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HomeMy WebLinkAboutMiscellaneous - 55 LINDEN AVENUE 4/30/2018 55 LINDEN AVENUE 210/022.0-0038-0000.0 Date.....1.. '"..� ��.� NORTH "° TOWN OF NORTH ANDOVER • 'e p PERMIT FOR WIRING �,SSACMUS� This certifies that ... ... /. .S /��..........z .......................... has permission to perform .......... .1-./.7 n , wiring in the building of............... at........�.. �ii v ./l..5 .......................... North Andover,Mass. Fee..�.a..—".�.... Lic.No..l..7�q-- ............ �f ?.... LECTR[CALINSPECTOR r Check # 9070 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 71) Occupancy and Fee Checked, ---f V IF BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CM 12.00 (PLEASE PRWflV INK OR TYPE ALL INFORMATION) Date: O &1 0 City or Town of: NORTH ANDOVER To the Inspector Wi es: By this application the undersigned gives notice of his or er intention to perform the electrical work described below. Location(Street&Number) ;<- Owner or Tenantl U 1 LoS '6 a44 140s . Telephone No. Owner's Address -$ ygQyQ Is this permit in conjunction with a building permit? Yes No ❑ "(Cheek Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overheid❑ Und rd g ❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: f '� `fie/,( "�►;^� � �> ® vC, Completion of the followin table may be waived by the Inspector of Wires. ,r No.of Recessed Luminaires No.of Ceil: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- o.o Emergency Lighting d. d. Batte Units - No.of Receptacle Outlets 6 No.of Oil Burners FIRE ALARMS No.of Zones i No.of SwitchesNo,of Gas Burners No.of Detection and TotInitiatin Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: __......._....._..._.................__...._. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems: :! No.of Water No.of No.of Devices or E uivalent Heaters KW o.of Data Wiring: Si s Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total gp Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 2�o-luv ,cr'm . (When required by municipal policy.) Work to Start: 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 habili cc including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the pains andpenaldes ofperjury, that the information on this application is true and complete. FIRM NAME- v� �Z�i/C,,gt LIC.NO.: 4 /-4/44 , Licensee: -- Pf Signature LIC.NO.: (If applicable, enter "exempt"in t e license number line.) ' Address: Tel.No.:Bus. 0-4 *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: lt L cl.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 agent. Owner/Agent Signature Telephone No. PERMIT FEE. $-36 c1 P� Y ,� Ot �D �%- r� .. The Commonw as ealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street L. 4% Boston, MA 02111 c' www.massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AopGcant Information Please Print Legibly Name(Business/Organizadon/Individual): o Address: _ 7�® � r c-rs� ST LC � � J��`D 1-1-�,�-i y��ISt• �Z U� City/State/Zip: Phone5 I L S^ _� Are�Yon employer?Check the appropriate box: Type of project(regnired): 1. am a employer with 4, ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a.sole proprietor or partner. listed on the attached sheet.x 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity, workers' comp.insurance. q, ❑Building addition I "14 [No workers'comp,insurance 5. ❑ We are a corporation and its '. required-] officers have exercised their l0E&iectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[] Plumbing repairs or additions � myself,y [No-workers'comp, c, 1.52, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.❑:Other `Any applicant flair checks b00l must also fiil out the section below showing their workers'compensation policy information. t Homeowner;who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. lComtraetors that check this box must attached an additional sheet showing the name of the sub-c omractors and their workers'comp.policy infomuttion. I am an employer that is providing workers'compensation insurancefor my.employees: Below is the information. policy and job site Insurance Company Name:_ ATM , Policy#or Self-ins.Lie. /(� Expiration Date: f2 O a1 Job Site Address 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- 1 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 under the pai nalties of perjury that the information provided above ' true nd correct Si Lure: --------------- Date: Phone#: [6. only. Do not write in'bis area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector son: Phone#: 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 hire, 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 of the'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or 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 required." Additionally, MGL chapter 152,§25C(7)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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)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 Industrial Accidents. 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 nurnber.listed below. Self-insured companies should enter their self insurance 1.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 permitllicense 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-7274900 ext 406 or 1-8.77-MASSAFE Fax#617-727-7744 Revised 5-26-05 VVNVw,,mass.goV/dia Date. . TOWN OF NORTH ANDOVER/ 00 49 PERMIT FOR PLUMgjI4G � r a r SSACMUS� �. . This certifies that . . ./. a- . . ./ . . � `�`:. . . . . . . `has permission to perform . . . . . . . . ��. . . . . . . . . . . . . . . . . . plumbing in the bildings of t �. . . . . .--? .- --. . . . . . . . . . . . . . at .,`i', - ! . . . . . . . . North Andover, Mass. Zn Fee-�G. . . . . . Lic. No../,' Q PLUMBING/WCTI Check # // 8252 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location l�,,.� �if, Owners Name Date Permit# Type of Occupancy S? Amount New Renovation Replacement 1-3 Plans Submitted Yes No ❑ FIXTURES Cr x E a x w c A � a � ern�ctt f / 3MKJOCR au1HfM sm HIM sIx HJXR MFLOCIZ (Print or type) �V� \ Check one: Installing Company Name � Certificate ❑ Corp. Address u r 6o Partner. _ Business Telephone Firm/Co. 6 Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: 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 Signature Owner Agent I hereby certify that all of the details and information I ve submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and' stallations ormed under Permit Issued for this application compliance with all pertinent provisions of the Ma ac etts to Pltym ' tr GenerlL will be in / b Code an ter 142 of the General Laws. By: igna ure o icense um er Title Type of Plumbing License City/Town License um er APPROVED(OFFICE USE ONLY Master ® Journeyman ❑ The Co »vnanwealfh of Massachusetts 1 Deinartnrent of.industrhd Accidents $` O is e ..l`�, .1�" of InveslriQbatiorrs sa�. 600 FFja.shin.ton Street!� Boston c , , MAOZIIl Workers, Compensation Iusiu-ance Affirl Applicant Information Contractors/Electricians/Plnmbers Please Print Leeibl BITle (Business/prganjrabon/Individoal): A Address: Citysta&Zip: 0 Phone Are you an employer?Cheek.the appropriate boz: I. I am a employer with�� 4. ❑ I am 8 en Type of project(required):(full and/or * general contractor and I eRflire�: part-time).* have Mired the m&contmactors d. ❑New construction 2• i am.a.sole proprietor or partner- listed on the attached sheet i 7• Remo Ship and.haven de}m o em to ees g P Y Thes es v, ub-eontractots have Orkin forme a 8. g . . m Demolition. capacity. � rtlo airy n [No workers, � . �', workers imp,insurance. comp. insurance 5. ❑.We are a corporation and its 9' Building addition ' ���] officers have exert}sed their . 3 D 1 ain a homeowner do' 1 Q.0 Electrical repairs or additions m self, co all work right of exemption per MOL l 1. Y [No-Workers,s'comp, c, }� ❑ Plumbing repairs or additions }nsurance §I(4),and we have no required.]t .employees. [No workers' 12.0 Roof repairs "An �P• insurance uired. 13.[]Other Y ticarrt �q I aPA that dt ] erdts botC#I must also fill out the section below shovvin t Homeowners who submit this a'ffi'davit inti'c�tin th B their rk='aompensetiori poi' $CanMwWre that ch r g they ars doing all work land then hie outside con i; infomtation elk this box nwst attP , tractors must submit a new affidavit indi eh�sir additions.sheet trhowitrg•the creme of the sub- �such. I am,an etplvrer flint is ro contmctonr and their workers`cam...golf-irfnrmatior.. P ,W4r"r:warlcers compensa9ona insccranre or mfornratiom f any.employe= Below&r theo • P k and job site . Insurance Company Name: li Pocy#or Self-ins.Lie.#: . - f Expiration Bate: .lob Site Addres • S �� Attach a copy of the workers' urt City/Swazip. co pensation policy dec}ar-ation page(showing the policy number and expiration Failure to secure coverage as required under Section 25A of MGL C. 152 cart lead to the imposition o fine up to$1,500..00 and/or one-yew' f criminal Of up to 5250.00 a Y imprisonment, a well a civil penalties in the form of a STOP Wp1-K ORDER�a fine da3'against the violator. Be advised that a copy of this statement may be forwarded to the investigations of the DIA for ins Office of insurance coverage verification. I do nerdy cerfify nder the Si tore: p and penalties'ofPerjurY '*Wthe inform oa provided above is trice and rorred . Date: /o- 14i 'C) Phone#: 0°icial use only. Do not write is this area,>n be compler and by city or town o rxa( City or Town: Issuing Authority(circle one): Permit/License# I.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbingfns 6.Other pector Contact Person: Phone#: Information a nd Instructions. Massachusetts General Laws chapter 152 requires all emp 3oyers 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 hi - express or implied,oral or written." An employer is defined as"an.individual.,partnership,assOOiation,corporation or other legal entity,or any two Or More of thelbregoing engaged in a joint enterprise,and includirig the legal representatives of a deceased employer,or the receiver ortrustce-of an individual,partnership,associatiori or other legal entity,employing employees. 'iioweverthe owner-of a dwelling house having not more than three apa3-tments 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 enzpioyment 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 *o construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required" Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter intoany contract for the performance of public work- until-acceptable evidenc c of compliance with the insurance requiremertts of this chapter have been presented to the corttranting authority." Applicauts Please fill out the workers'compensation•affidavit complmtely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es).acid phone number(s)along with their certificate(s)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 UP 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'boe sure to sign and-date the affidavit. 'Che affidavit should be returned to the city or town that the.application for.the permit or license is being requested,notth. a Department of Industrial Accidents. Should you have any.questions regarding the law or if you are required to obtain a workers'• oompensation policy,please.call the Department at the nurmber.listed below, Self nzsured comprnim should enter their self insumnce-license number on the'appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes provided a space at the bottom of the affidavit for yon to fill out in the event the Office of lnvest ptions has to contact you regarding the applicant. Please be sure to fill in the permit/license number which%%-iIl be used as a.mference number. In addition,an appiicant that must submit multiple permit/iieanse applications in any given year,need only submit one affidavit indicating-current policyinformation(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of•the affidavit that has be=officially stamped or marked by the city or town may be provided to the applicant as proof that a valid afFidiivrt is on file for framr permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen i obtaining a license: or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidaviL The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, piease do not hesitate to give us a call. The Depamnent's address,telephone and fax number: The Commonwealth of Massachusem Depart mznt of Industrial Accidents Office of Lnvestisations 600 Washington Street Boston, MA 02111 TeL #617-727-4900 ext 406 or 1-9.77-MASSAFE Fax 4 617-727-774 Revised 5-2645 www.mass.gov(dia Date. . . . .. . . . . ,,0RTF, pf o= TOWN OF NORT ANDOVER 1 P PERMIT FOR GAS INSTALLATION s ° i SA US This certifies that . . . . . . . . . . . . . . . . has permission for gas installations� ��� . . . . . . . . . . . . . . . . in the buildings of .. -. . . . `. . . . . . . . . . . . . . . . . . . . . . atm . . . -�'-'. .