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Miscellaneous - 43 VEST WAY 4/30/2018
TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING AThis certifies that ................................. to perform .......... ..a has pernussion plumb*pg in th buildings of ............................................................................................. ....... North Andover, Mass. at ..... .............................. ...................... .... Lic. No. 13Y.q .19 .. ................................................................................. PLUMBING INSPECTOR -Check 4 P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY North Andover MA DATE j PERMIT # / JOBSITE ADDRESS 43 Vest Way OWNER'S NAME Smith OWNER ADDRESS TEL IFAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL NEW: ED RENOVATION: [A REPLACEMENT: FIXTURES 7 FLOOR— BSM I 1 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM r— DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM _=F DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK 3 LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES WATER PIPING OTHER I � I PLANS SUBMITTED: YES [] NO[j 2 1 3 1 4 1' 5 1 6 1 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES (] NO (] IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY j OTHER TYPE OF INDEMNITY [] BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [I AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are t n4ac9firate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Laurence Crofts LICENSE # 13199 SIGNATURE _ MPE JPD CORPORATION El# PARTNERS # LLCEI# COMPANY NAME I L. Crofts Inc. ADDRESS 67 Winthrop Ave CITY Beverly � STATE MA ZIP01915 TEL 978-922-1276 FAX 978-922-3117 CELL EMAIL I Icrofts@comcast.net ,r il O z o � F U W Pr rAz 0-4 � o w Rb oEl Z z �El o w O w z W a atLU O Q a x a W O w Q 3 U O o a W a � U J IL a a � w x w � w W F O z z 0 U W a ' Z z z as ZA a , 0 F,� r -w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Print Form �7, '11" www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): L. Crofts Inc. Address: 67 Winthrop Ave itv/State/Zip: Beverly, MA 01915 Phone #: 978-922-1276 Are you an employer? Check the appropriate box: 1. ✓Q I am a employer with 4 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' compinsurance comp. insurance.1 required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑✓ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑✓ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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. TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: The Hartford Policy # or Self -ins. Lic. #: 08WECC17819 Expiration Date: 2/26/16 Job Site Address: 43 Vest Way City/State/Zip:North Andover, MA 0114 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 cert under thepains andpenalties ofPePjury that the information provided above is true and correct #: 978-922-1276 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. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: V4 67 WI NT4R1' "AVE 0191.5-4 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 28,357.00 m $ - $ 490.00 Plumbing Fee $ 42.54 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 42.54 Total fees collected $ 675.07 43 Vest Way 257-2016 on 8/31/15 Bathroom Remodel ,,1 a Date 5 L 3a01(k; c� TOWN OF NORTH ANDOVER PERMIT FOR WIRING p• ,8S'►CHuS�t Thiscertifies that ........................ ................. ....... .......... ...... ....... ....... ...... .....�--........................... haspermission to perform .......................:..................................................... �-✓� ......... F wiring in the building of..,.,,, rn .................. ..... ..:..... 7/ G� at................................North Andover, Mass. ...... Fee::. ..... %� x :......... Lic. No. .... .................... ELECTRICAL INSPECTOR f f . .'ChecK # C2 917 V 6 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. I °� Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM EL CTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 5 CN&�00 � (PLEASE PRINT W INK OR TYPE ALL INFORMATIOA9 Date: 4 ��s City or Town of: NORTH ANDOVER To the Inspe tot of Wires: By this application the undersigned g&* es n�� of � or her intention to perform the electrical work described below. Location (Street & Number) X/®%y Owner or Tenant /'XVL. --Jo Owner's Address m Is this permit in conjunction with a building permit? Yes LE Purpose of Building 5�FD Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. - Existing Service�0 Amps (% / s` b Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: See -on d A/ r- /9-�/1,4 ro o 00N -T , �, �_ ,Vf.L1J A/6 rl-e- 0,1 -r— e5 �� Zd -K , Completion of the_following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. o-.