-tDoyE.PC h'i A m 18 Print PROPERTYOWNER PAuL MuRPH�% Unit# Print MAP NO/�PARCEL:� ZONING DISTRICT: Historic District yeso Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE v Residential Non�Residentfial ❑ New Building ❑ One family ❑ Addition 0 Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic 11 Well ❑Floodplain OWetlands D Watetshed District DESCRIPTION OF WORK TORP PRRRnP-k fPn (Identification Please Type or Print Clearly) OWNER: Name: PA u 1. m uRpN41C' Phone: q7,1 B_ oi�R Address: -1-16 C�9LF_5MFF_—r tJ. A,_A00VP_TZ, MA a16 q5 - z CONTRACTOR Name: sc>_1TAFzptFF/qu"-•% Eat -oma'.; ►C . phone: („m3 -q2 --1 y22 Address: P0 2-2-41, S" K—ACCCI V-, til i -k m 32.-15 Supervisor's Construction License: SU3 g cD Exp. Date Home Improvement License: i L -1 15m1 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No II•m-j• 13 (D4,) .21-o • 12. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ 14,uaxD • mm FEE: $ Check No.: ��� Receipt No.: �--�� NOTE: Persons contractin u registered contractors do not have access to the guaranty fund nature of A" ent/Own " r-y� 9_ _ - Signature 6f;contractor4. Location No. Date 2" MORT1y 1ti TOWN OF NORTH ANDOVER f • OL 9 Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ s�cwust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # , 24954 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunmmg 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 PLANNING & DEVELOPMENT ❑ COMMENTS DATE APPROVED A CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS b Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS yes. no I - 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 Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ 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 Permi Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ 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 2008mi O z I cd x °x 0 a 0 � Ca vr. Uw a°' w O U w°' ci) . w G4 rx°cE E" `z � o v o :M o c 'E CD C h ' Olei C w... O IS C.2 CL CL C CL C A O CDC C Cc O � Ea m o y H CD LMJ E� CL CD C.) rc O O. w... C h _W � O m L L C_ m ca � =C - `■ CO A m E� CD o CL +-"-S � Ca .10 O O :HOZ is c o m y.O C _ ® m � 3 F- w vi m.~ LUWC O=..-0=CD � O O F- • •C y ev C CD U m CD CLh a 5 o _ w ..=my O N .0 .- m E CA Z r.+ H 12 23 N C O 0 in CD ac CO 0 co c •C N m r O Z O 8 O F. • L4 I 7 0 u C/) A 140 • t,l O O a) L _ O O Z Z CL a) O y Q � co cm I � C V2 Q 'p M E m m CD CD Q L !D O CL a ra o c c O O CJ J .O as CO2 z m CL V N2 O C E C _c C. CO2 N/ LLI Y+ W W It W U) Enviro M55C-FPI PELLET STOVE OWNER'S MANUAL f�w SHERWOOD INDUSTRIES IS AN ENVIRONMENTALLY RESPONSIBLE COMPANY. THIS MANUAL IS PRINTED ON RECYCLED PAPER. � PLEASE KEEP THESE INSTRUCTIONS FOR FUTURE REFERENCE %M PLEASE READ THIS ENTIRE MANUAL BEFORE INSTALLATION C tic US AND USE OF THIS PELLET -BURNING ROOM HEATER. FAILURE TO FOLLOW THESE INSTRUCTIONS COULD RESULT IN Intertek PROPERTY DAMAGE, BODILY INJURY OR EVEN DEATH. Contact your building or fire officials about restrictions and installation inspection requirements in your area. 50-2257 TABLE OF CONTENTS Introduction........................................................................................3 Rating Label Location................................................................3 FuelQuality...............................................................................3 Safety Warnings & Recommendations....................................................4 Operating Instructions..........................................................................6 Dimensions & Specifications.......................................................6 Control Board Functions.............................................................7 Automatic Safety Features of Your Pellet Stove ............................7 Operating Your Pellet Stove........................................................8 Turning Your Pellet Stove Off......................................................9 Slider/Damper Set-Up................................................................9 Routine Cleaning and Maintenance......................................................10 Optional Service Rail Kit............................................................13 Warranty...........................................................................................14 Installation Data Sheet.......................................................................17 2 INTRODUCTION * This manual is designed for the home owner in conjunction with the technical manual. RATING LABEL LOCATION: The rating label is located on the top of the hopper. FUEL QUALITY' Fuel quality is important, please read the following: Your Enviro pellet stove has been designed to burn 1/4" (6mm) dia wood pellets and other organic fuels. DO NOT use this appliance as an incinerator. DO NOT use unsuitable and non recommended fuels, including liquid fuels as this will void any warranties stated in this manual. The performance of your pellet stove is greatly affected by the type and quality of fuel being burned. As the heat output of various quality fuels differs, so will the performance and heat output of the pellet stove. CAUTION: It is important to select and use only fuel that are dry and free of dirt or any impurities such as high salt content. Dirty fuel will adversely affect the operation and performance of the unit and will void the warranty. The Pellet Fuel Industries (P.F.I.) has established standards for wood pellet manufacturers. We recommend the use of pellets that meet or exceed these standards. Ask your dealer for a recommended pellet type. ASH: The ash content of the fuel and operation of your stove will directly determine the frequency of cleaning. The use of high ash fuels may result in the stove needing to be cleaned daily. A low ash fuel may allow longer intervals between cleaning. CLINKERING: [clinkers are silica (sand) or other impurities in the fuel that will form a hard mass during the burning process]. This hard mass will block the air flow through the Burn