�`` "i. '�., North Andover, Mass. Fee-R-09 Lic. No: . . . . . . . . . GAS INSPETOFC Check# - &� 6960 i l MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTIlVG (Type or print) Date NORTH ANDOVER, )MASSACHUSETTS Building Locations Permit# Amount$ Owner's Name l''t S Y2y2j::)c 5 New Renovation Replacement Plans Submitted U o a a W d x > w w z v w x W o q F . .. w a x �a �a w a V F W C'> U w z w > w z d a d a Oz 0 O W a O W H a > g a F o SUB -BASEM ENT BASEM ENT IST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or typeCheck one: Certificate Installing Company Name V ZD Corp. Address Partner. usmess Telep one C) Finn/Co. Y � �I;��Tame of Licensed Plumber or Gas Fitter .sc .a I14SURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1 No Ili If you have checked yes,please indicate the type coverage by checking theappropriate ro riate box. Liability insurance policy F' Other type of indemnity 13 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 application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 install ions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse I State Gas e and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber / -22z, City/Town Gas Fitter License Nurn5er Master APPROVED(OFFICE USE ONLY) Journeyman The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, 3"-02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name (Business/Organization/Individual): Address: - 3 tel/ l�'L City/State/Zip:` � rY�/ Phone#: -2 Are you an employer? Check the appropriate bog: Type of project (required I.[l�I am a employer with 4. ❑ I am a general contractor and I 6. F-1 New construction employees full and/or par(-time .* have hired the sub-contractors ( P ) 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working forme in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ 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 12.0 Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.[_ Other *..ay applicant that checks box#1 .._:also tilt 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 sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: _ Policy#or Self-ins. Lica#: t,•} ( ! Expiration Date: S, a Job Site Address: S J� Z,_Ji� lU->�_ City/State/Zip: /0,(Oa ,Q v 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 certi under ains and penalties of perjury that the information provided above is true and correct Signature: - Date: -Phone#: 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#: 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 hire, 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 of the foregoing engaged in a joint enterprise,and including the legal representatives of.a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartrnents 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 required." Additionally,MGL chapter 152, §25C(7)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-contractors)name(s), address(es)and phone number(s)along with their certificate(s)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 Industrial Accidents. 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 bum leaves etc.)said person is NOT required to complete this affidavit.. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth.of Massachusetts Department of Industrial Accidents Office of Invesfiptions 600 Washington Street Boston, MA 0:2111 Tel. # 617-7274900 ext 406 or 1-8.77-MAS:SAFE Fax 4 617-72.7-7749 Revised 5-26-05 wwm,.mass,Lov/dia Locationw/- No. �� Date NORTq TOWN OF NORTH ANDOVER 10- 9 t Certificate of Occupancy $ �'�s''••°'E<�' Building/Frame Permit Fee $ �""" sACHUS _a Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # F 18943(A8 / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBED O DATE ISSUED: SIGNATURE: Building Cominissioner/I r of Buildin Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ^� Ate-, Map Number Parcel Number i 1.3 Zoning Information: 1.4Property Dimensions: v ZoningDistrict Proposed Use Lot Area Fronto ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Reqiired Provide Required Provided Required Provided 1.5. Flood Zone Infomudion: 1.8 Sewerage Disposal System: 1.7 Wator supply M G L C.40. 54) Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSE IP/AUTHORIZED AGENT Historic District: Yes No m 2.1 Owner oF Record ^ / Name(Yrinff Address for Service: lU- 740 ew d M Signature ` Telephones 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number wn Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Con for Not Applicable ❑ A) ee S Company Name 1 111-- M m Registration Number rM Address A,) C00 -5 Expiration Date Z Signature/' Telephone G) I SECTION 4-WORKERS COMPENSATION(MLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No........❑ SECTION 5 Description of Proposed Work checkapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Akd ha2dm ov,f ancl 1 f SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ;, „t)FFICIAL FTSE fi}NLY-- Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 1 3 Plumbin Building Permit fee(a)x (b) 4 Mechanical HVAC 4. •---• 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT h as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. ' Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/A ent Date NO.OF STORIES SIZE I BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE V4ORTH T0VM Of ove r O r dover, Mass., � COCHICHE W ICK AoRAreo BOARD OF HEALTH Food/Kitchen Septic System ��e� � BUILDING INSPECTOR THIS CERTIFIES THAT... ....................................................:.................................... Foundation has permission to erect........................................ buildings on .a ...0 e.011 4 v...4400............................ Rough to be occupied as...............�ie�i'hI'l�Imo! / ....... ...... /1//�f'!prl� Ch�mn yeprovided that the person accepting this permit II in every respect conform tot erms of the apion on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN LATHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough ............ Service BUILDING INS Final Occupancy Permit fired to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. TOWN OF NORTH ANDOVER �'- OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 i>{rt7YU ✓'r Gerald A. Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: JOB LOCATION: Number Street Address Map/Lot HOMEOWNER V S/ &J/ 77( 02,-5 563 0 63 3 09 Y'9 Name Home Phone Work Phone r PRESENT MAILING ADDRESS 410&14 &,2 /V, City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption -VOOD STOVE INSTALLAI�ION CHECKLIST FI_'.!Ii!' IIU: 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. :1 Stove .� A. New Used B. Typelradlant Circulating C. Manufacturer r Lab.No. Name/Model No. Collar size 6 OlmensionsJHeight -2/ ;/A" Length __ o�J 31 � Width Chimney A. New Existing, B. Size(flue area) C. Other appliances attached to flue(Number and flue size) 0. Prefab(Manufacturer—name and type) E. Masonry/tined Flue liner Unlined wfa*A masulaclurerr F. Height(refer(o diagrams) cap avE�Ic' _. i 2' MIK Z `.11'y. 3 MIK o I �':•tltl. ' 18'btlN. HEARTH CHIMNEY HEIGHT Hearth(non-combustible) A. Materials B. Sub-floor construction )0nd C. Minimum dimensions(refer to ciaoraml Clearances and Wall Protection Isee stcve ins,allat:cn c!e=_rances chart) A. Type of wall protection provided B. Clearances(refer to diagrams) f FIREPLACE '� ORr1Ea wALVCENTER. ATTENTION -HOMEOWNER FOLLOW THESE CHIMNEY IVjAINTENANCE INSTRUCTIONS: INSTALLATION Vic" MAINTERANCE The chimney connector and Saf-T Liner should be inspected frequently during the heating season and cleaned annaally (more often if necessary) INSTRUCTINSW b ti by a professional, certified chimney sweep. The chimney should be inspected at least every 6 to, 8-weeks during the 1 Scu FVT LL116ame heating season and once prior to the season to determine if (1) a creosote STAINLESS STEEL CHIMNEY LINER or soot buildup has occured or (2) if some other mechanism has caused a failure of the liner system. To inspect and/or clean the'chimney, loosen the . " ~"` Sizes: four Tek screws with-a nutdriver and remove the rain cap. If creosote or soot 4'95",6",7",8" has accumulated, have the chimney professionally,cleaned-to reduce the Diameters risk of a chimney fire. ti "� 9",10°,12",14"Available Properly installed and well maintained stovepipes anis chimneys' can , : The Heat-Fab Saf-T Liner system is intended for use in conjunction usually withstand an occasional moderate chimney fire, but the..intentional with any residential building, heating 'appliance burning gas, liquid 7 or solid fuels, such as a woodstove, fireplace insert, or an oil or setting of a chimney fire to "burnout" the creosote=should be avoided. This ��- f gas fired central heating furnace, vented through masonry chim- is a dangerous method to clean a chimney and can cause severe damage Heys only. These heating appliances may not exceed the maxi- to chimneys, liners and'.possible damage to thd•structure of th"e house. r i mum continuous flue-gas outlet temperatures of 1000°F or cause condensation of corrosive acids on the liner, or create positive After any chimney fire always have the chimney system inspected by a pressures in the chimney system. knowlegeable and. certified. professional before any further use. The excessive heat during a chimney fire can crack chimney walls, and cause Saf-T Liner is a high quality U.L. tested and Listed stainless steel lining cracking, buckling, distortion and/or burnout in chimney liners. A chimney system designed for relining existing masonry chimneys. It satisfies liner damaged in such a way as to permit'leakage of flue gases should be code requirements as a substitute for 5/8" fireclay liners and has under- repaired or replaced, since there is a greater likelihood that a subsequent gone extensive testing to make it the leader in the stainless steel chim- chimney fire could spread beyond the confines of the damaged flue to the Hey lining industry. Heat-Fab recommends that the installation of Saf-T u house itself. If no such damage is visible'the chimney system, installed per, Liner be performed by an experienced professional who works with these instructions,- is suited for further, se subject to the inspection schedule outlined above. chimney and woodstove related products on a regular basis. Saf-T Wrap is a safe, high quality, easy to install cerarr.ic insulation jacket for Heat-Fab,~Inc: 1988 stainless steel lined masonry chimneys. Saf-T Wrap when used in Printed in U.S. conjunction with Saf-T Liner will upgrade a chimney to an HT type chimney system. The following instructions are;intended as a guide to f assist a qualified professional installer. Check your local building codes and contact local building or fire officials to obtain any required permits. Warning: Incorporation of parts or materials not manufactured or „High-performance Chimneys and vents. supplied by Heat-Fab may not provide a Listed system. Order Heat- TURNERS FALLS, MASSACHUSETTS j Fab's installation videotape for further information, available in VHS (800) 772-0739 ' format. www.heatfab.com PI-LINER R0201 • r Repair all structural weaknesses before 2 inches SAFETY FIRST proceeding with installation of Saf-T Insulation Minimum Liner. „„„„„„„ , ,,,,,,, „ The National Fire Protection Association Standards Nos. 54 and CLEARANCE FROM COMBUSTIBLES 211 require the chimney to extend 10 Fe Air space clearances between the at least 3 feet above the highest Tet masonry chimney exterior and combus- point where it passes through the tible materials should be checked to Combustible roof, and at least 2 feet higher than 3 Feet verify that the chimney is in accor- framing 9 any portion of the building within C dance with the following clearance wall or 10 feet (Fig.1). specifications (Fig. 2). The minimum air space clearance between masonry The Saf-T Liner should not extend Fig. 1 chimneys and combustible materials more than 6 inches above the . shall be at least 1” for a UL Listed mason chimney. An additional flue liner height above the mason 1 Inch minimum masonry Y Y 9 masonry Installation. Fig. 2 chimney will create condensation resulting in the buildup of excessive creosote. DETERMINING THE LINER B DIAMETER Do not connect more than one solid fuel burning appliance to a single The Saf-T Liner must be properly sized chimney flue and do not connect gas or liquid fired appliances to chim- for your heating appliance. The diam- ney flues serving a solid fuel burning appliance. eter of the Saf-T Liner for a single appliance shall not be less than the Wear eye protection and heavy gloves throughout installation. Wear diameter of the appliance flue collar or F7A, . eye protection and dust respirator whenever in contact with creosote, that specified in the appliance soot, mortar or insulation. Caution must be used when working on a manufacturer's instructions. Measure Area A roof. Proper and safe scaffolding should be used for a safe installation. the dimension of the chimney opening 1/10 Area B All ladders should be secured to the building. Check overhead for at its smallest point (Fig.3). Take the antennas, power lines, or other obstacles before erecting the ladder and smaller of the two measurements installing liner. (A&B) and deduct 2” to arrive at the maximum diameter of Saf-T Liner that CHIMNEY PREPARATION may be installed. Saf-T Liner may be Lay out ground cloths to protect the inside of the home before sweeping installed in any chimney with an inside Area B Fig. 4 the chimney. Clean and remove all tar glazed creosote and soot depos- diameter greater than 7"x7" and con- ited on the internal chimney walls, and smoke chamber of the fireplace, failure to throughly clean the chimney before installing a new liner structed of 4” thick nominal solid or cored, brick or masonry. When using I system may lead to fire and or smoke damage to the home. Always Saf-T Liner to vent a fireplace, the cross section opening of the flue shall use a dust respirator when in contact with soot and creosote. not be less than 1/10th of the face area of the fireplace opening, to insure proper draft (Fig. 4). Custom rectangle or square Saf-T Liner is available Inspect the chimney for the following structural weaknesses before it is for flues which