—omergency Ug ting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: Number Tons KW ....................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW SecuritNo. o Systems:* or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications of Devices or E u valent OTHER: Attach additional detail if desired, or as required by the Inspector of -Wires. Estimated Value of Electrical Work: /846. (When required by municipal policy.) Work to Start: f� �� /s Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q. BOND ❑ OTHER ❑ (Specify:) Icertify, under tlaepains and enalties ofperjury, that the information on this application is true and complete. FIRM NAME: _ Q ✓L LIC. NO.: 37V-52 b og: �V g Licensee: -1'G Signature LTC. NO.: 3 7ys9 (If applicable, t r "exlIem`g", •i� t e lice se nuxber li ) $us. Tel. NOV, `Q Address: /�' /t/! / eC.ii /Un A � t � 305 Alt. Tel. No.�77fl S2 3 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ .J Signature Telephone No. F ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the p permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence' during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: - Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSP TION: Pass M V Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: --�. FINAL INSP TION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: VfAd, ILDate: a �� DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com J The Commonwealth of Hassachusetts Department of IndustrialAceldents r X Congress Sheet, Suite 100 Boston, MA 02114-2017 www massgov/dia •a ��M s��V Workers' Compensation Insurance Affidavit: Builders/Contractors/I+;]ectricians/Plwmbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name l—u L,,q( (v) 'C i'c Address: � tlo City/State/Zip:_ Are you an employer? evi ttie appropriate box: 1.Q I am a employer with employees (full and/or part-time).." a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.0 I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractgis either have workers' compensation insurance or are sole "t N proprietors with no.employees. 5. ❑I am a general contracto 4 and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. inswance.t 6. Q We are a corporation and its. officers have exercised their right of exemption per MGL c. 152, §1(4), and'we have no empldyd. [No workers' comp. insurance required.] 1" s_. ` *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information 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 sub -contractors and state whether or pot those entities have comp. policy number. employees. If the sub -contractors have employees, they must provide their workers' I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site 3 .S'1:0;- 40L Type of project (Required): 7. ❑ NeVd6nstr6ttion 8:. temodelitig 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12,,.fl°Plumbing repairs or additions 13% El Roof repairs 14.n Other information. Insurance Company Name: Policy # or Self -ins. Lie. #:, Expiration Date_ City/State/Zip: Job Site Address: declaration page (Showing the polic numtber and expiration date). Attach a copy of tote workers' compensation policypolicy number to secure coverage as required under MGL e. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der thepains and penalties ofperjury that the information provided above is true and correct. • Date:_ e. sp /� P � ( O 51 Phone #: / � 4Y/ 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. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone Contact Person: 5 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of here, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more ofthe foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receivef6r trustee of an individual, partnership, association or other legal entity, employing employees. • However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant,who: has not produced -acceptable evidence of compliance with the insurance coverage r`equiked." Additionally, MGL chapter 152, §25C(1) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub:contractor(s) name(s), address(es) and phone number(s) along with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of IndustrialAccidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia 9800 Fredericksburg Road San Antonio, TX 78288 USAW 04664.1W3WK.JSS1043067357.01.01.852 CITY OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER,MA 01845-2420 Reference: MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B Attention Building Commissioner, I am writing regarding the claim referenced below. Policyholder: Ronald A Smith Reference #: 001139973-9 Date of loss: March 24, 2015 Location of loss: North Andover, Massachusetts Address: 43 Vest Way, 01845 May 1, 2015 A claim has been made involving loss, damage or destruction of the property referenced above, which may either exceed $1000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to my attention and include the reference #. You may submit correspondence or questions to me. My contact information is: Address: P.O. BOX 33490 SAN ANTONIO, TEXAS 78265 Fax: 1-800-531-8669 Phone: 210-531-8722 ext 44841 Sincerely, Melanie K Maynard PROPERTY - CVA UNIT 9 United Services Automobile Association P O Box 659461 San Antonio, TX 78265 Phone: 210-531-8722 ext 44841 Fax: 1-800-531-8669 CMG/MKM 001139973 - DM -04664 - 9 - 8025 - 18 54577-0914 Page 1 of 1 Date ) ..�`? - (. ? TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSAtwUS� This certifies that ..��.z..,f' c ..T ......Ij ��.. .�........... . has permission to perform ....... ?.% . t ...................... . plumbing in the buildings of . . f . '..'......................... . at ... ZY : ......... North Andover, Mass. Fee.?..:..Lic. No...31.t.. ...... ......... PLUMBING INSPECTOR Check # S e- 5513 fZ> MASSACHUSETTS UNIFORM APPLICATION FOR PERMITTO O -PLUMB G (Print or Type) 5- � / Mass. Date Permit # hL�Y-� Owner's Name Building Location '' -3 Type of Occupancy Residential New f._J Renovation CJ Replacement N Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name tier itage Htg . &Pig . Co. Inc • Check one: Address 35 Pleasant Street LX Corporation Stoneham, Ma 02180 ❑ Partnership Business Telephone__781-A3-8---73-7-6--- Fl Firm/Co. Name of Licensed Plumber Gordon Switzer Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes V No CJ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy M Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit appChetio waives this requirement. Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stale Plumbing and Chapter 142 of the General Laws. By----- Signatwe o icensod Plum er Type of Liconse: Master [ Journeyman $ ❑ City/Town8 3 2 2 AppHOvED- (OFFICE USE ONLY1 License Number___.__..______ T --TZ ara � z X r_ O W > U 't 7 N 0. n (�` � $4 W n O X Z W J Uf 6 Q ¢ F' z w N /> Z Z a 6 w Z Z Z -. a i:�t a 3 i� rtj 41 Q� rd 1�n-q1i O N [Y m m N 2 Lu T `t X Q m a a cc Z z O 7 2 OC ,� 3 z o a ¢ z=' Q W X N a 0 rt O ~ 0 J Z ._ z O `< W G O LL HLL X is o (J0 >4 y r O __ cc a 3 O O J X r- N O 7 O Q c -C7 CU ?V 3 X J m N SUB—BSMT, — BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6Tri FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name tier itage Htg . &Pig . Co. Inc • Check one: Address 35 Pleasant Street LX Corporation Stoneham, Ma 02180 ❑ Partnership Business Telephone__781-A3-8---73-7-6--- Fl Firm/Co. Name of Licensed Plumber Gordon Switzer Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes V No CJ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy M Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit appChetio waives this requirement. Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stale Plumbing and Chapter 142 of the General Laws. By----- Signatwe o icensod Plum er Type of Liconse: Master [ Journeyman $ ❑ City/Town8 3 2 2 AppHOvED- (OFFICE USE ONLY1 License Number___.__..______ J z O w N D w u LL LL O cc 0 LL 3 O J w m N z O ►_ U w a N z N N w K C7 O Cr a 1 #r U z m s J IL O c 0 ►- c9 z O � Q Z O w J � m O LL LL O m z w LL 0 a O 4~ 0 w _U l 1 U 7 uw. Q z I cJ N Z O F- CL 0. N Z_ J Q z 2 E Im O U W CL N z O z The Commonwealth of Massachusetts Department of Public &fety lug BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12:w oCftce use only permit So. 13 VP occupancy b Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed In accordance with the Massachusens Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) / /4& City or Town of %UD /�rtJ�!9�l e To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 143 O -e ¢ u.) of 0 A�1-0 d c9 e,� -e y Owner or Tenant o )u �- Owner's Address Is this permit in conjunction with a building permit: Yes O --No ❑ (Check Appropriate Box) Purpose of Building R e S i ds y c °-(— Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts 0verbead ❑ Undgrd ❑ No. of Meters Namber of Feeders and Ampacity. Location and Nature of proposed Electrical Work Rio n"9 d t° ( ! h) No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total RVA No. No. of Lighting Fixtures Swimming pool Above ❑ In - grnd. ❑ Generators . RVA No. of Receptacle. Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection Sounding Devices Local 1:1 Municipal [:]Other Connection No. of Ranges No. of Air Cond. Total tons No. of Dis sals p° No. of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating RW No. of Dryers Heating Devices KW No. of Water Heaters KW No, of No. of Signs Ballasts Voltage WirLow ng No. Hydro Massage Tubs No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabilit Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES[] NO I have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the rappropriate, box. INSURANCE 0 BOND ❑ OTHER ❑ (Please Specify) (_7 e w e w a./ Estimated Value of Electrical Work $ (Expirationate Work to Start oZ !L Inspection Date Requested: Rough Signed-u-.,ier b -e penalties of perjury: FIRH NAME ,C I n Itl it l 1 I .o Final LIC. NO. Licensee r r� Gc% Signature � 4J -Z, LIC. NO.; Address L4 ��;/u ry, /1 ��r4� u /viu S S [ �d Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts Generalws-La and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ Signature of Owner or Agent N° 1,"646 Datez ..... fP%......1.� A TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 6 has permission to perform-..; ......... ............. ......�r�.............. /................. .......:...: ��.wiring in the building of— ..:.....:.:.. ' n, .................................... . North Andover, Mass. r ....... Lic. No:.,..... .• 7 ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer IIIIN��I►bs�V�c s a v ut,lss-vs�tvs hrra.t�.ta 1 tVt�t•rV1i.rCrc .` �8: °•'r. (Type or Print) ' NORTH ANDOVER ,Mass.., -�•,. �;4: Date• • � � �.'; C Building Location y3 //gs j t c a y Permit # -19�" Owners Name �.. New '❑ Renovation j0'* Replacement ❑ Plans Sybmitted �F • ry;M,f (Print or Type) Check one: Certificd�e ' Installing Company Name &F-�O rjo 6/e LSV„ z— ❑ Corp. .• Address no Sa o Partner. i' C C4 lea, Firm/Co. Business Telephone�'7��—�3S�o Name of Licensed Plumber: Pa it L F. ra cfyeC • Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:} �g Liability insurance policy Other type .of indemnity z Insurance -Waiver: I, the undersigned, have been made aware •that the licensee of this application does not have any one of the above three insurance coverages. ;. • • Signature of owner/agent of property Owner ❑ Agent. ❑ , , ,;. s a I betcby certify Wal all of U,c dcuas and information 1 l,a.c subasitecd lot camcd) in alwwc antliolios rite lute asi/ syam 10 ON beu 41, p k"wkdbe aad tba/ all plumbing wosk and installations l,cs(ntnicd undo rcrnoit lssucd lot this application will be Jai" 11►10 •q Pq�4KM r vi"" of lbs M"WAwclls Statc rlombit; Codc and Chaptct 141 of Ufic (:mull Lawt. z Z 4n Y 8y • 1 '' Title • Signature of 'Licensed Plumber ' City/Town: Type of Plumbing License Z06 y� r /1ADR�1VFr1 7oFFtcF USE oril rI License Number Master [] Journeypq h N O J O O N Z. Cl < it h y 0_ O J •" W t» 1. tp W = -n tom, V Q Y t W = Z H V z' a0 ; oc Q W ¢ Q w O4 O z ac o► a6 J. Ib O AQ Y Z. Y d ♦• -C1L O M. ac > f' O ha. ' to F. y O Oa O W _x _x W HAL 1C W y �L J m Q Q J f. N W O SUB—,BSMT. .' BASEMENT 1ST FLOOR o� 2ND FLOOR 3RD FLOOR 4TH FLOOR STN FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR �F • ry;M,f (Print or Type) Check one: Certificd�e ' Installing Company Name &F-�O rjo 6/e LSV„ z— ❑ Corp. .• Address no Sa o Partner. i' C C4 lea, Firm/Co. Business Telephone�'7��—�3S�o Name of Licensed Plumber: Pa it L F. ra cfyeC Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:} �g Liability insurance policy Other type .of indemnity Bond ❑„ Insurance -Waiver: I, the undersigned, have been made aware •that the licensee of this application does not have any one of the above three insurance coverages. ;. 