Pot Liner and affect the performance of the stove. Any fuel, even approved types, may clinker. Check the Burn -Pot Liner daily to ensure that the holes are not blocked with clinkers. If they become blocked, remove the liner (when the unit is cold) and clean/scrape the clinkers out. Clean the holes with a small pointed object if required. Refer to the section Routine Cleaning and Maintenance. FUEL FEED RATES: Due to different fuel densities and sizes, fuel feed rates may vary. This may require an adjustment to the slider damper setting or to the auger feed trim setting. Since Sherwood Industries Ltd. has no control over the quality of fuel that you use, we assume no liability for your choice in fuels. FILLING FUEL HOPPER: Open lid on top of unit, check hopper for foreign objects, empty the bag into the hopper, and ensure hopper lid closes completely. Store fuels at least 36" (1 m) away from the pellet stove. WARNING: Parts of the appliance, especially the external surfaces, will be hot to touch when in operation so use due care. FLAMMABLE LIQUIDS: Never use gasoline, gasoline -type lantern fuel, kerosene, charcoal lighter fluid, or similar liquids to start or "freshen up" a fire in the heater. Keep all such liquids well away from the heater while it is in use. 3 SAFETY WARNINGS & RECOMMENDATIONS Please read this entire Owner's Manual before installing or operating your Enviro Pellet Stove. Failure to follow these instructions may result in property damage, bodily injury or even death. Any unauthorized modification of the appliance or use of replacement parts not recommended by the manufacturer is prohibited. All national and local regulations and shall be complied with when operating this appliance. Caution: Do not connect to any air distribution duct or system. Warning: Never place wood, paper, furniture, drapes or other combustible materials within 48" (122cm) of the front of the unit, 12" (30.5cm) from each side, and 4" (10cm) from the back of the unit. Do not let children or pets touch it when it is hot. To prevent the possibility of a fire, ensure that the appliance is properly installed by adhering to the installation instructions. An Enviro dealer will be happy to assist you in obtaining information with regards to your local building codes and installation restrictions. FIRE EXTINGUISHER AND SMOKE DETECTION: All homes with a pellet burning stove should have at least one fire extinguisher in a central location known to all in the household. Smoke detectors should be installed and maintained in the room containing the stove. If it sounds the alarm, correct the cause but do not deactivate. You may choose to relocate the smoke detection devise within the room; DO NOT REMOVE THE SMOKE DETECTOR FROM THE ROOM. CHIMNEY OR RUN AWAY FIRE: Call local fire department (or dial 911). Close the draft fully. Extinguish the fire in the burn pot liner with a cup of water and close the door. Examine the flue pipes, chimney, attic, and roof of the house, to see if any part has become hot enough to catch fire. If necessary, spray with fire extinguisher or water from the garden hose. IMPORTANT: Do not operate the stove again until you are certain the chimney and its lining have not been damaged. OPERATION: The door and ash drawer must be kept closed when the unit is in operation to prevent fume spillage and for proper and safe operation of the pellet stove. Also ensure all gaskets on the door are checked and replaced when necessary. Unit hot while in operation. Keep children, clothing and furniture away. Contact may cause skin burns. CAUTION: When operating during adverse weather, if the unit exhibits dramatic changes in combustion stop using the unit immediately. FUEL: This stove is designed and approved to only burn wood pellets of any quality, corn, wheat, barley, and grass. Dirty fuel will adversely affect the operation and performance of the unit and may void the warranty. Check with your dealer for fuel recommendations. THE USE OF CORDWOOD IS PROHIBITED BY LAW. Do not burn garbage or flammable fluids such as gasoline, naptha or engine oil. SOOT: Operation of the stove with insufficient combustion air will result in the formation of soot which will collect on the glass, the heat exchanger, the exhaust vent system, and may stain the outside of the house. Frequently check your stove and adjust the slider/damper as needed to ensure proper combustion. See: "SLIDER/ DAMPER SETTING". CLEANING: There will be some build up of fly ash and small amounts of creosote in the exhaust. This will vary due to the ash content of the fuel used and the operation of the stove. It is advisable to inspect and clean the exhaust vent semi-annually or every two tons of pellets. The appliance, flue gas connector and the chimney flue require regular cleaning. Check them for blockage prior to re -lighting after a prolonged shut down period. ASHES: Disposed ashes should be placed in a metal container with a tight fitting lid. The closed container of ashes should be on a non-combustible surface, well away from all combustible materials pending final disposal. If the ashes are disposed of by burial in soil or otherwise locally dispensed, they should be retained in the closed container until all cinders have thoroughly cooled. 