will not fit the required size round liner. lined: • Loose or eroded mortar DETERMINING THE TOTAL LENGTH OF SAF-T LINER • Cracks in the masonry Saf-T Liner is recommended for use in chimneys measuring in height from • Missing bricks 8' to 80'. • Internal obstructions that could inhibit installation Non-Fireplace Chimney Measure the length of the chimney flue to determine the length of liner length subtract 14 for each -Calculate the number of fixed and/or telescoping lengths required to line needed by utilizing a tape measure. From this length the chimney and extend not more than 6" above the termination of the tee required. It is recommended that Saf-T Liner be installed with an accessible clean-out tee that will facilitate easy cleaning and maintenance masonry (Remember each fixed length's measurement must be reduced by 2" to account for overlap of each section) of the chimney system. One tee will be required for the appliance, as well -Determine the number of fixed or telescoping lengths between the as a tee at the base of the Saf-T Liner as a clean-out. Determine the appliance tee and the clean out tee (if required). distance between these two tees and then the distance above the appli- ance tee to the top of the chimney. The liner assembly will be supported DETERMINING THE AMOUNT OF SAF-T WRAP INSULATION by the tee take-offs and the clean-out tee resting on non-combustible Saf-T Wrap is available in tee sections and 24" lengths, therefore two material. lengths will be required for each 4' section of Saf-T Liner. Saf-T Wrap Hearth/Fireplace Insert Stove must cover the Saf-T Liner from the appliance tee or the top of the If installing a hearth or fireplace insert stove using an existing fireplace smoke chamber area to within 8 but not closer than 3 of the top of the chimney, the length of rigid Saf-T Liner required will be the distance from masonry chimney. the chimney top to the top of the smoke chamber. Listed stainless steel ASSEMBLY MATERIALS REQUIRED Chimney Liner components, an engineered Direct Connect Assembly or any other method approved by the local building authority will be required- The following tools and supplies are needed to complete the installation to pass through the smoke chamber/damper area to the appliance flue of the Saf-T Liner System: collar. The liner assembly will be supported from the top of the chimney. -Hammer •1/8" or #30 high speed drill bit The installer must verify that there is at least 1 inch clearance to combus- .Rope -Bag of mortar mix tibles outside a 3" nominal layer of masonry as well as 1 inch clearance •Mortar pan -Screwdriver from the masonry to the connector inside the smoke chamber area for the .Eye protection -Cold chisel entire length within the smoke chamber area. -Masonry drill bit -Electric or hand drill Fireplace -Ladder and staging -Tin Snips When lining an open fireplace, the total liner length will be the distance *Trowel *Duct tape from the top of the smoke chamber to the top of the chimney. This liner •Pliers •Silcone caulking assembly will be supported from the top of the chimney. The liner may -Drop Cloth •Dust respirator (3M 9900, also be extended to the damper area if the smoke chamber area is in poor •Pop rivet gun 3M8710 or equiv.) condition. The installer must verify that there is at least 1 inch clearance to PRE-ASSEMBLY OF SAF-T LINER PARTS combustibles outside a 3" nominal layer of masonry to insure safe opera- In order to reduce unnecessary trips up and down the ladder, the liner tion of the fireplace. may be pre-assembled into sections 8-10' in length. These can be safely DETERMINE THE NUMBER OF LINER SECTIONS carried up a ladder to the chimney. However, always check overhead for Saf-T Liner is available in 12", 18", 24", 36" and 48" fixed lengths and antennaes, power lines, or other obstacles before erecting your ladder telescoping sections. NOTE: Two is the maximum number of telescoping ' and installing liner. Preassemble the Saf-T Liner on the ground and lengths which may be installed above the appliance tee. A telescoping check the overall length. REMEMBER- the small, crimped end is always section between the appliance and clean out tee will allow for both radial facing down and the arrows marked on each liner section are to point up. Using the high speed drill bit, drill through the pilot holes of one section and vertical adjustments during the installation. To determine the length into the crimped end of the next section. Pop rivet the liner into manage- and number of liner sections required complete the following: able lengths using the four rivets supplied. Non-Fireplace Chimney able bands fully extended, into the opening in the chimney making sure In the case of a straight chimney liner job, the clean out tee should be there is room to tighten the screw on the take off's retractable band. riveted to the first liner section and the tee cover attached to the tee. 5 Place either a telescoping section or slip connector and a liner section INSTALLING YOUR SAF-T LINER AND SAF-T WRAP INSULATION between the cleanout tee and the appliance tee to allow for expansion CAUTION must be used when working on a roof. Proper and safe and contraction of the system. scaffolding should be used for a safe installation of the Saf-T Liner. Always use a respirator and eye protection when using Saf-T Hearth/Fireplace Insert Stove Wrap. The appliance connector should be riveted to the first liner section with four opposing pop rivets. Non-Fireplace Chimney Carefully lower the first section of liner, consisting of cleanout tee body, ATTACHING LOWERING ROPE tee cover and first liner section for between the tees, until the top is The lowering rope should be attached to the first section of Saf-T Liner by about W-12" above the chimney top. Secure the lowering rope to the any one of many methods including, S hooks, duct tape or by riveting chimney top to prevent the Saf-T Liner from falling further into the loops into place on the liner. Use any method that will provide a secure chimney. Insulate the first section of Saf-T Liner with a 24" section Saf- hold on the liner and allow easy removal of the rope after installation. T Wrap by closing the snap-lock seam and crimping and slide it down to form a continuous enclosure of insulation. Attach the next liner section When using telescoping sections, it will be necessary to attach an addi- to the one in the chimney and rivet the two sections together with four tional length of rope that will drop to the base of the chimney flue. This opposing rivets. Repeat these procedures rope will extend the telescoping sections as they are lowered into the until the liner section is ready to be guided Saf-T Liner chimney. through the retractable bands of the appli- . Section ance and clean-out tee take offs. Carefully OPENING THE CHIMNEY lower the liner system through the appli- NOTE: Wear eye protection and dust respirator. ance take off, then through the clean out An opening for the liner system will have to made for any existing chimney take off band until the cut out sections line without an opening. If there is an opening, it may need to be expanded in up. Secure the take off to the clean out tee order to insert the tee take off into the removable tee or accomodate the by tightening the retractable band. Return support system chosen. to the appliance opening and tighten the retractable band in the same fashion. Trim Saf-T Wrap To make the initial opening into the chimney, select a brick that is at the the last section of Saf-T Wrap as required Section level you want the stove pipe to enter the wall (at least 18" from unpro- so that it is at least 4" from the cover plate tected combustibles unless a listed wall penetration assembly or other at the top of the chimney. This will allow :. approved method is used). The wall penetration assembly must be above for expansion of the liner during normal the appliance. Drill a series of holes in the mortar around the perimeter of use. the brick with a masonry drill bit. Hearth Stove and Fireplace Insert Stove Saf-T Wrap Knock the remaining mortar surrounding the brick free with a hammer and Insulate the first section of Saf-T Liner with Tee cold chisel and remove the brick. Additional bricks are usually easier to a 24" section of Saf-T Wrap by closing the Appliance remove than the first one. snap-lock seam and crimping. Slide the Tee Saf-T Wrap down until it abuts the top of ,- Non-Fireplace Chimney the appliance connector. Attach the next Repeat for clean out tee, being sure to maintain the distance between the sections of Saf-T Liner and insulate with Fig.5 two tees as originally planned. Position the two take offs, with the retract- Saf-T Wrap using the above procedures _ • r located directly behind the heating appli- until the desired height is acheived. Trim the last section of Saf-T Wrap ance. Note: When a listed or approved wall as required so that it is at least 4" from the cover plate at the top of the penetration assembly is not used, the single Rain Cap chimney. This will allow for expansion of the liner during normal use. wall connector pipe must be at least 18 Storm Collar from combustible construction materials. Cover Plate CLOSING THE CHIMNEY OPENING Non-Fireplace Chimney Clearances from the solid fuel burning Before closing the opening in the chimney, make certain that the Saf-T appliances to combustible materials must be strictly adhered to. Follow all local codes Wrap is positioned securely around the applaince tee. and appliance manufacturers directions Several brick halves and mortar will be needed to close in around the (Fig.7 next page). Saf-T Liner w/ take off. Rebuild the chimney using brick as square as possible. Fill I Saf-T Wrap mortar in tightly around the take off. Make sure that the starter section Hearth Stove and Fireplace Insert Stove fits smoothly into the takeoff before the mortar cures. Install the bottom termination of the liner system and appliance connector to the If desired a cover plate may be installed over the opening in lieu of filling appliance flue collar. (see Fig.6) with masonry. Attach the cover plate with four tapcon screws or other Complete the hearth stove or fireplace masonry anchors. insert installation per the manufacturer's INSTALLING THE COVER PLATE, RAINCAP AND STORM COLLAR instructions and guidelines. Place the coverplate on the top of the masonry chimney to create a dead air space around the Saf-T Liner system. Trim the cover plate to 4" After completing the installation of the larger than the outside of the chimney. Using tin snips, notch each appliance it is required that the initial firing corner 2" and fold each corner under 90 degress. Set the cover plate precautions of the appliance manufacturer's over the liner onto a bead of silicone caulk on the chimney top. Do not instructions be strictly followed. attempt to secure the liner with mortar or fasteners directly to the CHIMNEY MAINTENANCE masonry chimney top. There must be room for vertical expansion The chimney connector and Saf-T Liner of the Saf-T Liner due to the heating and cooling process during should be inspected frequently during the Appliance normal use. heating season and cleaned annually (more Connector Install the storm collar directly below the expanded portion of the liner by often if necessary) by a professional, certi- fiedtightening the clamp screw. The storm collar will then rest on the cover chimney sweep. Formation of creo- plate, supporting the upper sections of the liner system. Slide the rain sote and soot and the need for removal Appliance cap into the expanded portion of the liner and secure with the four self- occurs when wood is burned slowly, produc- Tee drilling screws provided. (see Fig. 6) ing tar and other organic vapors, which combine with expelled moisture to form INSTALLING THE APPLIANCE creosote. The creosote vapors condense in Non-Fireplace Chimney the relatively cool flue of a slow burning fire. The first section of stove pipe will connect to the tee take off, either As a result, creosote residue accumulates Tee Cover through a Saf-T Thimble or other listed and/or approved wall penetration on the flue lining. If ignited, this can make assembly. Any stove pipe connector used which is not open to plain an extremely hot chimney fire. view from the room must be made of stainless steel. The wall penetra- tion assembly must be located above the appliance and may not be Fig.6 The chimney should be inspected at least every 6 to 8 weeks during the Rain Cap woodburning season to determine if a Saf-T Liner Stainless Steel Chimney Liner Limited Warranty creosote or soot buildup has occured. Storm Collar � cTo inspect and/or clean the chimney, Cover Plate Heat-Fab, Inc. warrants to the original consumer purchaser that the Type 304 Saf-T loosen the four Tek screws with a Liner will be free from defects in material or manufacturer's workmanship when properly installed with Saf-T Wrap insulation pursuant to these manufacturer's nutdriver and remove the rain cap. If installation instructions and according to the local building codes,when used under creosote or soot have accumulated, normal conditions as connector pipe or chimney relining material for Wood Burning have the chimney professionally residential appliances Tested and Listed by a recognized laboratory, or site build cleaned to reduce the risk of a chimney Saf-T Wrap,-- masonry fireplaces and when inspected and cleaned by a certified professional at the fire. consumer's expense at intervals of no more than twelve (12) months, commencing from the date of purchase, as verified below.Type 316 Saf-T Liner will be free from A round-wire steel or Poly chimney these same defects when connected to coal burning appliances for a period of 10 cleaning brush is recommended to years. clean the Saf-T Liner. Heat-Fab does Saf-T Liner In order to obtain warranty service,the consumer must give prompt written notice of not recommend the use of chemical any defect to Heat-Fab,Inc.at it's current address or via e-mail to mail @ heat-fab.com. chimney cleaners which may be harmful Appliance Tee The sole responsibility of Heat-Fab,Inc.shall beto replacethose lengths of linerfound to the Saf-T Liner. After thoroughly to be defective upon return F.O.B. to the Heat-Fab factory. Heat-Fab, Inc. shall not cleaning the chimney re-install the rain be responsible for the cost of removing or installing the lengths which are subject cap by using the four Tek screws. hereto, nor shall it be liable for any special, incidental or consequential damages or expenses incurred by the consumer. WARNING! Do not use any This warranty gives the consumer specific legal rights, in addition to any other rights loose fill, cementious, or blan- which may pertain, which vary from state to state. ket insulation thicker than 1/4 Year 1 Maintenan]Done Year 2 Maintenance Year 3 Maintenance Year 4 Mainentance inch equivalent refractory Done by Done by Done by Done by- ceramic y ceramic fiber. These Products Date Date Date Date p Clean Out The void the Saf-T Liner and may I Year 5 MaintenanYear 6 Maintenance Year 7 Maintenance Year 8 Maintenance create unsafe conditions Tee Cover Done by by Done by Done by resulting in damage to the Fiii Date Date Date Date 9 9 ear ain e a ce • • - r maintenance. masonry chimney and/or the Fig. 7 Done by • . • . _ • . Done by liner system, Date Date Name Phone ( ) Address City, State, Zip Installing Company Address Phone( ) Date of Installation Installed by ' TM TRAVIS INDUSTRIES HOUSE OF FIRE Flush Wood Insert A Owner's Manual m y E d" � n Masonry Fireplace Insert Save these instructions �., for future reference 12,{ E u 1 SAFETY NOTICE: If this appliance is not properly installed, a house fire may result. For your safety, follow the installation directions. Contact local building or fire officials about restrictions and installation inspection spection requirements in your area. r, TrCiV/S IlldilStl" e5, InC. ©Copyright 2004, Travis i Industries, Inc. 4800 Harbour Pointe Blvd SWSted Mukilteo,WA 98275 $10.00 100-01157 `� , p '. 4041116 Tested to: U.L. 1482 i Introduction We welcome you as a new owner of a Travis Industries Flush Wood wood-burning fireplace insert. In purchasing a Flush Wood you have joined the growing ranks of concerned individuals whose selection of an energy system reflects both a concern for the environment and aesthetics. The Flush Wood is one of the finest appliances the world over. This manual will explain the installation, operation, and maintenance of this appliance. Please familiarize yourself with the Owner's Manual before operating your appliance and save the manual for future reference. Included are helpful hints and suggestions which will make the installation and operation of your new appliance an easier and more enjoyable experience. We offer our continual support and guidance to help you achieve the maximum benefit and enjoyment from your appliance. Important Information No other Flush Wood appliance has the same serial number as yours. The serial number is stamped onto the label on the back of the appliance. Mai your Warranty-Card Today, and Save Your Bill 0Sale. This serial number will be needed in case you require To receive full warrant, Covera e, you viill needto service of any type. y 9 ".,.thI...ow evidence of the date you purchased your. appliance. Do"not mall your Bill;,of Sale to Model: Flush Wood Insert Wesu est that3 ou attach r Bi 99 ,_y, c,:you ll of Saie to this_ Serial Number: page.so that you..will have all the.information you need in:ode place should the need for service or information ',occur. 3 Purchase Date: Purchased From: NATIONAL We suggest that our woodburning hearth FIREPCE INSTITUTE products be installed and serviced by Elprofessionals who are certified in the U.S. by the National Fireplace Institute®(NFI) as NFI Woodburning Specialists or who are certified in Canada by d CERTIFIED Wood Energy Technical JyjftodEnergy ! w.nrcert10 Technical Training r�ea.m9 Training (WETT). w� �•<<. • • © Travis Industries 100-01157 4041116 General Information Maintaining Your Appliance Introduction......................................................2 Daily Maintenance(while stove is in use)................25 Important Information .........................................2 Remove Ash(if necessary)..............................25 Safety Precautions.............................................4 Clean the Glass(if necessary) .........................25 Features&Specifications....................................6 Monthly Maintenance(while appliance is in use).......26 Fireplace Insert Installation Door and Glass Inspection..............................26 Planning The Installation.....................................7 Creosote-Formation and Need for Removal ......2 Preparation for Installation..............................7 Yearly Maintenance............................................27 Packing List.................................................7 Touch Up Paint.............................................27 Additional Accessories Needed for Installation....7 Cleaning the Air Duct and Blower.....................27 Suggested Order of Installation........................7 Firebrick and Baffle Inspection.........................27 Installation Considerations..............................8 Door Parts............................................:...........28 Fireplace Requirements......................................8 Replacing the Glass.......................................28 Insert Placement Requirements............................9 Replacing the Door Gasket..............................28 ' Hearth Requirements .........................................9 Replacing the Door Handle..............................28 Blower and Electrical Parts..................................29 Masonry Fireplace Requirements..........................9 Drafting Performance .........................................10 Firebox Parts ....................................................29 Leveling Bolt Installation......................................10 Baffle Parts..................................................29 Flue Installation.................................................10 Baffle Removal.............................................29 Block-Off Plate Installation...................................11 Air Tube Removal&Replacement....................30 Surround Panel Installation..................................12 Brick Rmwal&mit.................................31 Face Installation................................................14 Warranty Re-Routing the Electrical Cord to the Left Side ........15 Warranty..........................................................32 Insert with Positive Connection.............................16 Listing Information Insert with Direct Connection................................16 ListingLabel .....................................................33 Operating Your Appliance Index . Safety Notice:...................................................17 Before Your First Fire.........................................17 Index...............................................................34 Door Operation .................................................18 BypassOperation..............................................19 Startinga Fire...................................................19 Adjusting the Burn Rate......................................21 AshRemoval....................................................21 Blower Operation..............................................22 Re-Loading the Stove.........................................22 Overnight Burn..................................................22 Normal Operating Sounds...................................22 Hints for Burning................................................23 Selecting Wood.................................................23 Troubleshooting ................................................24 ©Travis Industries 100-01157 4041116 The viewing door must be Gasoline or other flammable closed and latched during a liquids must never be used to operation. start the fire or"Freshen Up"the fire. Do not store o e or use gasoline or other flammable Never block free airflow through aS liquids in the vicinity of this the air vents on this appliance. appliance. This appliance is designed and Ashes must be disposed in a approved for the burning of cord metal container with a tight lid wood only. Do not attempt to 0 and placed on a non- burn any other type of fuel other combustible surface well away ,R than cord wood in this ASHES from the home or structure. appliance, it will void all warranties and safety listings. Do not touch the appliance while Keep furniture, drapes, curtains, it is hot and educate all children wood, paper, and other of the danger of a high- combustibles a minimum of 36" temperature appliance. Young away from the front of the children should be supervised ss° appliance. when they are in the same room as the appliance. This appliance must be properly Contact your local building installed to prevent the officials to obtain a permit and possibility of a house fire. The information on any installation instructions must be strictly Uw restrictions or inspection adhered to. Do not useDk requirements in your area. makeshift methods or Notify your insurance company compromise in the installation. of this appliance as well. Inspect the chimney connector and chimney at least twice This appliance must be monthly and clean if necessary. Creosote may build up and 1'y connected to a listed high cause a house fire. Type C•,lay temperature(UL 103 HT) Linea residential type chimney or an Do not connect this appliance to approved masonry chimney with any chimney serving another a standard clay tile, or stainless appliance. steel liner. ©Travis Industries 100-01157 4041116 s • EMEMEMEEIMM Never try to repair or replace any part of this appliance unless , instructions are given in this Do not place clothing or other manual. All other work must be I C flammable items on or near this done by a trained technician. appliance..� Allow the appliance to cool Do not make any changes or before carrying out any modifications to an existing maintenance or cleaning. : masonry fireplace or chimney to install this appliance. i Do not make any changes to the appliance to increase combustion air. I Maintain the door and glass seal and keep them in good 111 ;. condition. - Overfiring the appliance may cause a house fire. If a unit or chimney connector glows, you Avoid placing wood against the ® are overfiring. glass when loading. Do not slam the door or strike the glass. Do not throw this manual away. Do not use a grate or other This This manual has important device to elevate the fire off of Manual operating and maintenance the firebox floor. Burn the fire instructions that you will need at directly on the bricks. a later time. Always follow the instructions in this manual. Travis Industries, Inc. grants no warranty, implied or stated,for the installation or maintenance of your appliance, and assumes no responsibility of any consequential damage(s). © Travis Industries 100-01157 4041116 • r • • r • Installation Options: Features: • Masonry Fireplace Insert • EPA Phase II Approved WARNING: Do not install this fireplace insert into a • 2.9 Cubic Foot Firebox Volume. Single Operating Control factory-built metal (Z.C.)fireplace. . Accepts Logs Up to 24" Long • Steel Plate Construction (5/16"& 1/4") • Heavy Duty Refractory Firebrick • Standard High-Tech Blower • Five Sided Convection Chamber Heating Specifications: Approximate Maximum Heating Capacity(in square feet)* 1,200 to 2,000 Maximum BTU's per Hour(Cord Wood Calculation) 73,300 Overall Efficiency(Oregon Method) 71.1 % Maximum Burn Time Up to 12 Hours *Heating capacity will vary depending on the home's floor plan, degree of insulation, and the outside temperature. It is also affected by the quality and moisture level of the fuel. Dimensions: 6"Diameter Flue Vent Weight 450 Lbs. 28-7/8" 5 5/81 21-1/4" u: A 21-1/2" WRI, ! 0 r � II NOTE: Clearances are x Electrical Line 20-1/2" (may be re-routed measured from the base to opposite side) of the fireplace insert. 1-1/4 Fireplace Opening Figure 1 Emissions: 4.1 Grams Per Hour(EPA Phase II Approved) ©Travis Industries 100-01157 4041116 SAFETY NOTICE: Please read this entire manual before you install and use your new room heater. Failure to follow instructions may result in property damage, bodily injury,or even death. Contact local building orfire officials about restrictions and installation inspection requirements in yourarea. Planning The Installation 0 We suggest that you have an authorized Travis Industries dealer install your fireplace insert. If you install the fireplace insert yourself,your authorized dealer should review your installation plans. 