't • Signature of owner/agent of property Owner ❑ Agent. ❑ , , ,;. s a I betcby certify Wal all of U,c dcuas and information 1 l,a.c subasitecd lot camcd) in alwwc antliolios rite lute asi/ syam 10 ON beu 41, p k"wkdbe aad tba/ all plumbing wosk and installations l,cs(ntnicd undo rcrnoit lssucd lot this application will be Jai" 11►10 •q Pq�4KM r vi"" of lbs M"WAwclls Statc rlombit; Codc and Chaptct 141 of Ufic (:mull Lawt. 8y • 1 '' Title • Signature of 'Licensed Plumber ' City/Town: Type of Plumbing License Z06 y� d{ /1ADR�1VFr1 7oFFtcF USE oril rI License Number Master [] Journeypq yb••—�..,;�,. _.,,� � ,... -v,.- r..-�:.ti,t^�re-' `-Y`r.-.�..ya_,;,•�i��,..-,.,.: _ ...rte -w..... __..:.._,,...�t,�..C:.�'�---.� .06' Date l /. N2 3 5-6 5- l ..ORTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .,f`?Ufd..� �'�.�� ...l�� .�'�........... k �. has permission to perform ...r}... ......................... plumbing in the buildings of ... F3 + t).t .c ....Q.(,t i A......... . , , , , , , . . . .. , North Andover, Mass. Fee. Lica No. A)6. . ... ........................ . PLUMBING INSPECTOR 12/12/97 09:26 30.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer C9 W 0 10 I< I= 1�. I— la. r - u O z S t w• in z 0 u ul Z ^ ` b 0 1 z z I o O , u u W W � M M p O O • J J A 1 O .3 W < < M L L 1 J O Mh Y 1 4 I p O ~ W W 10-09-1997 TJ-Beam(TM) Page 1 of 2 v4.62 217201110 1111 BEAMUSA PELHAM BUILDING SUPPLY PO BOX 553 ATWOOD RD. PELHAM, NH 03076 USA Phone: 603-635-7555 --------------------------------------------------------------------------`---------------------------------------------- Name: MARK BEDARD Project Name: SMITH RES Page Title: HEADER dlg ���T 0�y X0&,0( Based on Allowable Stress Design (ASD) BOCA building code for. TJM products available through Distribution Application........ Floor - Res. Deflection Criteria ( S) Member Use ............... HEADER Load Classification....... Floor LL Defl TL Defl Member Top Slope(in/ft)... 0.000 Load Duration Factor....... 1.00 Span 1 L/360 L/240 Roof Slope(in/ft)......... 0.000 Live Load(psf)............. 40.0 Floor Decking............... N/A Dead Load(psf)............. 20.0 Repetitive Member Use....... N/A Tributary Width('-").... 7- 0.00 Reinforced Overhangs........ N/A LOAD: Class LDF Begin End Live Load Dead Load Comment 1 Conc(lbs) Floor 1.00 7'- 0.00" 882 496 Add 2 Unif(plf) N/A N/A 0'- 0.00" 141- 0.00" 0 80 Add 3 Unif(plf) Floor 1.00 0'- 0.00" 14'- 0.00" 105 70 Add 4 Unif(plf) Snow 1.15 0'- 0.00" 14',- 0.00" 366 160 Add Copyright (c) 1997 by Trus Joist MacMillan, a limited partnership, Boise, Idaho, USA. Microllam(R) is a registered trademark of Trus Joist MacMillan. TJ-Beam(TM) is a trademark of Trus Joist MacMillan. 10-09-1997 TJ-Beam(TM) Page 2 of 2 v4.62 217201110 1111 BEAMUSA PELBAM BUILDING SUPPLY PO BOX 553 ATWOOD RD. PELHAM, NB 03076 USA Phone; 603-635-7555 2 Pcs of 1.15" x 16" 2.0E Microllam(R) LVL ----------------- 14'- 0.00" ------------------------------------------ S I Z E A N A L Y S I S - A S D ----------------------------------------- This analysis for TJM products only! Substitution voids this analysis. IMPORTANT! The analysis presented below is output from software developed by Trus Joist MacMillan(TJM). TJM warrants the sizing of its products by this software will be accomplished in accordance with TJM product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJM Associate. The maximum unbraced length(s) shown are based on the controlling compressive forces on either the top or bottom edges of the member. Lateral bracing needs to be properly attached and positioned to achieve stability. Note; See TJM SPECIFIER'S / BUILDER'S GUIDES for multiple ply connection. Not all products are readily available. Check with your supplier or TJM technical representative for product availability. Maximum Design Allowable Control o Shear(lb) 9204 7582 ( 12236 62% RT. end Span 1 under Snow Roof loading Moment(ft-lb) 34626 34626 C 39979 87% MID Span 1 under Snow Roof loading Live Defl.(in) 0.352 C 0.461 L/477 MID Span 1 under Snow Roof loading Total Defl.(in) 0.568 t 0.700 L/296 MID Span 1 under Snow Roof loading Span 1 Max. Reaction Total(lb) 9204 9204 Live(lb) 5698(S1.15) 5698(S1.15) Required Brg. Length(in) 6.19(W) 6.19(W) Max. Unbraced Length(in) 32 t Copyright (c) 1997 by Trus Joist MacMillan, a limited partnership, Boise, Idaho, USA. Microllam(R) is a registered trademark of Trus Joist MacMillan. y TJ-Beam(TM) is a trademark of Trus Joist MacMillan. r I T I I ,:date. R�,ctrictod To. V• Of 8 G CnY/TOWN. /110* 7-15-j �.