4 SAFETY WARNINGS & RECOMMENDATIONS ELECTRICAL: The use of a surge protected power bar is recommended. The unit must be grounded. The grounded electrical cord should be connected to a standard 110-120 volts (4.2 Amps), 60 hertz electrical outlet and also must be accessible. If this power cord should become damaged, a replacement power cord must be purchased from the manufacturer or a qualified Enviro dealer. Be careful that the electrical cord is not trapped under the appliance and that it is clear of any hot surfaces or sharp edges. This unit's maximum power requirement is 504 watts. GLASS: Do not abuse the glass by striking or slamming the door. Do not attempt to operate the stove with broken glass. The stove uses ceramic glass. Replacement glass must be purchased from an Enviro dealer. Do not attempt to open the door and clean the glass while the unit is in operation or if glass is hot. To clean the glass, use a soft cotton cloth and mild window cleaner, gas or wood stove glass cleaner, or take a damp paper towel and dip into the fly ash. This is a very mild abrasive and will not damage the glass. KEEP ASH PAN FREE OF RAW FUEL. DO NOT PLACE UNBURNED OR NEW PELLET FUEL IN ASH PAN. A fire in the ash pan may occur. INSTALLATION: Contact your local building or fire official to obtain a permit and any information on installation restrictions and inspection requirements for your area. Be sure to maintain the structural integrity of your home when passing a vent through walls, ceilings, or roofs, and all construction meets local building codes. It is recommended that the unit be secured into its position in order to avoid any displacement. This appliance must be installed on a floor with an adequate load bearing capacity, if existing construction doesn't meet load capacity, suitable measures (e.g. load distributing plate) must be taken to achieve it. DO NOT INSTALL A FLUE DAMPER IN THE EXHAUST VENTING SYSTEM OF THIS UNIT. DO NOT CONNECT THIS UNIT TO A CHIMNEY FLUE SERVING ANOTHER APPLIANCE. FRESH AIR: This unit uses large quantities of air for combustion; outside Fresh Air connection is strongly recommended. Fresh Air must be connected to all units installed in Mobile and "Air Tight Homes" (R2000) or where required by local codes. Consider all large air moving devices when installing your unit and provide room air accordingly. NOTE: Extractor fans when operating in the same room or space as the appliance may cause problems. Limited air for combustion may result in poor performance, smoking and other side effects of poor combustion. The stove's exhaust system works with negative combustion chamber pressure and a slightly positive chimney pressure. It is very important to ensure that the exhaust system be sealed and airtight. The ash pan and viewing door must be locked securely for proper and safe operation of the pellet stove. Do not burn with insufficient combustion air. A periodic check is recommended to ensure proper combustion air is admitted to the combustion chamber. Setting the proper combustion air is achieved by adjusting the slider damper located on the left side of the stove. Soot or creosote may accumulate when the stove is operated under incorrect conditions such as a rich burn (black tipped, lazy orange flames). If you have any questions with regards to your stove or the above-mentioned information, please feel free to contact your local dealer for further clarification and comments. SINCE SHERWOOD INDUSTRIES LTD. HAS NO CONTROL OVER THE INSTALLATION OF YOUR STOVE, SHERWOOD INDUSTRIES LTD. GRANTS NO WARRANTY IMPLIED OR STATED FOR THE INSTALLATION OR MAINTENANCE OF YOUR STOVE. THEREFORE, SHERWOOD INDUSTRIES LTD. ASSUMES NO RESPONSIBILITY FOR ANY CONSEQUENTIAL DAMAGE(S). SAVE THIS INSTRUCTION MANUAL FOR FUTURE REFERENCE. SPECIFICATIONS DIMENSIONS' rF= 16 1/8" �— 24 3/4" 26 7/8" -� 12° 32 7/8" 23" 44" Figure 1: Dimensions of M55C-FPI. SPECIFICATIONS: Input rating when using: Wood Pellets/Corn - 55,000BTU (16.11(W -hr) & Wheat/Barley - 53,000BTU (15.5KW-hr). Table 1: M55C-FPI Specifications. Description Fuel type Residential Pellet Heater 6mm (1/4'� dia. Pellets - wood, corn, wheat, & barley* Voltage Current Max Power 110 - 120 V 4.2 Amps 504 Watts Frequency Hopper Capacity Consumption on Low 60 Hz up to 50 Ib (22.7 Kg) 1.5 Ib/hr (0.68 Kg/hr)* Testing Standard Weight (with full hopper) Consumption on High ASTM 1509-04 370 Ib (167.8 Kg) 6.5 Ib/hr (2.95 Kg/hr)* *Note: Consumption will vary with the type of fuel used. OPERATING INSTRUCTIONS CONTROL BOARD FUNCTIONS: Note: The Control Panel is located underneath the units Cast Hopper Lid which is attached to a safety switch that will immediatley stop the auger. The switch will stop operation of the stove and display a #4 flash code if the lid is not closed within two minutes. 1. ON/OFF BUTTON: Used to turn the unit ON and OFF manually. 2. HEAT OUTPUT INDICATOR: Shows the present Heat Level output setting and the Feed Trim while it is being adjusted. 3. THERMOSTAT SWITCH: Sets the unit's control mode; AUTO/OFF or HIGH/LOW (when using a Thermostat or Timer) or MANUAL. 4. FUEL TYPE LIGHTS: Shows the present Fuel Type selected; Premium Pellets are Red, Regular Pellets are Green, and Multi -fuel is Yellow. The Light flashes during start-up, and when the Thermostat is in control of the Unit. The Light stops flashing when the Exhaust Sensor closes. Figure 2: Circuit Board Control Panel Decal 5. FUEL TYPE BUTTON: Used to switch between three fuel type modes: Premium Pellets for high grade wood pellets, Regular pellet for mid or low grade wood pellets, and Multi -Fuel for other fuel types. 6. COMBUSTION AIR TRIM BUTTON: Increases or Decreases the Fan voltage by 2.5volts on all feed settings. When pressed all lights on Heat Level Indicator will come on except the one that is the set point. Hold Trim Button down and press the UP or DOWN Heat Level Arrow to adjust setting. #3 Light is the default setting. Depending on Fuel quality Ignition problems may occur at higher altitudes, this can be resolved by trimming the Combustion Fan to a higher setting. 7. FEED TRIM BUTTON: Used in conjunction with the Heat Level Adjustment Buttons to adjust the Feed Trim. It can be increased by two (2) feed settings or it can be decreased by two (2) feed settings. #3 Light is the default setting. 