0 Check with local building officials for any permits required for installation of this fireplace insert and notify your insurance company before proceeding with installation. Preparation for Installation • Check for damage to the exterior of the fireplace insert(dents should be reported, scratches can be fixed by applying touch up paint). • Check the interior of the firebox(replace cracked firebrick and make sure baffle is in place). eThe fireplace insert can be lightened by removing the firebricks and baffle (pg 29)-replace before operation. Packing List • Touch-Up Paint • Leveling Bolts • (3) Chimney Brackets with (6)Tek Self-drilling screws (for attaching the flue to the fireplace insert) • (6) 10-24 x 1/2"Type F Screws (for surround panels) • (7) Spring Clips (for surround panels) • Rheostat(for blower) • Pull Tool for Bypass Additional Accessories Needed for Installation 1 Face(see your dealer for details-see pg 14) 2 Surround Panels(see page 12) Suggested Order of Installation 1 Remove the firebrick and baffle components from the fireplace insert(see pages 29 and 31). 2 Place the fireplace on the hearth 12"from the fireplace(on top of cardboard to prevent scratching). If power is on the left side, switch the power cord at this time(see page 15). 3 Install the side suround panels (see page 12). 4 Slide the insert into place (it should portrude 1-1/4"from the fireplace opening). 5 Hook up the flue (with the baffle components removed -this allows for access from within the firebox). 6 Install the top panel and trim. Then replace the firebrick and baffle components. 7 Install the face(see page 14). ©Travis Industries 100-01157 4041116 Installation Considerations aNOTE: Face Seal Connections are not allowed with this fireplace insert. Installation Type Considerations Insert with Positive Flue(Full Reline) • Provides best draft (Page 16) - Easiest to clean - Easiest to install Insert with Direct Connect Flue • Provides good draft (Page 16) • Requires fireplace block-off plate-see page 11 Fireplace Requirements Figure 2 shows the minimum size requirements for the type of fireplace used. Minimum Fireplace Size Masonry (cow" Fireplace a Height (front) 21-1/2" rho ro. �I eco b Height (rear) 21-1/2" j b`'St%bie c Width (front)* 30-7/8" J d Width (rear) 21-1/4" h e Depth 20-1/2" i sbi f Hearth Depth 17-1/4" bg Hearth Width 44-7/8" 9 N1 a "'' h Facing Width 46-7/8" r. .� d :' i Facing Height 39" C j Mantel Height 41-1/2" A vs t, , ti�e 9 * Includes 2" for power cord. Figure 2 © Travis Industries 100-01157 4041116 Insert Placement Requirements • The insert must be placed so that no combustibles are within, or can swing within (e.g. drapes, doors), 36"of the front of the insert Insert and hearth must be installed on a level,secure floor The minimum clearances,facing, and hearth requirements in Figure 3 must be met. Minimum Clearances k Sidewall to Insert 9" a b4sf'b'QM I Side Facing 9" m Top Facing* 39" Side bVsf�b/e Wall T n Mantel to Insert* 41-1/2" h j Aac�n9 Hr. o Hearth (Front) 16" F p Hearth (Side) 8" q Front of Insert 36" 3. " 3ni. ✓ark 7 x Extension onto Hearth 1-1/4" `P 6, Measure bus \X * Measure from the base of the q fireplace insert. Figure ure 3 Hearth Requirements ! Must extend 16"in front of the insert and 8"on both sides. Hearth must be built to UBC standards. Masonry Fireplace Requirements • Chimney must have a clay the liner or a stainless steel liner(positive connection) • Entire fireplace, including chimney, must be clean and undamaged. Any damage must be repaired prior to installation of the insert ! Chimney height: 15'minimum; 33'maximum. ! Entire fireplace, including chimney, must meet local building requirements I © Travis Industries 100-01157 4041116 Drafting Performance This appliance relies upon natural draft to operate. External forces, such as wind, barometric pressure, topography, or factors of the home(negative pressure from exhaust fans, chimneys, air infiltration, etc.), may adversely affect draft. Travis Industries can not be responsible for external forces leading to less than optimal performance. Leveling Bolt Installation Two leveling bolts are included to level the insert if the fireplace has a stepped-up hearth. To install, raise the rear of the insert up and insert the leveling bolts into the holes in the rear corners of the insert. Adjust the bolts until they extend the same height as the hearth steps up. After the insert is installed,fine-tune the leveling bolts to level the insert(see Figure 4). The leveling bolts The leveling bolts go into the holes should stick out at the rear corners this far from the of the insert. base of the insert. Fireplace xf Hearth j 7_ x, Figure 4 Flue Installation nom` Flue(flexible or rigid) Included in the owner's pack are three"flue brackets"and six self- drilling screws. Use these E components to secure the flue to the Flue Bracket fireplace insert. x Self-Drilling Screws W,M% o ., . Flue Opening Figure 5 ©Travis Industries 100-01157 4041116 i Block-Off Plate Installation Whenever this appliance is installed with a direct connection a block-off plate, or other non-combustible seal-off device(e.g. damper adapter),will need to be installed. This device is used to seal the chimney, insuring no smoke enters the home and providing the chimney system with a seal to promote draft. The directions below detail the steps for construction and installation of a block-off plate. 1. Determine a location for the block-off plate at the top of the firebox below the damper area (make it high enough to allow installation of the connection pipe). The location should be level and in an area where it can be mounted easily. Measure the width at the rear("A")and front("B") of the firebox at the height where the block-off plate will be installed (see Figure 6). Then measure the depth of the location where the block-off plate will be installed ("C"). 2. Make a cardboard template of the measurements, but add a 2"flange to each side. This flange will be used to mount the block-off plate to the inside of the firebox. Bend the flanges downwards on the template and place it inside the fireplace. If the template fits correct) in its planned P p y p ed location, go to the next step. If it does not, make a new template with the appropriate corrections until it fits correctly. Y 3. With the template in place, mark the location of the flue(see"Dimensions"on page 6). This location approximates the center of the flue when the insert is in place(a slight offset may occur based upon insert and block-off plate placement). Remove the template and cut a 6 1/4"diameter hole centered on this mark. 4. Make the block-off plate of 24 gage or thicker steel to match the template. Drill two holes in each flange for mounting the plate. 5. Mount the block-off plate using masonry screws. 6. Insulate the block-off plate using high-temperature fiberglass insulation (Kaowool®or equivalent) and furnace cement(allow the cement to dry for at least 24 hours before burning). 7. After placing the appliance and installing the pipe through the block-off plate, use high-temperature fiberglass insulation and furnace cement to seal any cracks between the pipe and block-off plate. Block-Off Plate Template 2"Flanges Measurement — Damper — (for attaching 'A" — the block-offer plate) fes. ;- WN Measurement See the _ N1, a dimensions to determine the location of the Measurement T' _ center of the Firebox —_ flue. See the dimensions to determine the location of the center of the flue. Figure 6 ©Travis Industries 100-01157 4041116 Surround Panel Installation The surround panels are available in two sizes shown below. Width Height Part# 8"Panels 45-1/2" 29-1/2" 99300240 10" Panels 49-1/2" 31-1/2" 99300241 12" Panels 53-1/2" 33-1/2" 99300242 FOR INSIDE FIT PANELS ONLY:the panels may be cut down to fit within the fireplace-see directions below. Do not cut more than 4" from each side panel. The rheostat is mounted into the side panel. It requires 1/8"and 3/8" 7/16" diameter holes to be drilled into the panel. Position the rheostat a 4"Min. minimum 3"away from the insert. 1. Before installing the side panels, position the insert over the hearth (not inside the fireplace). You may wish to place something under the insert to prevent scratching (cardboard). Install the side panels following the directions below. Attach the surround panels with the 6 screws included with the fireplace insert. HINT:Before installingthe panels,pre thread the holes in the side of the insert(use the self- threading screws). y Run the rheostat wires m �. behind the El ° ® surround panel `v Sb (cut the lock-tie holding them in place). Run the power cord behind the surround panel (cut the lock-tie holding it in place). ©Travis Industries 100-01157 4041116 2. Install the top panel following the directions below. installing HINT:Before g the top panel,position the insert in its final location(1-114"from the fireplace opening)and attach the flue to the insert. Slide the top panel into place. The joggle clips on the back of the panel insert over the tabs on the `. side panel and the flange on top of the insert. 3. Install the trim and rheostat following the directions below. Trim Installation: Insert one leg of each"L"bracket into the top and side P trim piece. Align the trim to form a precise comer,then Spring Clips tighten the two set screws with a small standard screwdriver. Slide the trim over the panels.Place the spring clips behind the panels at the locations shown. This keeps the trim tight against the panels. 9 9 Top Trim W Micro(1/16") Slotted Screwdriver Right Side Trim "L"Bracket Secure the rheostat using the included nut and star washer. The knob presses into place. Attach the rheostat wires (orientation does not matter). Knock-Out for Power Cord / A knock-out is provided on both sides the trim.Use pliers to remove the knock-out. This allows the power cord to pass under the trim. ©Travis Industries 100-01157 4041116 Face Installation There are several face options available for this fireplace insert. They all install with hooks that allow the face to be hung on the fireplace insert. Follow the directions below to install the face, bypass handle, air control handle, and door handle cover. Face Installation: The face has four hooks that hang cast-iron on the cast-ir tabs near the door hinges. When installing,make sure the hooks insert fully and lock into place. 3 . b Air Control Handle Un-Screw the air control handle(with rod)from the air control. Install the air control knob, bypass control knob, and handle shield following the directions below. Bypass Knob Screw the bypass knob onto the damper control rod. Handle Shield Installation Use the two nuts(included with the face)to secure the handle shield and emblem to the right side handle. A u €P NOTE: There may be a slight gap Air Control Handle between the emblem and shield Screw the air control handle after installation(this is normal). (with rod attached)onto the air control. ©Travis Industries 100-01157 4041116 i Re-Routing the Electrical Cord to the Left Side The power cord is connected to the right side of the insert when it leaves the factory. It may be re-routed to the left side following the directions below. Do this procedure before installing the surround panels. 1. Disconnect the molex connector and remove the power cord following the directions below. Disconnect the molex connector leading from the power cord. Rheostat Wires i Power Cord Use pliers to compress the strain relief from the top and bottom while pulling it out of the hole in the side of the insert. Leave the rheostat wires in place. Make sure the power cord is disconnected Prior to conducting these steps. Remove the power cord. 2. Connect the power cord to the left side following the directions below. Attach the molex connector on the power cord to the molex connector on the left side of the insert. Power y ' Cord r N I M Re-attach the strain relief to the left side(use 4 pliers to compress the strain relief from the top 0 and bottom while pushing it into the hole). Remove the button plug from the left side. ©Travis Industries 100-01157 4041116 loom Insert with Install a non-combustible �_ cover plate to prevent water Cap(prevents water Positive from entering the chimney from entering) Connection — NOTE: — Flue Liner Most factory-built I The liner must be chimney manufacturers - stainless steelconnector or flexible make stainless steel vent. Follow the liner chimney liners, either manufacturer's -> instu ctions for flexible or rigid. This msta`lation and provides a wide variety support. of installation options. _ Make sure to follow the - x manufacturer's Combustible Mantle instructions for Airtight Insulated — Clean-Out installation and — — support. — Surround Panels Remove damper _ or wire it open See the section"Insert Plapement Requirements"for minimum clearances and ... hearth required. — — I L I 1 I I I I I — Figure 7 Insert with Direct Connection Stainless steel chimney connector must Extend 1' _ _ past the block-off plate or to — Flue • NOTE: the flue liner Liner Direct connections require installation of I an airtight block-off plate or damper ;— adapter(see"Block-off Combustible Mantle Plate Installation"on Airtight page 10). Insulated Clean-Out Remove Surround Panels — , damper er or wire it i open See the section "Insert Placement Requirements"for "" _ Block-off plate or minimum clearances _ _ damper adapter and hearth required. — IF 1I ©Travis Industries 100-01157 4041116 Safety Notice: If this appliance is not properly installed, a house fire may result. For your safety,follow the installation directions. Contact local building or fire officials about restrictions and installation inspection requirements in your area. /A Read and follow all of the warnings on pages 4 and 5 