�oov�'iE' DAM g15`7 STREET 13 : SU80 MON: SGILE. c�� LOT Na: �� P 04?AorAREA: �� �S� �� � �� � p MASSACHUSETTS a NEW HAMPSHIAE ISM) 454,M74 A - )S E 7') Paop•SEo OS043 ITi oN �ATPA 1p2�/1 A� � ",-1S r, 4 T NOT V4LV )GAMED 4 SHERBURNE AOAD HUDSON, N,M. 03051 (COV 635-27" FORM II - IAT RELF,ASE FORy INSTRUCTIONS: This form is used to verify approval form from Boards and Department. that all necessary have been obtained. This does not relieve ehavin landowner from compliance with an 9 jurisdiction regulations or re Y applicable locallcant and/or requirements. or state law, ****************Applicant fills out this section*�,��***********#* APPLICANT: J, LOCATION: Assessor's Map Number �t Subdivision Street f pfficial ATIONS OF TOWN AGENTS: .nf/„ nA - Phone Parcel Lots) D St. Number Use only**********************# . v • I r Conservation Administrator Date Approved j 16 Date Rejected Comments f U 1 ------------ s Town Planner Date Approved Date Rejected Comments Food Inspector -Health Date Approved Date Rejected Septic Inspector -Health Date Approved Date Refected Comments Public Works -.,sewer/water connections - driveway permit Fire Department Received by Building Inspector Date �_ 0 rA WD cl 'ji CD S c O N C V V :Y JCL : ca /Ea mo \. PJE� C3 o" r ` m c E CL= 16- cc, .m 3 •• cm m p � N y = C � A p E m M ch ymom amc _w cm `"..: c c Q ID CO rl C ` 0 CD d C Q ` N m = •o = m :m�3 N ~' w y m o ~' m t y C eO t m C•=.. .� W -a y te= z v .E Q � .� CL ti acm g = IA i v N C z 0 W w a z O U Cn �I O O W ac • L O Z s °D O � CL y C a w 2 •E a a CL ~ ♦_... 3.0 O U O a� a a -a x °°° c U w a LL x :rAco 3 w w W a°' v c� w xzi a°' w w aq z cn 4) cn CD S c O N C V V :Y JCL : ca /Ea mo \. PJE� C3 o" r ` m c E CL= 16- cc, .m 3 •• cm m p � N y = C � A p E m M ch ymom amc _w cm `"..: c c Q ID CO rl C ` 0 CD d C Q ` N m = •o = m :m�3 N ~' w y m o ~' m t y C eO t m C•=.. .� W -a y te= z v .E Q � .� CL ti acm g = IA i v N C z 0 W w a z O U Cn �I O O W ac • L O Z s °D O � CL y C O CM O•,C—O 2 •E O O m m CL ~ ♦_... 3.0 O U O O. L L O d CL a y c o O � cc "FL cl O Z w C irl V h ccC • c C CL H RORiq OFFICES OF: Town of BUILDING a NORTH ANDOVER CONSERVATION HEALTH �;""•'::r DI\'I�ION OF tACMU PLANNING PLANNING & COMMUNITY DEVELOPMEN'I' KAREN 111-) NULSON, DIRECTOR Manch 10, 1992 To: Ronaid A. Smith 43 Vett Clay No4th Andover, MA From: North Andover Building Department Re: Wood Stove Installation 120 Mail) Street North /Uidwer, r\IassachLISettS 01845 (508) 682-6483 This is to certify that I have inspected and approved the installation of a woodburning stove at your residence, located at the above address. The installation meets all the requirements of the State Building Code. Yours truly,,, 1/7' r Assistant Building Inspector MJG:gb Location No. 3 t Date j TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee OtOther Permit Fee SteUA o Tection Fee $ 2- QFC rgg it Connection Fee $ / TOTAL $ Z. S • c� c� J /VD. Andover Collector !^Building Inspector Div. Public Works ",.. w J I V4 W i cc •.. v a) n Or O C � 0 � oC v 4q Q V W O W O W a CL V) a H I �. O W z u U z �~ z W W a 0u o V) A W J N � ZD ? p z 0 z V �qq cc cc m LL. v 5 o m v m L C @ J d. L J W L V t �rjj LL Y O L O C O m � O C . O U ti LL CL to U. Ct 1L Co CO CO J I V4 W i cc •.. v a) n J E Cu z • cc •.. C � � v 4q 0 O V a V) I �. O ti u U �~ N 0u H C V) A W J z � ZD 0 �qq E Cu z • PERMIT NO. APPLICATION FOR 'PERMIT `TO BUILD — NORTH ANDOVER, MASS. PAGE 1 ,MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE\ ONE —I SUB DIV. LOT NO. I :1 � j i � � q, T10N "i:, �iS; V/ pC ��i% � /OWNER'S p y� , , 1� C /� � PURPOSE OF Ip�RG +1m �7TTJ�l• FI 1 I b m OF KJU®� J i �V 6 - —5 NAME �O A. �c)A w� �. t, (-r �— i"� NO. OF STORIES SIZE WNER'S ADDRESS 143 �i� � �1�y BASEMENT OR SLAB - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 3 ; PAGE 2 FILL OUT SECTIONS 1 - 12 6230,10 1-110 r.5 K/= -7q 0 -7,50 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS L//ANS MUST BE FILEDAND APPROVED BY BUILDING INSPECTOR MATE FILkD I t /-v 1-11 , SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E o2 -s0'0 PERMIT GRANTED I Imp" --w 19 J PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN ILI WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer •`.Y� �nOrG\r�VR NV1d 101d S30Vld3M SIH1 'C3S0dWM3dnS '013 'S30V21 -VO 'S3H:)HOd H11M 'SONIC-llns d0 S NNVII , X3 CNV S3N11 101 WOU.J 30NV1SIC CNV 10-I JOSNO1SP `' 3Y1�3 1SnW N011�3S SIHl L z L AONvd n 000 L G1033V JNiciins d� f 0NIIV3H ON _ I P 6 I 1 I PUZ DIM1J313 110 SWOON, 40 SVJ SM31V3H 11Nn J.1.H 1NVIOVM JNINOI110NOD MIV MOdVA MO M.1.M lOH WV31S Nei MIV IoH 03J8Oj 3:)VNMnj SS913dId _ _ SM31jVM DOOM 'S10D 18 'SW9 13315 'S10J V 'SW9 839W11 1SI0f 000M 0NI1V3H LL II ONIWVNd 9 OOVO 3111 M001j 3111 S3dn1X1j NM30OW `JNId0021 11021 _ 83MOHS 11VA 13AVdO 8 MVl `JN19Wnld ON 31V1S _ ANIS N3HJ11A S30NIHS DOOM kdOlVAV1 S910NIHS 11VHdSV 13S01D N31VM 03HS lVlj ('X[ Z) *M1,131 101 OMVSNVW �TT39WVJ 'Xlj; £I HlV9 dIH 319VJ ONiewnld . O L .' dood S r-1 3MOI3dns MOOd ONINIM - _I MOolj 8 'SM1S :)I11V 3WVdl NO 3NO1S AMNOSVW NO 3NOIS 'A19 M3(INO MO ':)NO:) 3WVdl NO ADIM9 AMNOSVW NO AJI89 —� —E _ E _ l slooll — _ 9 3WVMj NO O»n1S AMNOSVW.NO 0»n1S 3111 'HdSV ONIOIS '1M3A NO1°lWOD JNIOIS S01339S7V 0.N\O4VH JN1013 11VHdSV S310NIHS DOOM O1} HldV3 313d0N0D 6 I SOMVO9dNIGIS S71VM b N3HD11A NM300W W008 OV3H S37Vld 321[ 1.W.9 ON VRV 7111V 'NIJ '/i 1/1 1/1 V34V .1.W.9 'NIJ llnj V3MV 1N3W3SV9 E £ L 1 _ 9 NIINn liy, AM0 i M31SVld S2131d 3NO1S MO AOIM9 'A.19 31HDNOD O.MOMVH 3NId 313MDNOD HSINId NOINUNI 8 NOIlVONnoi Z N0110nHISN00 S1N3WldVdV _— S3DI310 AIIWVj I1lnW _— S31210!S I A11WVj 31JNIS z L AONvd n 000 L G1033V JNiciins d� f REGULATIONS After obtaining the permit, there are three major areas in the stove installation process to consider. First, the stove; second, the chimney; and third, the actual installation. First: All new woodburning stoves installed in Massachusetts must be tested and approved to U.L. 1482.and/or U.L. 737 as appropriate. Used stoves may be approved by the building department or the fire department. Every solid fuel -burning room heater shall bear a permanent and legible factory -applied label containing at least the following information: 1. Manufacturers name and trademark —Fro_, , 1 +-r L�_a 2. Model and/or identification number of the appliance 3. Type of fuel(s) approved 5 4. Testing laboratorys name or trademark and location a-rt(,��'74 � 3, 5. Date tested 6 /1LIM p�8� C % 6. Clearance to combustibles a. Side 3 b. Rear` e� y 7. Test standard UL i a 71oue- 9a '7 v _- L)'- -71 % 8. Label serial number 77� y - Second: Existing chimneys should be checked for the presence of a flue liner and general structural condition. A smoke test may be used to determine if the draft is adequate, if the flue is without obstruction and if there is any smoke leakage. A visual inspection of the chimney is needed to check for creosote deposits, surface cracks or breaks, and if the damper is in good working order. The following two areas related to the chimney are important to inspect. The area where the chimney penetrates through the floor of ceiling joists should be checked to be sure that there is at least two inches clearance between combustible materials and the chimney. Third: Chimneys and chimney connectors shall be installed with the required clearances (see installation clearance table). The connector should be sloped upwards'toward the chim- ney and the connections overlapped upwards to prevent creosote leakage. A two inch clear- ance shall be maintained where insulated pipe penetrates a combustible wall, unless it is tested and approved for lesser clearances. A non-combustible hearth must be provided. Most stoves have legs and allow air to pass below; if the legs are not present, an air space below the non-combustible hearth must be provided. Clearances vary with circulating and radiant stoves. In general, a non-combustible shield should be installed with ventilation behind it for lesser clearances, no protection for large clearances, and if the wall is a concrete foundation wall, a minimum distance may be allowed. The following systems have been approved by the Construction Material Safety Board: Permaflue, Air Krete, Smi Exterior Insulation and Finish System, Supaflu, Thermo Crete, and IsoKaern. The code requirement for two inch air space is exempted from this type of lining because of its high insulating and refractory qualities. ti• 5 '� OOD STOVE INSTALL,�I ON CHECKLIST YLI?I.11'1' I10: Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited -to the stove installation and not to the stove construction. Stove A. New ✓ Used B. Type/radiant Circulating C. Manufacturer %i��)Bn CTitUfs lnd�slrfesLab.No. f.0 �0 �' �t2- Z.l' Name/Model No. r11oei d -71G Collar size Dimensions/ Height c7!p'/k aL ngth !