8. HEAT LEVEL ADJUSTMENT BUTTONS: Changes the Heat Setting of the Unit from LO to HIGH. Press the Arrow Up button to increase Heat, and Arrow Down to decrease Heat. AUTOMATIC SAFETY FEATURES OF YOUR PELLET STOVE: A. EXHAUST TEMPERATURE SWITCH: The stove will shut off when the fire goes out and the exhaust temperature drops below 49°C (1200F). It will display a #3 flash code. B. HIGH LIMIT SAFETY SWITCH: If the temperature on the hopper reaches 93°C (2000F), the auger will automatically stop, the stove will shut down, and it will display a #4 flash code. If this happens, call your local dealer to reset the 93°C (200°F) high limit switch AND DETERMINE THE CAUSE OF THE OVERHEATING. C. VACUUM SWITCH: Notifies when the unit has lost vacuum. This can be caused by either a combustion fan/vent failure, or simply the unit's ash pan door, pedestal door. It will display a #2 flash code. OPERATING INSTRUCTIONS OPERATING YOUR PELLET STOVE: THE UNIT WILL NOT OPERATE WITH THE DOOR OR ASH BOX OPEN. Open the hopper lid only to re- fuel or to adjust the controls. the unit will shut down if the hopper lid is left open for longer than two minutes. CAUTION: When operating during adverse weather, such as high winds or freezing rain, if the unit exhibits dramatic changes in combustion stop using the unit immediately. Watch for blocked exhaust outlet. CAUTION: Radiant surfaces can become very hot and can cause burns when contacted. PRE -BURN CHECK: The burn pot liner holes must be clear and the liner installed properly against the ignitor tube and locked in place. Check the hopper for enough pellets to start the unit. Note: To change fuel type, ensure the Thermostat Switch is set to Manual Mode. Press the Off button and then press the Fuel Type button to cycle through the available fuel types. Note: The unit has an automatic cleaning cycle; every thirty minutes the agitator will turn continuously for one minute to help clean out the burn pot liner. MANUAL MODE: All control of circuit board function is adjusted at the circuit board. INITIAL START-UP: Press the ON / OFF button. The stove will turn on. Figure 3: Thermostat Switch The Fuel Type Light will flash (the Auger Feed Rate is pre-programmed during in MANUAL position. start-up). The Heat Level Indicator will show the Heat Level that the stove will run at after start-up. If this is the first time the unit has been started or the unit has run out of fuel, the auger may need to be primed. The liner can be primed with a handful of pellets, or after the two minute prefeed, the unit can be restarted. The agitator will not operate for the first five minutes after the ON button has been pressed. After the ten minutes it will pulse at the same interval as the feed auger. When the start-up sequence is complete, the unit will switch to the designated heat setting. Once a fire has been established, the convection blower will turn on after ten minutes. To OPERATE: Press the Heat Level buttons to change the desired Heat Level Output setting. The speed of the convection blower is controlled by the setting of the heat level. The Feed Trim button pressed in conjunction with the Heat Level adjustment buttons can be used to adjust the feed trim. It can be increased by two feed settings or it can be decreased by two HIGH/LOW MODE: (Requires a Thermostat or Timer) INITIAL START-UP: See MANUAL MODE above. OPERATION: When the thermostat calls for heat (contacts are closed) the stove settings are adjustable as per Manual Mode. When the thermostat contacts open, the HEAT LEVEL and Fans will drop down to the LOW setting until the thermostat contacts close again. The stove will come back to the previous HEAT LEVEL setting once the thermostat contacts close. AUTO/OFF MODE: (Requires a Thermostat or Timer) INITIAL START-UP: See MANUAL MODE above. OPERATION: When the thermostat contacts close, the unit will light automatically. Once up to temperature, the stove operates the same as in MANUAL. When the thermostat contacts open, the stove's HEAT LEVEL and Fans will drop down to the LOW setting for 30 minutes. If the thermostat contacts close within the 30 minutes, the HEAT LEVEL will return to the previous MANUAL in HIGH/LOW position. Figure 5: Thermostat Switch in AUTO/OFF position. OPERATING INSTRUCTIONS setting. If the thermostat contacts remain open, the stove automatically begins its shutdown routine. The stove will re -light when the thermostat contacts close again. TURNING YOUR PELLET STOVE OFF: • MANUAL and HI / LOW mode: To turn the unit OFF, simply press the ON / OFF button. This will stop the feed of pellets. The blowers will continue to operate and cool the stove down. When cool enough, the stove will turn off. • AUTO / OFF mode: To turn the unit OFF,_ turn the Thermostat down or Timer off. • On shut down the burn pot agitator will run continuously for five (5) minutes on premium mode, one (1) minute on regular mode, and five (5) minutes on multi -fuel mode. DO NOT turn unit off during start-up or unplug unit while operating; this may lead to smoke escaping from the stove. SLIDER/DAMPER SET-UP: This is used to regulate the airflow through the pellet stove. CONVECTION NNEL SLIDER DAMPER EXHAUST SENSOR 811 J�NOTE: THE SURROUND REMOVABLE PLATE VI/ PANEL MOUNT WAS REMOVED FOR CLARITY Figure 6: Slider/Damper Plate in Unit. Figure 7: Efficient Flame. This unit is designed to operate within a negative pressure range of 0.15-0.17 inches of water column (37-42 Pa). This can be measured using a Magnahelic pressure gauge once the unit has been running on heat level 5 setting after one hour of burn time. This adjustment is necessary for varying venting configurations. The reading can be taken from the 1/8" hole located above the top right corner of the door. A #8 screw must be removed in order to access this hole. The Combustion Trim, Feed Trim and Fuel Type Functions can be used to compensate for varying fuel qualities. Refer to page 7 for circuit board operation. If, after long periods of burning, the fire builds up or there is a build up of clinkers, this would be a sign that the fuel quality is poor - this requires more air. The easiest way to make sure that an efficient flame is achieved is to understand the characteristics of the fire. • A tall, lazy flame with dark orange tips requires more air. • A short, brisk flame, like a blowtorch, has too much air . • If the flame is in the middle of these two characteristics with a bright yellow/orange, active flame with no