of this manual. Before Your First Fire Verify the Installation Before starting the stove,verify that it is properly installed and all of the requirements in this manual have been followed. AKeep all flammable materials 36"away from the front of the stove (drapes, furniture, clothing, etc.). Curing the Paint 2 to 4 hours a � i j This heater uses a heat-activated paint that will emit some fumes while4 starting the first fire. Open doors and windows to the room to vent these fumes. This typically lasts two to four hours. You may also notice oil burning off of the interior of the heater. This rust-stopping agent will soon dissipate. Door Gasket-The door gasket might adhere to the paint on the front of the heater. Leave the door slightly ajar for the first fire and be careful when opening the door after the first fire. Over-Firing the Stove This stove was designed to operate at a high temperature. But due to differences in vent configuration, fuel, and draft, this appliance can be operated at an excessive temperature. If the stove starts to glow red (check the faceplate or inner top),you are over-firing the stove. Shut the air control down to low and allow the stove to cool before proceeding. j AOver-firing may lead to damage of plated surfaces. If you are uncertain of over-firing conditions,we suggest placing a stove thermometer(e.g. Rutland®Model 710) directly over the doors-temperatures exceeding 800° are generally considered over-firing and will void the warranty. © Travis Industries 100-01157 4041116 Door Operation /A The door becomes hot during use. Use a glove to open the door if the handle is hot. 0 To prevent smoke from entering the room, open the bypass before opening the door(see following page e for directions). You can also open the door a small amount and let air enter the firebox. Opening the Doors 3 $ d ee Rotate the right door handle down. Swing open the right door. Swing open the left door. Closing the Doors P NOTE:Make sure the door latch clears the left side door. Rotate the door handle upwards to secure the Shut the left door first. With the door handle pointing doors. down, swing the right door shut ©Travis Industries 100-01157 4041116 e ' o o ' oe • Bypass Operation The bypass controls the flow of smoke inside the heater. When pulled out, smoke goes directly up the flue, creating more draft. When pushed in,the smoke goes around the baffle, utilizing the secondary combustion and making the heater more efficient. • When starting or re-loading, pull the bypass out. • During normal operation, push the bypass in. Use the included pull tool to operate the bypass rod Bypass Pulled Out Used for starting and re-loading Joe .: Q 0 o s AV* n 9 x Bypass Pushed In Used for normal operation g1:79.F © Travis Industries 100-01157 4041116 Starting a Fire Since the dawn of time man has debated the best way to start a fire. Some use the boy-scout"tee-pee", some prefer the"tic-tac-toe"stack. Either way, review the hints and warnings below to ensure proper fire starting. • Make sure the air control is pushed in and the by-pass pulled out. If additional air is needed, open the doors 1/4"during the first five minutes of start-up. ,.i ✓, 5 l'r 3 Never use gasoline, gasoline-type lantern fuel, kerosene, charcoal lighter fluid, or similar liquids to start or"freshen up"a fire in this stove. Keep all such liquids well away from the stove while if is in use. /A If using a firestarter, use only products specifically designed for stoves-follow the manufacturer's instructions carefully. 0 If the smoke does not pass up the chimney, ball up one sheet of newspaper, place it in the center of the firebox and light it. This should start the chimney drafting (this eliminates"cold air blockage"). 0 Use plenty of kindling to ensure the stove reaches a proper temperature. Once the kindling is burning rapidly, place a few larger pieces of wood onto the fire. © Travis Industries 100-01157 4041116 •mums • ` • • Adjusting the Burn Rate Use the air control slider to control the burn rate of the stove. See the illustration below for details. Use the air control to change the burn rate. Low Burn High Burn (air control closed) (air control open) exv w R F �,� � . � > " � vis �j�i ✓� Approximate Air Control Settings: Overnight Burn Pulled Fully Out to 1/32" In Medium Burn 1/32"to 1/16" In Medium High Burn 1/16"to 3/16" In High Burn 3/16"to Pushed All the Way In The air control becomes hot during operation-use gloves or a tool to prevent burns. aThe air control may take several minutes to influence the burn rate. When making adjustments, you may wish to let the stove burn for 10 minutes to gauge performance. Ash Removal 0 Ashes should be placed in a metal container with a tight fitting lid.The closed container of ashes should be placed on a noncombustible floor or on the ground, away from all combustible ASHES materials, pending final disposal. If the ashes are disposed of by burial in soil or otherwise locally dispersed,they should be retained in the closed container until all cinders have thoroughly cooled. ©Travis Industries 100-01157 4041116 Emus. o • • e e Blower Operation The blower will turn on once the stove is up to temperature. This is typically 15 to 30 minutes after starting the fire. Follow the directions below to alter the blower speed. OFF HIGH LOW U w Tum the dial all the The high position is all the Turn the dial all way counter-clockwise way counter-clockwise, the way until it clicks off. without clicking off. clockwise. a�'tn3 sg C aThe blower may be used to affect heat output(i.e.:to reduce heat output,turn the blower down). /A Route the power cord in a location where it will not come in contact with the appliance or become hot. Re-Loading the Stove Follow the directions below to minimize smoke spillage while re-loading the stove. 1 Open the air control all the way (push it in). Open the bypass (pull it out). 2 Open the door slightly. Let the airflow inside the firebox to stabilize before opening the doors fully. 3 Load wood onto the fire. Overnight Burn This stove is large enough to accommodate burn times up to twelve hours. Follow the steps below to achieve an overnight burn. 1 Move the air control to high burn and let the stove become hot(burn for approximately 15 minutes). 2 Load as much wood as possible. Use large pieces if possible. 3 Let the stove burn on high for 15 minutes to keep the stove hot,then turn the air control to low. 4 In the morning the stove should still be hot,with embers in the coal bed. Stir the coals and load small pieces of wood to re-ignite the fire, if desired. aDifferences if chimney height and draft may lower overall burn times. Creaks and Clicks: Normal Operating Sounds The steel may creak or click when the stove heats up and cools down-this is normal. �// Blower Sounds: The blower will make a slight"humm"as it pushes air through the stove. ©Travis Industries 100-01157 4041116 ��fto', Y I I , ® • ® e Hints for Burning • Get the appliance hot before adjusting to low burn • Use smaller pieces of wood during start-up and high burns to increase temperature • Use larger pieces of wood for overnight or sustained burns • Stack the wood tightly together to establish a longer burn 9 Y 9 9 • Leave a bed of ashes (1/2"deep)to allow for longer burns • Be considerate of neighbors&the environment: burn dry wood only • Burn small, intense fires instead of large, slow burning fires when possible • Learn your appliance's operating characteristics to obtain optimum performance Selecting Wood • Dry Wood is Key Wet / r Wood Wood • Dry wood burns hot, emits less smoke and creates less creosote. Leads Leads �Yo / To Testing Wood Moisture ' • Split wood stored in a dry area will More J Less be fully dry within a year. This .4 � I i Heat ii, ,� I� ,� Heat insures dry wood. If purchasing wood for immediate use, test the ., LeadsLeads wood with a moisture meter. Some qO experienced wood burners can qO measure wood moisture by knocking pieces together and More Smoke Less Smoke listening for a clear"knock"and not and Creostoe and Less AM a"thud". Why Dry Wood is Key Wet wood,when burned, must release water stored within the wood. This cools the fire, creates creosote, and hampers a complete burn. Ask any experienced wood burner and he or she will agree: dry wood is crucial to good performance. Wood Cutting and Storage Cut wood to length and Store the wood off the ground in a chop into quarters. covered area. Allow for airflow around the wood to dry the wood. Air Flow �s 0 T6 45 �• O Air Flow Air Flow ©Travis Industries 100-01157 4041116 • ' i • • Q • Troubleshooting Problem Possible Cause Smoke Enters Room During • Open the bypass(pg. 19). Start-Up • Open the air control (pg. 21). • Cold Air Blockage-burn a piece of newspaper to establish a draft. • If the flame is not getting enough air, a small crack in the door is all that is needed. Kindling Does Not Start - Fire • Open the bypass(pg. 19). Smolders . Open the air control (pg. 21). • Not enough starter paper-use additional newspaper if necessary. • If the flame is not getting enough air, a small crack in the door is all that is needed. Smoke Enters Room While Re- • Open the bypass before opening the door(pg. 19). Loading . Open the air control before opening the door(pg. 21). • Let the air stabilize before fully opening the door. Then open the door approximately 1 inch. Let air go into the firebox for a few seconds. Once the smoke appears to be flowing up the chimney consistently, open the door. • Insufficient Draft-Chimney height and outside conditions can negatively affect draft. In these cases a small amount of smoke may enter the home. Adding more pipe or a draft-inducing cap may help. Stove Does Not Burn Hot Enough • Wood is Wet-see the section "Selecting Wood"on page 23 for details on wood. • Make sure the air control is all the way open. Slide the control back and forth to insure the control is not stuck. • Insufficient Draft-Chimney height and outside conditions can negatively affect draft. In these cases the fire may burn slowly. Adding more pipe or a draft- inducing cap may help. Blower Does Not Run • Stove is Not Up to Temperature-This is normal. The blower will come on when the stove is hot-usually 15 to 30 minutes. • Electricity is Cut to the Blower-Check the household breaker or fuse to make sure it is operable. Stove Does Not Burn Long • Depending upon wood, draft, and other factors,the Enough burn time may be shorter then stated. Make sure the doors are sealing and not allowing air into the firebox- See the section"Door and Glass Inspection"on page 26 for details. • Check the ash bed for coals. Often, coals are still glowing under a slight bed of flyash. By raking these into a pile you can re-start your stove quickly. ©Travis Industries 100-01157 4041116 /A Failure to properly maintain and inspect your appliance may reduce the performance and life of the appliance,void your warranty, and create a fire hazard. Daily Maintenance (while stove is in use) Remove Ash (if necessary) • Ash removal is not required q ed once it builds up. 1/2 to 1 of ash may y be desirable because It slows the burn rate. Generally, remove ash once it has built up over 1". Follow the directions below to remove ash. • Let the stove cool completely(at least two hours after the last coal has extinguished). • Place a cloth or cardboardrotector over p the hearth to catch ash and protect against scratching. • Open the doors and scoop the ash into a metal container with a tight fitting lid.The ASHES closed container of ashes should be placed on a noncombustible floor or on the ground, away from all combustible materials, pending final disposal. /A Improperly disposed ashes lead to fires. Hot ashes placed in cardboard boxes, dumped in back yards, or stored in garages, are recipes for disaster. 0 Wood-burning stoves are inherently dirty. During cleaning have a vacuum ready to catch spilled ash (make sure ash is entirely extinguished). aThere are vacuum cleaners specifically made to remove ash (even if the ash is warm). Contact your dealer for details. Clean the Glass (if necessary) This appliance has an airwash to keep the glass clean. However, burning un-seasoned wood or burning on lower burn rates leads to dirtier glass(especially on the sides). Clean the glass by following the directions below. Allow the stove to fully cool. Apply glass mY^`" cleaner or soapy water to the inside ofs the glass. Wipe with newspaper or a paper towel. I r�r, For Stubborn Creosote: Dip newspaper paper towel in cool PPer ora PP ashes and wipe it on the glass. The ash acts as a light abrasive. a m aThe glass will develop a very slight haze over time. This is normal and will not affect viewing of the fire. ©Travis Industries 100-01157 4041116 Monthly Maintenance (while appliance is in use) AMake sure the appliance has fully cooled prior to conducting service. Door and Glass Inspection aThe door can be lifted off the hinges if extensive repairs are conducted. Use wood stove gasket cement to re-adhere loose gasket. s a2 �^ High-Temperature anti-sieze The door must form ' may be used on the door an air-tight seal to the hinges to eliminate squeaks. firebox for the stove to work correctly. T �— Inspect the door x Fes. 9 e sure it gasket to mak forms an air-tight seal to the firebox. Severely frayed or thread-bare gasket should be replaced. ' Y If the glass is damaged,replace it-see"Replacement Parts"for details. Door Frame The door latch should pull the door against the face of the stove (but Door Cam not so tight as to not allow full handle rotation). If the latch requires tightening, remove a washer between the door cam and door frame. If the latch is too tight, Nut Q' add a washer between the door � cam and door frame. Washers >ff Door Handle Note flat portion on bottom of door handle shaft. Creosote - Formation and Need for Removal When wood is burned slowly, it produces tar and other organic vapors,which combine with expelled moisture to form creosote. The creosote vapors condense in the relatively cool chimney flue of a slow- burning fire. As a result, creosote residue accumulates on the flue lining. When ignited,this creosote makes an extremely hot fire. The chimney and chimney connector should be inspected at least once every two months during the heating season to determine if a creosote buildup has occurred. If creosote has accumulated, it should be removed to reduce the risk of a chimney fire. AIf you are not certain of creosote inspection, contact your dealer or local chimney sweep for a full inspection. Excess creosote buildup may cause a chimney fire,that may result in property damage, injury, or death. ©Travis Industries 100-01157 4041116 Yearly Maintenance /A Make sure the appliance has fully cooled prior to conducting service. Touch Up Paint Included with the owner's pack of this appliance is a can of Stove-Brite® paint. To touch up nicks or dulled paint, apply the paint while the appliance is cool. Sand rusted or damaged areas before preparation (use 120 grit Touch-Up sandpaper). Clean and dry the area to prepare the surface. Wait at least one Paint hour before starting the appliance. The touched up area will appear darker than the surrounding paint until it cures from heat. Curing will give off some fumes while curing—open windows to ventilate. Cleaning the Air Duct and Blower Use a vacuum to clean the air ducts (channels). This prevents dust from burning and creating odors. The blower(including blades)should be vacuumed every year to remove any buildup of dust, lint, etc. II , ,ra Remove the face. Use a vacuum cleaner to remove any debris or dust in the convection chamber or near the blower ry l s (WARNING:do not touch the blower blades). SKr 3 yf it Y � Firebrick and Baffle Inspection Use the illustration on page 29 as a reference for checking the following items. Make sure the appliance is cool before proceeding. Baffle Firebricks-check the bricks along the ceiling of the firebox to make sure they are intact and have no gaps between them. Slide the bricks to eliminate any gaps. Baffle Supports-make sure the front and back baffle supports in are place and not degraded. Slight scaling or rusting of the metal is normal. Secondary Air Tubes-Check the two air tubes and collars to make sure they are intact and not severely deteriorated. Slight scaling or rusting of the metal is normal. Make sure the pins hold the air tubes in place. Floor and Wall Firebricks -replace any severely damaged firebrick along the side or floor of the firebox. I © Travis Industries 100-01157 4041116 � • r 0 . � 0 0 • Door Parts 4 x, b� �� �~ ✓ $ice , 3 2 /! \\ 0 '`,�� f 6 s o gym. f 7 5 1 ! ! p 9 12 s 10 • ds ' i 8 O lle e ID# Description QtyPart# 6 113# Description Qty Part# 1 Door Gasket(3/8"Rope) 99900429 2 Door Gasket Cement 1 220-00147 3 Door Hinge Asbly-Lower Left 1 224-11096 4 Upper Glass Clip 2 224-23026 Door Hinge Asbly-Lower Right 1 224-11097 (with screws&9 asket) Door Hinge Asbly-Upper Left 1 224-11098 Lower Glass Clip 2 224-23025 Door Hinge Asbly-Upper Right 1 224-11099 ,;, (with screws&gasket) 5 1 Right Side Door w gasket 1 224-11101 " 6 1 Left Side Door(w gasket) 1 224-11100 7 Glass either side 2 173-01042 8 Glass Gasket(1/4"Rope) 224-11086 9 Wood Door Handle 2 224-14062 10 Left Door Handle Assembly 1 224-14055 11 Right Door Handle Assembly 1 224-14057 12 Door Cam 1 150-07108 13 Door Shield included with face Replacing the Glass /A The glass must not contact the door or glass clips directly. The glass gasket and glass clip gaskets isolate the glass to prevent contact with the metal components. Do not over-tighten the glass clips. Lay the glass gasket in the door frame(cut off excess gasket). Place the glass on the gasket. Secure the glass clips to hold the glass in place(make sure the glass clip gaskets are in place). Replacing the Door Gasket The door gasket is attached to the outer groove of the door using stove gasket cement. Before installing, remove any residual cement. Lay the gasket in place(start at the lower outside corner) and cut off any excess gasket(do not stretch the gasket).The cement fully cures with heat from the stove. You may need to open and close the door repeatedly to get the gasket to seat fully. Replacing the Door Handle See the illustration above for a component list(see pg. 28 for details on adjusting the door). ©Travis Industries 100-01157 4041116 Blower and Electrical Parts Description I city Part# nw d Description I city I Part# Left Blower 1 171-01010 Right Blower 1 171-01011 Blower Grommet and Spacer(4) 2 93005017 Rheostat 1 100-00122 Rheostat Knob 1 100-04111 Power Cord 1 100-00260 Firebox Parts Baffle Parts fy` y wr XV,rl.U"IN* W xc—kn ON-Al ID# Description city Part# ,y ID# Description Qty Part# 1 Sec.Air Tubes w Pins all 4 1 98900742 2 Air Tube Pin(w Screw) 4 3 Baffle Front 1 210-05342 ; 4 Baffle Rear 1 210-05343 5 Baffle Brick see page 31 r 6 Bypass Plate 1 221-12120 7 Damper Plate Assembly 1 221-12122 f4r!'�—w, 8 Damper Yoke 1 221-12123 9 Damper Rod Extension 1 100-11508 " Baffle Removal 1. Remove the face to prevent damage. Open the doors. • Remove the front two air tubes(see"Air Tube Removal & Replacement'on the following page). • Remove front baffle support(rotate it forward to disengage it from the rear baffle). • Remove front row of six bricks. • Unscrew the damper rod extension from damper yoke and slide it forward to remove (you may need to use pliers to unscrew the rod). • Lift the damper yoke up to disengage it from the damper plate. Remove the yoke from the stove (this requires some angling and rotation to remove). • Remove the bypass plate and damper assembly by pulling forward and leaning the front edge down. • Remove the four rear bricks. • Remove rear baffle by angling one side down and then removing at an angle through the firebox opening. ©Travis Industries 100-01157 4041116 r r • • � • 0 r Air Tube Removal 81 Replacement VIEW FROM THE FRONT VIEW FROM THE REAR Air Tube Air Tube Bolt Air Channel Air Channel Air Tube Bolt Air Tube Pin AIR TUBE REMOVAL .. �F 3/8"Wrench Loosen this bolt 2 or 3 Note how the center of the air tube pin turns(do not remove). inserts into a hole on the air tube. a With the bolt loosened the air tube can be slid out of the air channel. i 0 The pin will then disengage from the air tube (you may wish to rotate the tube slightly). f Pivot the air tube downwards and slide it out of the air channel on the opposite side. ©Travis Industries 100-01157 4041116 Brick Removal & Replacement Floor and Side Brick Baffle Brick O xl, O /A O E •� Q � � �R �€ 11 Do not pry the brick-they chip and crack easily Remove the floor bricks first. The side bricks are pinned in place by the floor firebrick. Clean the firebox prior to replacing the brick. Refer to the section "Baffle Removal"on a e 29 for details on removing the baffle bricks. 1D# Description Qty Part# ti..,: ," 1D# Description Qty Part# 1 Brick-Uncut 10 175-000012 s 5/a" 2 99900126 (4-1/2"x 9"x 1-1/4") (qty=1) 2-3/4" (notate size) Brick-Box of 9 98900102 A 4-1/2" box Of 9) - 91, 1-1/4"thick 3 113-5/8" 2 99900126 4 E 13-1/8" 1 99900126 s" 1-1/4"thick (notate size) :, v 9. 1-1/4"thick (notate size) 5 2-5/8" 2 99900126 6 7-3/8" 2 99900126 �1 (notate size) =1/4' � (notate size) 3/4"T3" 2-3/4" 9 1-114"thick8 1-1/4"thick 7 q13-1/e" 1 99900126N 8 5/a' 2 99900126 1-1/4"thick (notate size) �a-vr (notate size) 1-5/8" 1-1/4"thick M 9" 9 Large Brick-Uncut 4 99900127 « 10 4 3/8 1 175-00003 (4"-1/2'X5-3/8"X 2-3/8" ? 4-1/8j❑Ia v2" (notate size) I—� 2-3/8"thick ..,/_.. 11T 1 175-00003 3-5/8'T❑I4 (notate size) 11 5-/3 8 1 2-318"thick ; © Travis Industries 100-01157 4041116 To register your TRAVIS INDUSTRIES,INC.7 Year Warranty,complete the enclosed warranty card and mail it within ten(10)days of the appliance purchase date to:TRAVIS INDUSTRIES,INC.,4800 Harbour Pointe Blvd.SW,Mukilteo,WA 98275. TRAVIS INDUSTRIES,INC.warrants this gas appliance(appliance is defined as the equipment manufactured by Travis Industries,Inc.)to be defect-free in material and workmanship to the original purchaser from the date of purchase as follows: I Years 1 &2-COVERAGE: PARTS&LABOR Firebox Assembly: Ceramic Glass Re-Installation Allowance Firebox,Baffle Supports,Air Tubes,Air Channels,Convection Chamber Glass(breakage from thermal shock) In cases where healer must be removed from home Door Assembly: for repairs,a partial cost of re-installation is covered Solid Brass or Cast Door,Latch Assembly,Glass Retainers Firebrick (pre-authorization required) Plated Finish Breakage from thermal shock One-Way Freight Allowance Plated Door,Legs,etc... See"Conditions&Exclusions"#9 below. Accessories One-way freight allowance on pre-authorized repair Air Control Assembly Legs,Pedestal,Panels,Blower done at factory is covered. Slider Plate,Pressure Plate Exclusions: _ Paint.Gasketing Years 3 Through 5-COVERAGE: PARTS&LABOR Firebox Assembly: Door Assembly: One-Way Freight Allowance Firebox,Baffle Supports,Air Tubes,Air Channels,Convection Chamber Solid Brass or Cast Door,Latch One-way freight allowance on pre-authorized Air Control Assembly Assembly,Glass Retainers repair done at factory is covered. Slider Plate,Pressure Plate Exclusions: Paint Gasketing,Plated Finish Accessories(Legs Pedestal Panels Blower) Glass Firebrick Re Installation Allowance Years 6&7-COVERAGE: PARTS ONLY Firebox Assembly: Door Assembly: Air Control Assembly Firebox,Baffle Supports,Air Tubes,Air Channels,Convection Chamber Solid Brass or Cast Door,Latch Assembly,Glass Retainers Slider Plate,Pressure Plate Exclusions: Paint,Gasketing,Plated Finish,Accessories(Legs,Pedestal,Panels,Blower),Glass,Firebrick,Re-Installation Allowance,One- Way Freight Allowance Labor CONDITIONS&EXCLUSIONS 1. This new appliance must be installed by a qualified installer. It must be installed,operated,and maintained at all times in accordance with the instructions in the Owner's Manual. Any alteration,willful abuse,accident,neglect,or misuse of the product shall nullify this warranty. 2. This warranty is nontransferable,and is made to the ORIGINAL purchaser,provided that the purchase was made through an authorized Travis dealer. 3. Discoloration and some minor expansion,contraction,or movement of certain parts and resulting noise,is normal and not a defect and,therefore,not covered under warranty. Over-firing(operation where the steel may glow red)of this appliance can cause serious damage and will nullify this warranty. 4. The warranty,as outlined within this document,does not apply to the chimney components or other Non-Travis accessories used in conjunction with the installation of this product.If in doubt as to the extent of this warranty,contact your authorized Travis retailer before installation. 5. Travis Industries will not be responsible for inadequate performance caused by environmental conditions such as nearby trees,buildings,rooftops,wind,hills or mountains or negative pressure or other influences from mechanical systems such as furnaces,fans,clothes dryers,etc. 6. This Warranty is void if: a. The unit has been operated in atmospheres contaminated by chlorine,fluorine or other damaging chemicals. b. The unit is subject to submersion in water or prolonged periods of dampness or condensation. c. Any damage to the unit,combustion chamber,heat exchanger or other components due to water,or weather damage which is the result of,but not limited to,improper chimney/venting installation. 7. Exclusions to this 7 Year 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,damage incurred while the appliance is in transit,alteration,or act of God. 8. This 7 Year warranty excludes damage caused by normal wear and tear,such as paint discoloration or chipping,worn or torn gasketing,chipped or cracked firebrick,etc. Also excluded is damage to the unit caused by abuse,improper installation,modification of the unit,or the use of fuel other than that for which the unit is configured(use cord wood only). 9. Damage to brass or plated surfaces caused by fingerprints,scratches,melted items,or other external sources left on the surfaces from the use of abrasive cleaners is not covered in this warranty. Damage to the surfaces from over-firing(operation where the steel may glow red)is not covered in this warranty. 10. TRAVIS INDUSTRIES,INC.is free of liability for any damages caused by the appliance,as well as inconvenience expenses and materials. Incidental or consequential damages are not covered by this warranty. In some states,the exclusion of incidental or consequential damage may not apply. 11. This warranty does not cover any loss or damage incurred by the use or removal of any component or apparatus to or from the Travis appliance without the express written permission of TRAVIS INDUSTRIES,INC. and bearing a TRAVIS INDUSTRIES,INC.label of approval. 12. Any statement or representation of Travis products and their performance contained in Travis advertising,packaging literature,or printed material is not part of this 7 year warranty. 13. This warranty is automatically voided if the appliance's serial number has been removed or altered in any way.If the appliance is used for commercial purposes, it is excluded from this warranty. 