`� `�" Width Chimney �� �a,- �k-�- A. New Existing ✓r B. Size (flue area) C. Other appliances attached to flue (Number and flue size) 10 �' rrAf4 D. Prefab (Manufacturer—name and type) E. Masonry/Lined Flue liner type b manufacturer) Unlined F. Height (refer to diagrams) cap OVER Ir Z tAIt`. CHIMNEY HEIGHT Hearth (non-combustible) Z,� A. Materials b" br,6, e B. Sub -floor construction u C. Minimum dimensions (refer to diagram) Clearances and Wall Protection (see stove installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE CORNER 12't Mitt 12" ,UIN. 18 f MIN. (FUEL,',4_<�H ��i c5y yll:� HEARTH WALVCENTER 13 780 CMR: STATE BUILDING CODE COMMISSION 1. Front: ruel or aSE+ access i1Ct. 2. Thimble required for passage through combustible construction. ), Non-combustible spacers required. 4. Clearances on each side of a radiant stove with a heat shield shall be measured as If a circulating type. I Figure 2109-4 (CLEARANCES FOR SOLID FUEL BURNING APPLIANCES 4"Brick Veneer CAP Material FACTORY -BUILT CHIMNEY Foundation wall ,Noor SUPPORT Radiant Steve 1. SUPPORT SRACReT NON-COMBUSTIBLE WALL PROTECTION s — CONNECTOR ►Ve A CONN CTOR OVERLAP _ I Circulating Stove 1. WOODBVRNINO STOVE A ' A It 3 i j'' \� AIR SPACE 12" y f � I$ L Is IB" 12^ NON-COMBUSTIBLE —Side/Back FLOOR PROTECTION STOVE INSTALLATION CLEARANCES 1. Front: ruel or aSE+ access i1Ct. 2. Thimble required for passage through combustible construction. ), Non-combustible spacers required. 4. Clearances on each side of a radiant stove with a heat shield shall be measured as If a circulating type. I Combustible 6" Asbestos Mtilboard Concrete/Masonry 4"Brick Veneer Stove Corgonents Material Spaced Out 1" ) Foundation wall SiDaced Out- „ Radiant Steve 1. j649 —Front Circulating Stove 1. 2449 —Front A. Radiant Stove 4. 36" IB" 6" 18'9 —Side/Back A. Circulating Stove 12" 614 614 600 — Sidef$ack B. Singlc Vert 2. Fate 1214 6,9 B,. Connector Pipe Insulatcd 2 " 211 211 211 Connector Pipe C. Chlaney Height Three (3) feet above ad)mcent roof and (Metal or Masonry) two (2) feet above an roof ride ..Ithln 10 feet If a damyer s notIncludedm e stove construction. . Dapper it must be Installed In the connector pipe. 1. Front: ruel or aSE+ access i1Ct. 2. Thimble required for passage through combustible construction. ), Non-combustible spacers required. 4. Clearances on each side of a radiant stove with a heat shield shall be measured as If a circulating type. I George Rose Georgetown Chimney Sweep 218 Andover Street Georgetown, MA 01833 (R6-14) 352-2222 Date' (o Name 6-Y) 6-1CL Address') V Q-st rte +1 t' s' �,. e- n h OE 'OVAUZED FLEXIBLE STAINLESS STEEL The first ovalized relining damper, hook up the system I7L-Li`s_ted-to the -1777] appropriate adaptors, boots, and Standard, HomeSaverT1 ra OvalFlex- is the superior done. ovalized pipe on today's market. It is manufactured to the same 1D� IS4E® 018"Q4;ply cerfi�ed 304:�> OvalFlex, RoundFlex, RectangleFlex (page 46), and %V to'08 avite gero Cleo, fd adaptors, insert boots, and 3 sgoc►dord quality and popularity. It also comes with a IiTefime u=arranty`., n h OE 'OVAUZED FLEXIBLE STAINLESS STEEL The first ovalized relining damper, hook up the system I7L-Li`s_ted-to the -1777] appropriate adaptors, boots, and Standard, HomeSaverT1 hardware pieces, and you're OvalFlex- is the superior done. ovalized pipe on today's market. It is manufactured to the same In fact, the whole system of 018"Q4;ply cerfi�ed 304:�> OvalFlex, RoundFlex, RectangleFlex (page 46), and ;stainless specs that have made UL7Listed RoundFlex (previous adaptors, insert boots, and pages) unsurpassed in both hardware pieces allows you to build whatever type of direct or quality and popularity. It also comes with a IiTefime u=arranty`., positive connect system you for woodburning applications. need. Just mix and match —it's modular in nature. See page 41 for warranty details. Please refer to "Typical With HomeSaver's 4%z" wide Installations" (page 50) for illustrations and other OvalFlex you don't have to tear out damper frames when important information. relining most flues. Just run OvalFlex is featured the OvalFlex through the o n page on page 53.1181 wye4 WN, a s4 we 218 DOVER STREET GEORGETOWN, MA 01833 6 1 `�.Pi�� UL 1 a 7 v L RD -7 �Go�- 4� � a-1 C� L �v z- 7�7 � \� \ /: � � � �§ \� -J� ��/��� .G ` J®{� <. �) t� x : �� �. , � � `\�A^� »t«\��� �;� �.y �� ��,..««;:. &�� � ���\��������\2z:w\2� � � � � �� : ®� , � \ :� . a \ � \ �� . .���®S!!©� �- �. � �y»��\\�\ �®. < �:y° � \ � �.22�Z _ : � 2«:� f�a � \��\.��� \' � � ' c � /� :/ � � � \