black tips then the air is set for proper operation, refer to Figure 7. Fuel quality is a major factor in how the stove will operate. If the fuel has a high moisture content or ash content the fire will be less efficient and has a higher possibility of the fire building up and creating clinkers (hard ash build-up). �i ROUTINE CLEANING AND MAINTENANCE The following list of components should be inspected and maintained routinely to ensure that the appliance is operating at its optimum and giving you excellent heat value. The appliance, flue gas connector and the chimney flue require regular cleaning. Check them for blockage prior to re -lighting after a prolonged shut down period. Check the Burn Pot Liner DAILY Week) Bi -annually or 2 Tons of Fuel Burn Pot and Liner - Empty Exhaust Vent Agitator Fresh Air Intake Tube Heat Exchanger Tubes Blower Mechanisms Door Glass Heat Exchanger Tubes Ash Pan and Door Gaskets Behind Firebox Liners Inside Firebox All Hinges Door Latch Post Season Clean - TOOLS REQUIRED TO CLEAN UNIT: Torx T-20 Screwdriver, 1/4", 5/16" 3/8", & 7/16" wrench and/or socket, Brush, Soft Cloth, and Vacuum with fine filter bag BURNER POT AND LINER (Checked Daily/Emptied Weekly) This is the 'pot' where the pellets are burned. Only clean when the unit is cold. Note: If, after long periods of burning, the fire continually builds up and overflows the burn pot or there is a build up of clinkers, this is an indication that the pellet fuel quality is poor or the stove may need cleaning. Check the stove for ash build up (clean if required) and adjust the slider / damper to produce the proper clean combustion. 1. Open the door using the door handle located on the right-hand side of the stove. 2. Lift the lever on burn pot to unlock the fire grate and remove it. 3. The agitator locks at the right; rotate the top of the agitator towards the back of the firebox to unlock it, slide it to the left, and lift it out of the burn pot liner. 4. Lift the burn pot liner out of the stove. 5. Lift the burn pot from the firebox by gently lifting it up at the front of the burn pot, then slide it out from around the air intake tube and the ignitor cartridge. 6. Remove any build up on the agitator (calcium build-ups are common when burning corn). Using a metal scraper, remove material that has accumulated or is clogging the liner's holes and dispose of the scraped ashes from the liner and from inside the burn -pot. 7. Place the burn -pot back into the stove, there are hooks at the front of the burn pot that sit in a mount in the firebox. Ensure that the air intake tube and the ignitor cartridge are properly inserted into the burn pot. 8. Place the liner back into the burn -pot, making sure that the ignitor hole in the liner is aligned with the ignitor tube. 9. Slide the agitator back into place and turn rotate the top towards the front of the stove to lock it in. 10. Set the fire grate in place, it should sit level on the front and back of the burn pot liner. Lock it in with the lever on the burn pot. 11. Close the door 10 Agitator Sum Pot Liner Figure 8: M66C-FPI Burn Pot Assembly. ROUTINE CLEANING AND MAINTENANCE HEAT EXCHANGER TUBES (Weekly) The exchanger tube scraper rod handle is located above the firebox door. Move the handle all the way in and out a few times (ONLY WHEN THE UNIT IS COLD) in order to clean away any fly ash that may have collected on the heat exchanger tubes. As different types of pellets produce different amounts of ash, cleaning of the tubes should be done on a regular basis to enable the unit to run efficiently. DOOR GLASS CLEANING (Weekly) To maintain optimum heat transfer through the glass, clean it weekly. Cleaning of the glass must only be done when stove is cold. Open the door by lifting the handle. The glass can be cleaned by wiping down the outside and inside of the glass with a dry soft cloth. Do not use abrasive cleaners. Figure 9: M55C-FPI Heat Exchanger Cleaning. If the glass has build up that can not be removed with only the cloth, clean the glass using paper towel and a gas appliance glass cleaner, this may be purchased through most dealers. If a gas appliance glass cleaner is not available, use a damp paper towel dipped in fly ash to clean the glass. After the glass has been cleaned use the dry soft cloth to wipe down the outside and inside of the glass. ASH PAN AND DOOR GASKETS (Weekly) After extended use the gasketing may come loose. To repair this, glue the gasketing on using high- temperature f berglass gasket glue available from your local dealer. This is important to maintain an airtight assembly. ASH PAN (Weekly) IMPORTANT: The unit must be OFF while the ash pan is removed. The ash pan is located behind the lower castings (see Figure 10). To remove the ash pan, swing the cast front door out to the left, rotate the ash pan latch to the left and pull the ash drawer out towards you. Reach inside and pull the ash pan tray out. Dump the ashes into a metal container stored away from combustibles. Monitor the ash level every week. Remember that different pellet fuels will have different ash contents. Ash content is a good indication of fuel efficiency and quality. Refer to "SAFETY WARNINGS AND RECOMMENDATIONS" for disposal of ashes. Vacuum the inside of the ash pan compartment. Insert the ash pan fully and reverse the previous steps. DO NOT PLACE UNBURNED OR RAW PELLET FUEL IN ASH PAN. EXHAUST VENT (Biannually) This vent should be cleaned every year or after two tons of pellets. We recommend -contacting your dealer for professional cleaning. To clean the vent pipe, tap lightly on the pipe to dislodge any loose ash. Open the bottom of the "T" to dump the ash, then vacuum as much of the ash out of the vent pipe as possible. FRESH AIR INTAKE (Biannually) Inspect periodically to be sure that it is not clogged with any foreign materials. 11 ROUTINE CLEANING AND MAINTENANCE EXHAUST PASSAGES (Biannually) 1. Swing open the cast door, and unlatch the firebox door. (Both removed for clarity) 2. Remove the burn pot assembly and clean all the parts. 