14. No dealer,distributor,or similar person has the authority to represent or warrant Travis products beyond the terms contained within this warranty. TRAVIS INDUSTRIES,INC.assumes no liability for such warranties or representations. 15. Travis Industries will not cover the cost of the removal or re-installation of hearths,facing,mantels,venting or other components. 16. If for any reason any section of this warranty is declared invalid,the balance of the warranty remains in effect and all other clauses shall remain in effect. 17. This 7 year warranty is the only warranty supplied by Travis Industries,Inc.,the manufacturer of the appliance. All other warranties,whether express or implied, are hereby expressly disclaimed and purchaser's recourse is expressly limited to the warranties set forth herein. IF WARRANTY SERVICE IS NEEDED: 1. If you discover a problem that you believe is covered by this warranty,you MUST REPORT it to your Travis dealer WITHIN 30 DAYS,giving them proof of purchase,the purchase date,and the model name and serial number. 2. Travis Industries has the option of either repairing or replacing the defective component. 3. If your dealer is unable to repair your appliance's defect,he may process a warranty claim through TRAVIS INDUSTRIES,INC.,including the name of the dealership where you purchased the appliance,a copy of your receipt showing the date of the appliance's purchase,and the serial number on your appliance. At that time,you may be asked to ship your appliance,freight charges prepaid,to TRAVIS INDUSTRIES,INC. TRAVIS INDUSTRIES,INC., at its option,will repair or replace,free of charge,your appliance if it is found to be defective in material or workmanship within the time frame stated within this 7 year warranty. TRAVIS INDUSTRIES,INC.will return your appliance,freight charges(years 1 to 5)prepaid by TRAVIS INDUSTRIES, INC.,to your regional distributor,or dealership. 4. Check with your dealer in advance for any casts to you when arranging a warranty call. Mileage or service charges are not covered by this warranty.This charge can vary from store to store. © Travis Industries 100-01157 4041116 • e e Listing Label CONTACT YOUR LOCAL BUILDING OR FIRE OFFICALS ABOUT RESTRICTIONS AND INSTALLATION INSPECTION IN YOUR AREA Tested d SERIAL NO: aeaverlon Listed ey Oregon USA TRAVIS INDUSTRIES NOUS■OF FIRS OMNI-Teat Laboratories,Ina MODEL: Report No.028-S-54-2 Flush Wood Insert WARNING-DO NOT REMOVE THIS LABEL Listed Fireplace Insert for Installation Into a masonry fireplace only. A representative product sample of this model stove has been tested to meet UL 1482 Standards for safety.Install and use only In accordance with the manufacturer's installation and operation instructions.Check all local building codes.Install with a direct flue connector pipe or a full re-line.Do not connect this unit to a chimney flue serving another appliance. Do not remove bricks or mortar from masonry fireplace.The fireplace insert must be placed on a code-conforming masonry hearth extending 16"In front and 8"to the sides of the insert. For use with solid wood fuels only.DO NOT USE GRATE OR ELEVATE FIRE.Build fires directly on the fire brick.Operate only with the door closed.Inspect and clean chimney frequently.Under certain conditions of use,creosote buildup may occur raidly.DO NOT OVERFIRE.If heater glows,you are overfiring.OPEN DAMPER BEFORE OPENING LOADING DOORS!Maintain 36"front clearance to all furnishings and other combustible materials. DANGER:Risk of electric shock.Disconnect power before servicing unit. Electrical Rating:Volts-115 Amps-1.6 Hz-60. Note:Replace glass only with 5mm Travis Industries ceramic glass. CLEARANCE TO COMBUSTIBLES,MASONRY FIREPLACE INSTALLATION INSERT CLEARANCE DIAGRAM Minimum Clearance to Masonry MANT L Combustibles and Hearth Fireplace Requirements Installations J A.Sldewall to side o1 Insert 8" D O/ B.Side facing to side of Insert 9" ra C :/ C.Top facing(from base of Insert) 39" A B INSERT LL/ D.Mantel(from base of Insert) 41.5" Maximum Mantel depth Is 10" 6 16 Hearth Extension Front 16" HEARTH EXTENSION Hearth Extension Sides B" Manufactured By: � �TI,7VIS IIldL1sWes,Inc. 1W 4800 Harbour Pointe Blvd.SW Mulditeo,WA 98275 - U.S.ENVIRONMENTAL PROTECTION AGENCY Certified to comply with July 1990 particulate emission standards. Date of Manufacture 2004 2005 2006 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 0527 I © Travis Industries 100-01157 4041116 ' e - Air Control(Burn Rate)...................................21 Operation ....................................................17 Air Tube Part Number....................................29 Over-Firing the Stove.....................................17 Air Tube Removal&Replacement....................30 Overnight Burn .............................................22 Ash Disposal................................................25 Paint(Touch-Up Paint)...................................27 Baffle Parts..................................................29 Paint Curing.................................................17 Baffle Removal and Replacement.....................29 Re-Loading the Stove.....................................22 Blower Cleaning............................................27 Safety Label.................................................33 Blower Does Not Run(Troubleshooting) ............24 Safety Precautions ........................................4 BlowerOperation ..........................................22 Smell..........................................................17 Burn Rate....................................................21 Smoke Enters Room(Troubleshooting)..............24 Chimney Cleaning.........................................26 Sounds(Normal Operating Sounds)..................22 Chimney Inspection(Creosote)........................26 Starting a Fire...............................................20 Cleaning the Ash...........................................25 Stove Does Not Burn Long Enough...................24 Cleaning the Glass........................................25 Stove is Not Hot Enough(Troubleshooting) ........24 Clearances..................................................9 Table of Contents..........................................3 Creosote Check............................................26 Touch-Up Paint.............................................27 Daily Maintenance.........................................25 Troubleshooting(Operation).............................24 Dimensions..................................................6 Warranty Card..............................................2 Door and Glass Inspection..............................26 Warranty.....................................................32 DoorAssembly.............................................28 Wood..........................................................23 Door Gasket Replacement..............................28 Yearly Maintenance.......................................27 Door Handle Replacement..............................28 Door Opening...............................................18 DoorParts...................................................28 Draft Performance.........................................10 Emissions....................................................6 EPAApproval...............................................6 Features......................................................6 Fire Starting.................................................20 Firebox Assembly..........................................29 Firebox Parts................................................29 Firebrick and Baffle Inspection.........................27 Firebrick Removal&Replacement....................29 Floor Protection Requirements(Hearth).............9 Glass Cleaning.............................................25 Glass Replacement.......................................28 Hearth(Floor Protection).................................9 Heating Specifications....................................6 Hints for Burning...........................................23 Installation(planning).....................................7 Installation Options........................................6 Installation...................................................7 Listing Label.................................................33 Maintenance ................................................25 Masonry Fireplace.........................................9 Monthly Maintenance.....................................26 Noise(Normal Operating Sounds) ....................22 Opening the Door..........................................18 © Travis Industries 100-01157 4041116 Date..,?..... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING sS�CHU Thiscertifies that ....................................................................................................... has permission to perfonyi ..............I.......................................... 4)I - wiring in the building of......... �... ...... ........................................................ - ..................................<� at .................. ..j........................ .............4orthn Andover,M ss. r T Fee Lic.No. P30... ..... .. ........6. . . .. ........... ...... ........... ...... .... . I* L CTKICALINSPECTO Check# 1271 Commonwealth of Massachusetts Official Use Only a Department of Fire Services Permit No. 17/ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),127 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Ins ectot�of Wires: By this application the undersigned gives notice of hiy or her intention to perform the electrical work described below. Location Street&Number tet/ Owner or Tenant 11Q a d. s Telephone No. Owner's Address O-t Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the ollowin table m be waived b the Inspector of Wires. P f S may Y P No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA iAbove In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. grnd. 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 No,of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: "' "'"""'""""" """'............... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWLocal❑ Municipal ElOther Connection No.of Dryers Heating Appliances KW Security Systems:* No,of Devices or Equivalent No. of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent ' No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent " OTHER: v Attach additional detail if desired,or as regadred by the Inspector of Wires. Estimated Value of E c ical Work: (When required by municipal policy.) Work to Start: &r 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 coverae is . force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURA-NCE UY BONDE] OTHER ❑ (Specify:) I certify, under theWnsl; d enalties of per' ry,that the i tion on this application is true and complete. FIRM NAME: e -r, c �°Com' LIC.NO.:X030 Licensee: Signature LIC.NO.�,?,j 14e/— (If applicable,enter "exempt"i the icense um r line.) , Bus.Tel.Noll Address: , > Alt.Tel.No.: *Per M.G.L c. 147,s.Z61,security work requires Depaitment 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 agent. Owner/Agent F&RMITFEE.- $ Signature Telephone No. ❑ 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 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: t Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comm 4 Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com ..J The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip. Phone Are you an employer?Check the appropriate box: Type of project(required): [214 1. amemployer a with_� 4. El 6.I am a general contractor and I ❑ ' . New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.# ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. F1 Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 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' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they a-re doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. Jam 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.#: Expiration Date: Job Site Address: City/State/Zip: a GYM Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. Ido hereby cert" der f4epams and pen Ities of perjury that the information provided abo a is rue and correct. - Si ature: Date: / Phone#: 4 ^� 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#: r'' G ' r 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 hire, 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 of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or 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 required" Additionally,MGL chapter 152,§25C(7)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 certificate(s)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 maybe 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 Industrial Accidents. 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Mgssachvsetts Department of ZndusWal Accidents Office of havestigations 6.00 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass,govfciia J1 1 1 F }COMMONVyEALTH O ° F M • • A$SACHUSET T's . i BOAR n OF J.E. I C1 qNS :< ISSUES THE , E FOLLOWING Rf:GISTERED MASTERGELECT,RSE AS A ICC'ANlu KEir NNF7H q `,' ROUSSEL'LE 2 BEAN DEE"RF'Pt LDNH 030o2t J o 36004 4f,-.COMMONWEALTH OF MASSACHUSETTS e o o • • • g rn !. z B-)ARD''OF ELECTRICIANS ISSUES THE FOLLOWING LfCENSE A5 A REG JOURNEYMAN; ELECTRI,CI�AN ' /74 Y c7 .KENNETH A ROUSSELLE -, 2 BEAN .H LLL.ROAD 22 1 sDEERFIELD NH 03037 9 23640E 01/31/:;16 36003