3. Lubricate all screws with penetrating oil. 4. Pull the Tube Scraper Rod fully out. Remove the firebox liner, and lift out the firebox lower. Vacuum the firebox and firebox liner thoroughly. 5. Open the ash drawer; remove the ash pan and clean out the cavity. 6. Re -install the parts in reverse order 7. Close all doors securely. FIREBOX LINER FIREBOX LOWER ASH DRAWER cv 7 - re I ASH PAN BLOWER MECHANISMS (Annually) Unplug the stove and pull the unit forward to access the two blowers. Vacuum all dust from motors. The blower motors have sealed bearings, DO NOT lubricate these motors. Check gaskets and replace if needed. POST SEASON CLEAN-UP Once you are finished using the pellet appliance for the season, unplug the stove for added electrical protection. It is very important that the stove be cleaned and serviced as stated above. CLEANING PAINTED SURFACES Please clean painted surfaces with a soft damp cloth. FIREBOX LINER The paint on the Firebox Liner may peel. This is due to extreme conditions applied to the paint and is in no way covered by warranty. DOOR GLASS REPLACEMENT It is recommended that your dealer replace the glass if broken,. The door glass is made of high temperature PYRO CERAMIC. To replace the glass, unscrew and remove the six retainer nuts using a 5/16" socket. Remove the glass and any broken pieces. High temperature fiberglass tape should be used around the glass in the same location as the original fiberglass. Insert the glass into the retainer and screw the door to the retainer. The use of substitute materials is prohibited. Use Enviro Part: #50-2119 12 ROUTINE CLEANING AND MAINTENANCE Optional Service Rail Kit 1. Remove Cast Ash Drawer Fr 2. Slide open the Cast Top. 3. Lift off Cast Sides. 4. Clip Side Rails to unit. 5. Attach Front Rail using the c as shown in Fig. 12. 6. Adjust leg height and lock tl the thumb screws. (Fig 12) 7. Slide unit forward on rails. Figure 12: Close up of Front Rail 13 WARRANTY Sherwood Industries Ltd. is the manufacturer of the Enviro line of heating products. At Sherwood Industries, our commitment to the highest level of quality and customer service is the most important thing we do. Each Enviro stove is built on a tradition of using only the finest materials and is backed by our Exclusive Lifetime Limited Warranty to the original purchaser. With Enviro, you're not just buying a stove, you're buying a company with years of unequalled performance and quality. Limited Lifetime Warranty: Under this warranty, Sherwood Industries Ltd. covers the fireplace or stove body and accessories against defects in materials and workmanship, for part repair or replacement for the first seven (7) years and limited labour for the first two (2) years to the original purchaser. This Warranty covers: Firebox, Heat Exchanger, Burn Pot, Firebox Panels, Ceramic Glass, Pedestals, Panels, Legs, and Door Assembly. Please see the exclusions and limitation section below as certain restrictions and exclusions apply to this warranty. Limited Three (3) Year Warranty Under this warranty, Sherwood Industries Ltd. covers the Burn Pot Liner and Log Sets against defects in materials and workmanship, for part repair or replacement for the first three (3) years and limited labour for the first two (2) years to the original purchaser. Please see the exclusions and limitation section below as certain restrictions and exclusions apply to this warranty. Limited Two (2) Year Warranty: Under this warranty, Sherwood Industries Ltd. covers: Ignitor, Auger Motor, Circuit Board, Timers, Temp Sensors, Blowers, Vacuum Switch and Wire Harness, against defects in materials and workmanship, for part repair or replacement for the first two (2) years and limited labour for the first two (2) years to the original purchaser. Please see the exclusions and limitation section below as certain restrictions and exclusions apply to this warranty. Limited One (1) Year Warranty: Under this warranty, Sherwood Industries Ltd. covers all exterior surface finishes against defects in materials and workmanship, for part repair or replacement and limited labour for the first (1) year to the original purchaser. Please see the exclusions and limitation section below as certain restrictions and exclusions apply to this warranty. Please Note - Burning Com or Grains - Burning com or other grains creates a harsher environment than burning wood pellets. The sugar in com turns to acid during the combustion process and erodes certain components at a faster rate. The bum pot liner and the agitator in your Multi - Fuel stove is a consumable item when burning com or other grains, and not covered under warranty. We expect that these components will last a couple of bum seasons but due to the wide variety and quality of grains we are not able to accurately predict how long they will last. Here is how our Warranty works If you have any concerns with your Enviro product please contact the dealer where you purchased the fireplace or stove. Your dealer shall make all claims under this warranty in writing. To the Dealer When filling out a warranty claim please complete the following information on an official warranty claim form: Customer information: Name, address and telephone number of purchaser and date of purchase. Dealer information: Date of installation, name of installer and dealer, serial number of the appliance, nature of complaint, defects or malfunction, description and part numbers of any parts replaced. To the Distributor Sign and verify that work and information are correct. 14 WARRANTY Exclusions and Limitations: 1. This Warranty does not cover tarnish, discoloration or wear on the plating or paint. 2. This Warranty excludes wear and tear or breakage caused by cleaning, moving or service on log set. 3. A qualified installer must install this stove or fireplace. This Limited Warranty covers defects in materials and workmanship only if the product has been installed in accordance with local building and fire codes; in their absence, refer to the owner's manual. If the product is damaged or broken as a result of any alteration, willful abuse, mishandling, accident, neglect, or misuse of the product, the Limited Warranty does not apply. 4. The stove must be operated and maintained at all times in accordance with the instructions in the Owner's Manual. If the unit shows signs of neglect or misuse, it is not covered under the terms of this Warranty policy. Performance problems due to operator error will not be covered by the Limited Warranty policy. 5. As this is a heating appliance some changes in colour of surface finishes may occur. This is not a flaw and as such is not covered under this warranty. 6. Some minor expansion, contraction, or movement of certain parts and resulting noise, is normal and not a defect and, therefore, is not covered under this Limited Warranty. 7. Misuse includes over -firing. Over -firing this appliance can cause serious damage and will nullify the Limited Warranty. 8. The Limited Warranty will cover glass thermal breakage only and will not cover misuse of the stove glass, including but not limited to glass that is struck, has surface contaminates or has had harsh or abrasive cleaners used on it. 9. This warranty does not cover products made or provided by other manufacturers and used in conjunction with the operation of this stove without prior authorization from Sherwood Industries Ltd. The use of such products may nullify the Limited Warranty on this stove. If unsure as to the extent of this Limited Warranty, contact your authorized Enviro dealer before installation. 10. Sherwood Industries Ltd. will not be responsible for inadequate performance caused by environmental conditions. 11. The Limited Warranty does not cover installation and operational related problems such as spillage caused by environmental conditions. Environmental conditions include but are not limited to nearby trees, buildings, roof tops, wind, hills, mountains, inadequate venting or ventilation, excessive offsets, negative air pressures or other influences caused by mechanical systems such as furnaces, fans, clothes dryers etc. 12. The Limited Warranty is void if: a) The stove has been operated in atmospheres contaminated by chlorine, fluorine or other damaging chemicals. b) The stove is subject to submersion in water or prolonged periods of dampness or condensation. c) Any damage to the unit, combustion chamber or other components due to water, or weather damage which is the result of, but not limited to, improper chimney/venting installation. c) Salt air in coastal areas or high humidity can be corrosive to the finish; these environments can cause rusting. Damage caused by salt air or high humidity is not covered by the Limited Warranty. 13. Exclusions to the Limited Warranty include: injury, loss of use, damage, failure to function due to accident, negligence, misuse, improper installation, alteration or adjustment of the manufacturer's settings of components, lack of proper and regular maintenance, alteration, or act of God. 14. The Limited Warranty does not cover damage caused to the fireplace or stove while in transit. If this occurs, do not operate the stove and contact your courier and/or dealer. 15. The Limited Warranty does not extend to or include firebox paint, door or glass gaskets with damage caused by normal wear and tear, or exterior paint discoloration or chipping, worn gaskets, etc. 16. The Limited Warranty does not include damage to the unit caused by abuse, improper installation, or modification of the unit. 15 WARRANTY 17. Damage to plated surfaces caused by fingerprints, scratches, melted items, or other external scores and residues left on the plated surfaces from the use of abrasive cleaners or polishes is not covered in this warranty. 18. The Limited Warranty does not cover tarnish, discoloration or wear on the plated surfaces. 19. The paint on the Metal Brick Liner may peel. This is due to the extreme conditions applied to the paint during normal usage. It is not a flaw and is not covered under warranty. 20. Sherwood Industries Ltd. is free of liability for any damages caused by the fireplace or stove, as well as inconvenience expenses and materials. The Limited Warranty does not cover incidental or consequential damages. 21. The Limited Warranty does not cover any loss or damage incurred by the use or removal of any component or apparatus to or from the Enviro fireplace or stove without the express written permission of Sherwood Industries Ltd. and bearing a Sherwood Industries Ltd. label of approval. 22. Any statement or representation of Enviro products and their performance contained in Enviro advertising, packaging literature, or printed material is not part of the Limited Warranty. 23. The Limited Warranty is automatically voided if the fireplace or stove's serial number has been removed or altered in any way. If the stove is used for commercial purposes, it is excluded from the Limited Warranty. 24. No dealer, distributor, or similar person has the authority to represent or warrant Enviro products beyond the terms contained within the Limited Warranty. Sherwood Industries Ltd. assumes no liability for such warranties or representations. 25. Sherwood Industries Ltd. will not cover the cost of the removal or re -installation of the stove, hearth, facing, mantels, venting or other components. 26. Labour to replace or repair items under this Limited Warranty will be covered per our warranty service fee reimbursement schedule. Labour rates are set per component and as such total labour costs may not be covered. 27. Sherwood Industries Ltd. is not liable for freight or labour on any stove replaced in -field and is not liable for travel costs for service work. In the event of in-home repair work, the customer will pay any in- home travel fees or service charges required by the Authorized Dealer. 28. At no time will Sherwood Industries Ltd. be liable for any consequential damages which exceed the purchase price of the unit. Sherwood Industries Ltd. has no obligation to enhance or modify any stove once manufactured (example: as a stove evolves, field modifications or upgrades will not be performed). 29. This Limited Warranty is applicable only to the original purchaser and it is non -transferable. 30. This warranty only covers Enviro products that are purchased through an authorized Enviro dealer. 31. If for any reason any section of the Limited Warranty is declared invalid, the balance of the warranty remains in effect and all other clauses shall remain in effect. 32. The Limited Warranty is the only warranty supplied by Sherwood Industries Ltd., the manufacturer of the stove. All other warranties, whether express or implied, are hereby expressly disclaimed and purchaser's recourse is expressly limited to the Limited Warranty. 33. Sherwood Industries Ltd. and its employees or representatives will not assume any damages, either directly or indirectly, caused by improper usage, operation, installation, servicing or maintenance of this stove. 34. Sherwood Industries Ltd. reserves the right to make changes without notice. Please complete and mail the warranty registration card and have the installer fill in the installation data sheet in the back of the manual for warranty and future reference. 35. Sherwood Industries Ltd. is responsible for stocking parts for a maximum of seven (7) years after discontinuing the manufacture or incorporation of the item into its products. An exception to this would be if an OEM supplier is not able to supply a part. 16 INSTALLATION DATA SHEET The following information must be recorded by the installer for warranty purposes and future reference. NAME OF OWNER: ADDRESS: PHONE: MODEL: M55C-FPI SERIAL NUMBER: DATE OF PURCHASE: (dd/mm/yyyy) DATE OF INSTALLATION: (dd/mm/yyyy) MAGNEHELIC AT INSTALL: INSTALLER'S SIGNATURE: NAME OF DEALER: PHONE: MANUFACTURED BY: SHERWOOD INDUSTRIES LTD. 6782 OLDFIELD RD. SAANICHTON, BC, CANADA V8M 2A3 www.enviro.com February 10, 2011 C-12332 17 1 . -I, E a' P.O. Box 224 Suncook, NH 03275-0224 Tel. (603) 928-.7422 Fax (603) 928-7423 SUBMITTEDTO L jV i STREET d CITY. STATE AND ZIP PHONE EMAIL ADDRESS JOB NAME _ JOB LOCATION JOBPHONE_ CONTRACT WE PROPOSE HEREBY TO FURNISH MATERIAL AND LABOR — COMPLETE IN PAYMENT TO BE MADE AS FOLLOWS: All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications 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 Workmen's Compensation Insurance. Balances over 30 days incur 2% monthly finance charge. WITH ABOVE SPECIFIC TIONS, FOR THE SUM OF: F �'r � DOLLARS ($ e��✓ ). AUTHORIZED SIGNATURE y ACCEPTANCE OF CONTRACT—THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE. SIGNATURE DATE SIGNATURE A h� DATE f SUNRA-1 OP ID: CC ,aiCORa°CERTIFICATE OF LIABILITY INSURANCE AT05/165/16/1111 YY) r0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE' AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 603-536-8200 Carl M. Caporale, Sr. 603-536-2206 Insurance24.com, Inc. P. 0. BOX 480 Plymouth, NH 03264-0480 Carl M. Caporale, Sr. NAME: CONTACT PHONE FAX A/C No Ext): A/C No E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Main Street America INSURED Sun -Ray Builders, Inc. J & L Chimney Works, LLC P.O. Box 224 INSURER B: INSURER C: INSURER D: Suncook, NH 03275-0224 INSURER E: - INSURER F: 04/15/11 COVERAGES CERTIFICATE NUMRFR• RGVIc1nN MI lu pro. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJF_CT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR I TYPE OF INSURANCE L SU POLICY NUMBER POLICYEFF MM/DDfYYYY) POLICY EXP (MMIDDfYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE s 1,000,00 A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR - MP17536Z 04/15/11 04/15/12A AG O RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,00 X Business Owners PERSONAL 8 ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,00 POLICY JFCT PRO- 7LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) S NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE_ s EXCESS UAB CLAIMS -MADE - AGGREGATE S DED I I RETENTIONS S WORKERS COMPENSATION WC STATU-OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? E-1 N / A TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S A Builders Risk BUILDING 30,00 Commercial Appli PROPERTY 15,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) NONE001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Carl M. Caporale, Sr. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD M Construction Supervisor CS -086380 JASON A TARDtFF 15 NOIRE DAME AVE ALLENSTOWN NH 03275: 11/03/2013 Offce of Consumer Affairs & Bisiness Regulation HOME IMPROVEMENT CONTRACTOR afton r Registr. 1507 Type: -40-61 . -2012 Ltd Liability Corpor SUN RA's BULD I JASON —1 ARDIFF 15 NOTRE DAME AW'. '. AILLENSTOVEN, NH, 03275-:-.-T-' 'Undersecretary The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 'a Jai 600 Washington Street AV Boston, MA 02111 XV www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Address: / J City/State/Zip:�,(% k_ -c r— z4A Phone #: Are you an employer? Check the appropriate boa: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors �• F1 Remodeling 2.�m a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have 9. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9• ❑ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its ME] Electrical repairs or additions required] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ 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' 134 Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information/ t 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 subcontractors 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: Policy # or Self -ins. Lic. #: Job Site Expiration Date: City/State/Zip: 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 uad- tji mains and peWit�of perjury that the information provided above is true and correct Oficial 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. Cityrfown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: