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HomeMy WebLinkAboutBLD-19-002875 Office Use Only Of.YAR 411C 1 O f H g, 4,73 Amow: ' ,-fi4 3r�d4 a "/�'—1, if 7 7. Permit expires 180 days from ..;%- 1 issue date RECEIVED EXPRESS BUILDING PERMIT APPLICATI N TOWN OF YARMOUTH NOV 0 8 2018 Yarmouth Building Department 1146 Route 28 BUILDING DEPARTMENT South Yarmouth,MA 02664 By — f�(508)398-2231 Ext. 1261 4+/ A/A 0444-0/ /NIN CONSTRUCTION ADDRESS: 4 30 /Y er/ 4�K ,& �"fr1 AH f y ASSESSOR'S INFORMATION: «< ® / at Parcell �r M 4 ,e'' i y g Ate rmg OWNER: ��/ /� I/moi/A"A . VSo/41 4/1 Jel .? t 77 A vW � NAME / / PRESENT ADDRESS- / TEL II CONTRACTOR: L A / C& tCE G io et Aimee v C v A rn ye /°4 d a-s NAME MAILING DRESS TEL# Oe �AAt!est e .v re cv•c v/�o2'r' ryi en.- b c/G Residential 0 Commercial Est.Cost of Construction S.., ,�3 e 9 c 0 Home Improvement Contractor Lic.# "/O 6 G ,, i erConstruction Supervisor Lic.#�YYsaa.C' €/cp./ Worlcrx s Compensation Insurance: (check one) am the homeowner 0 I am the sole proprietor ❑ I have Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# WORK TO BE PERFORMED Tent Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# ° Replacement doors: # Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation Old Kings Highway/Historic Dist ( )Replacing like for like Pool fencing *The debris will be disposed of at /V if 4 kit C a/40 tux_ Cn, 0A- (9u-GPd egorbofFa '& aZ (ti//GN 4oticyL I declare under penalties of perjury that the statements herein tained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or tion of my license for p minion under M.G.L Ch.268,Section 1. l Applicant's Signature: _leje Date: Owners Signature(or aehment) Date: /�' Approved By: 0,0040K/ / < /gnee) Date: // 7�TJ . Bui ref( r designee) L ADDRESS: Zoning District: Historical District: 0 Yes ❑ No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes ❑ No 0 Yes 0 No The Commonwealth of Massachusetts t =--'_ f Department o tet , IndustrialAccidents s!Myl=3 g'I_ a 1 Congress Street,Suite 100 is — �" Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information � � / Please Print Lezibly �/Q.r�/D,L 7-le/ q !/? , Name(Business/Organization/Individual): / / n - •� Address: `T 2 b//��// 9/ AA N/G to/ / / City/State/Zip: -1 CS ,2/1,0 ati1�f- Phone#.� oe 114 3 r Are you an employer?Check the appropriate box: Type of project(required): 1.01 am a employer with employees(M and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3..0 I am a homeowner doing all work myself[No worker'comp.insurance required.)t 9. ❑Demolition 4,`-` I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition / ensure that ell contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions pmprietorswith no employees. 12.0 Plumbing repairs or additions 5.0 I as a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs These sub-contractors have employees and have workers'camp.Guurnnce.t 6.0 We are a corporation and its officers have exercised their right of exemption per Mat,a 14.0 Other 152,II(4),end we have no employees.[No workers'camp.iasu ance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy Information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the rub-contractors and state whether or not those entities have employees. lithe sub-contractors have employees,they must provide their workers'comp.policy number. _ I am an employer that is providing workers'compensation Insurance for my employees Below is the policy andJob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: 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 MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby card under the pd nalties of perjury that the information provided above is true and correct Sisnature: Atri 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: • • LARRCAR-01 KDOYI .A ORO• CERTIFICATE OF LIABILITY INSURANCE 0 09/119/2019/201 "`) 9` 08 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer lights to the certificate holder in lieu of suchp endorsement(s).N PRODUCER NRM€ACT Rogers 8 Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134Arc,No,ENR I WC,No):(877)816.2156 South Dennis,MA 02660 jtbitRIltsa:mail©rogersgray.com INSURERIS)AFFORDING COVERAGE NAIC X INSURER A:Main Street America Assurance Company 29939 INSURED INSURER B:NOM Insurance Company 14788 Larry Carbonneau INSURER C:Associated Employers insurance Company 11104 dba Stove Place II 2C Harold Street INSURER D: Harwichport,MA 02646 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AINSD SWVD POLICY NUMBER POLICYEFTPOIJCYEXP YY LIMITS A X COMMERCIAL GENERALLIABILRY INMIDWYYYYI IMM/DDM•YYI 1,000,01 EACH OCCURRENCE S CLAIMS-MADE O OCCUR X BPT2173L 1011012018 10/10/2019 PRMI Gsp%1SE mneel $ 500,01 MED EXP/Any one person) $ 10,0' • PERSONAL SADV INJURY $ 1,000,01 — GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2'000'01 POLICY❑jEa a LOC PRODUCTS•COMP/OP AGG $ 2,000,01 �lI OTHER: S B AUTOMOBILE LIABILITY Ca accidEED SINGLE LIMIT entl $ 1,000,01 �_ ANY AUTO X M9T1263K 10110/2018 10/10/2019 BODILY INJURY(Perperson) $ AUTOS ONLY X SCHEDULED PBOODILY INJURYTypg (Per accident) S X AUTOS ONLY X 'ORTS (PerOexitlenD MAGE E $ B X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 3,000,01 EXCESSLIAB CLAIMS-MADE X CUT1263K 10/10/2018 10/10/2019 AGGREGATE 3'000'01 DED X RETENTIONS 10,000 C AND EMPLOYERS'COMPENSATION - X STATUTE ERCITS ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X TBD 09/08/2018 09/08/2019 500,01 QQF�FICERNEM RPARTNER/E ❑N NIA E.L.EACH ACCIDENT S (Mandatory In NH) Et.DISEASE•EA EMPLOYEE $ 500,01 If yes.desalt.under - DESCRIPTION OF OPERATIONS below EL.DISEASE•POLICY LIMIT $ 500'01 - DESCRIPTOR OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addlaonal Remarks Schedule,may be aaach.d s mon space Y r.Rulred) Larry Carbonneau is covered by the workees compensation policy. . Certificate holder is an additional Insured if required by signed written contract with the Insured for General Liability. Eastward Companies Business Trust and/or Eastward Homes Business Trust and project owner together with their subsldaries,affiliates,employees,agents members and directors ATIMA are lister/las additional Insured If required by signed Written contract with the Insured for General Liability. CERTIFICATE HOLDER CANCELLATION\ • .. • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Eastward Companies THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 155 Crowell Rd. - ACCORDANCE WITH THE POLICY PROVISIONS. Chatham,MA 02633 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rights reserver The ACORD name and logo are registered marks of ACORD 4 n' • • • • ' e N ... Itc Commonwealth of Massachusetts DNision of Professional Licensure "Il Board of Building Regulations and Standards Co n strt.tettertlapervisor CS-015911W i, ••,... ires:03(07/2020 ,..____ ,- ":944 4 le. t LAURENCE DAROIDellit 484 LONG PON,CiRfttc. HARWICH ma cams t • . -,-; • ,‘ :...•-•`' . se _ -t. o--..,' Commissioner CL • • • . / ...Z romoweeutwaldiagackwraewiel4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR • TYPE indhAdual Regis EIRICIBISEI tiSfiraffit...; 11/02J2020 LARRY F CARBDTaft4J5t--r - ,...-.) =MI-rt'=-...; '•,. LARRY F.CARBONaCc 484 LONG POND OWE? ' ae.r—car.ei--- HARWICH,MA 02645.-t ' ,--: • Undersecretary • --- ''t-r-ltrver..--nr,";st.r.-rv#9,49_ . , rift ,: _:::. .% ,-,,,-E:.,.W.,,,,..4,,:t.,,,,w ma Qty7,:::: -L-- .: -ntisern-t 4,5:Vit.-. .. : 40, ' -v.-, 1 •Ir` d10,0- -4-°r"1;" -...7` -- --- --tuat---, ai-- • ----...•_ ,-..-_. --- _ r. __„ ..isittatifigierri • • ;' LI 4_ --,,,iiv i e zl zit , • 40 ''' FL"... ' n.• ii" 1'-,A' 4C,"efstAK:: t4i n, ,, \,- -: - ,v,ie.,, t,.-:-„,;:%=, - -•:;,•,- . - • ;.., k 1, A n C,- • •- “ . . T srw ace Stove Place II Invoice 2-C Harold Street [I HarwichPort,MA 02646 DATE INVOICE# HARWICH PORT (508)432-5977 (508)432-9873 - Fax 10/26/2018 14763 www.stoveplace.com -- BILL TO SHIP TO Joseph Tripp 430 High Bank Road South Yarmouth,MA 02664 P.O. No. TERMS SOLD BY Phone No. fee for returned checks 508-776-3055 QUANTITY DESCRIPTION RATE AMOUNT 1 Jotul F45 Greenville 55,000 BTU Matte Black 400 1,949.00 1,949.00T Pound,Front Loading Wood Stove Includes: Cast Iron Convection Sides Fully Lined Firebrick Firebox 1,500 Square Foot Heating Capacity 18" Log Length(front to back) 8+Hours of Bum Time Serial# Discount -10.00% -194.90 1 Blower Kit 354.00 354.00T (MUST BE USED WITH A REAR HEAT SHIELD WITH FIRELIGHT) 1 Ember King by A. J. Hearth Originals Type I - 278.00 278.00T Ember Protection EKS 44"x30" Hearth Pad Freight Charge 0.00 0.00 1 DuraTech 6" Tee w/Cap, Standard-SS 310.73 310.73T 1 DuraTech 6" Tee Support Bracket 284.30 284.30T 1 DuraTech 6"x18" Chimney Pipe 123.77 123.77T 1 DuraTech 6" Wall Thimble 112.50 112.50T 1 DuraTech 6" Extended Wall Support- SS 202.74 202.74T 2 DuraTech 6"x48" Chimney Pipe 283.61 567.22T 1 DuraTech 6"x24" Chimney Pipe 164.01 164.01T Thank you for your business! Total E-mail info@stoveplace.com Page 1 • • sti lace Stove Place II Invoice 2-C Harold Street • II" 8HarwichPort, MA 02646 DATE INVOICE# HARWICH rorty (508) 432-5977 (508)432-9873 -Fax 10/26/2018 14763 www.stoveplace.com BILL TO SHIP TO Joseph Tripp 430 High Bank Road South Yarmouth,MA 02664 • P.O. No. TERMS SOLD BY Phone No. fee for returned checks 508-776-3055 QUANTITY DESCRIPTION RATE AMOUNT 1 DuraTech 6" Chimney Cap 105.31 105.31T 1 DuraTech 6" Finishing Collar w/Adapter 56.42 56.42T (Adapts to Single Wall and DVL Pipe) 1 6" Black Pipe 30.00 30.00T 1 Permit Fees 100.00 100.00 Labor(2)Man Rate 675.00 675.00 1 DepositNISA -500.00 -500.00 Sales Tax Massachusetts 6.25% 271.44 V / li . . ij �' r t � t, Thank you for your business! Total E-mail info@stoveplace.com $4,889.54 Page 2 • :4 , ' 'fi • f • _ ice- er _.. ,yp v� - •' M � ' . . : , . . 7 ..... • ..\NLq, __ � *'• i_.• -- 411110-w. �4 ., 4 av 1\'' Nt c '. a :fit'F \ 'JS ,l� w ri:�, ' _ vn .___-&� \ .L� 460 \\, \ £ 11 - I, _t .,I. : ..., 4„„ ,.,4.. ,„. ikt...,.1„,‘ %,. i. A ' 1 -- r, , i t t_ i .,. : ::: - ' JE2.;, i'ilifitis : 's .-•• ,r, , - -t,,,,f ..- Y , r t,. F t it F � � • ( ;[ lF E FF ! ?" iC • L . it ,. t. ; .et 11 w, -."�,8 pp } - i � '411� • 1 ' • _ a ,iilti' � / 6 Customer Notes 11/6/2018 11:59 AM r Customer:Job Mahaney,John ontact: John Mahaney Phone: (508) 255-5650 \ Alt Ph ne: (203) 755-4326 John Mahaney 9 Doane Road East Orleans, MA 02643 Off Cape Address: 175 Sowest Road Waterbury, CT 06708 07/18/06 Jotul Katandin Blue/Black Enamel DV Natural Gas Insert Serial#7215 Joey&Kevin 09/04/08 - Kent Cleaned, serviced and replaced thermostat 07/08/10 -Kent Cleaned and serviced 10/14/14 -Kenny 4, Cleaned,serviced and adjusted shutter Paid $130.00 VISA 11/04/17 - Kent Cleaned and serviced ' $150.00 Page 1 139575 Rev_o8 F45 9/17 4.o Clearance to Combustibles -_` 2 5 c + " 4.i Floor Protection scm i-- The Bottom Heat Shield provided with the stove must be f= - " installed unless the stove is installed on concrete poured on 1 1 11,, s earth.See instructions in the Appendix on page 26. v I it The Jetul F 45 also requires one of the following forms of t. �� �, , hearth protection if not installed directly on concrete poured 1117 cm ,. ,h I � ,/4 on earth: ,e ; lI�`', tj 1) Any UL/ULC Typel,TypeII,orWarnockHerseyListedhearth »s� y� �, board. ' tj.W�le!:��9r"a r%�r% 16" ' 1 cDOORe �,ilk t, 40.6 cm 2) Any noncombustible material.. ' OPENINGT ;, q r' IN THE U.S:Floor protection must extend forward from the 8" door opening at least 16 In.and 8 in.from the sides of the 20.3 cm door opening.Protection must also extend 2 in.from the rear 30 and 2"to the sides under any horizontal chimney connector. 76.2cm This will result in a minimum floor protector measuring 27" wide x44"deep.See fig g. Figure g. Floor Protection minimum dimensions, U.S. IN CANADA:Floor protection must extend 18"from the front of the stove and 8 In.(46omm)from the sides and rear.It must also extend z In.(51 mm)under any horizontal chimney 5 cm connector.This results In a floor protector dimension of 39 in. f'f art litcq+ `v fit s'`?, 8" x 52 in.(99 cm x 5z cm) See fig.to. ,i7":<)(7442,142, did st' 20 cm bu �s4 il9li f 4.2 Clearances to Walls and Ceilings �2x The clearances listed and diagramed in this manual have i– ,4,4 , been tested to UL and ULC standards and are the minimum I clearances to combustible materials specifically established 52" for the JetulF45. 132 cm �`I i,'',!:./'. A combustible surface is anything that can burn(i.e.sheet rock, wall paper,wood,fabrics etc.).These surfaces are not limited to those that are visible and also include materials that are behind noncombustible materials.If you are not sure of the 4517 cm combustible nature of a material,consult your local fire officials. F Remember:"Fire Resistant"materials are considered 8' combustible;theyare difficulttoignite,but will burn. Also —' 2o9cml� "Fire-rated"sheet rock Is also considered combustible. 39" Contact your local building officials about restrictions and 99`m installation requirements in your area. Figure lo. Floor Protection minimum dimensions,Canada. See pages 12-13 for clearance requirements and diagrams. 4.3 Using Shields to Reduce Clearances In Canada,refer to CAN/CSA-B365,Installation Code for Double Wall Connector: Listed double wall pipe is an Solid-Fuel Burning Appliances and Equipment,also for acceptable alternative to connector pipe heat shields. acceptable materials,proper sizing and construction guidelines. Wall-Mounted Protection:When reducing clearances Notice:Many manufacturers have developed woodstove through the use of wall-mounted protection: accessories that permit clearance reduction.Use only In the U.S.refer to NFPAar1,Standard for Chimneys,Fireplaces, those accessories that have been tested by an independent Vents and Solid Fuel Burning Appliances,for acceptable laboratory and carry the laboratory's testing mark. Be sure materials,proper sizing and construction guidelines. to follow all of the manufacturer's instructions. 11 :.1 - 4' 739575 F45 3/7/73 3 4.6 Jotul F 45 Greenville Clearance Specifications UNPROTECTED WALLS PROTECTED WALLS PER NFPArt OR CAN/CSA-B365-M93 JO SIDE REAR CORNER SIDE REAR CORNER Single Wall Connector'' AB •C D E F• / 15"/381 mm 18"/4o6mm Tr128omm 5"/AT mm 4 /102 tint 3.5"/84 mm %Single Wall Connector G H' I J • K L 1 ,/ w/Flue Collar Heat Shield '15"/381 mm 10"/254 mm 11"/28o mm 5"/127mm 4"/102mm 3.5"/89 mm Double Wall Connector M N - O P O R •15"/381mm 6"/452mm 11"/28omm 5"/127mm 4"/1o2mm 3.5"/89mm Double Wall Connector S T. . U V W X w/Flue Collar Heat Shield 15"/381mm 6"/152mm 11"/.28omm 5"/127 mm 4"hoz mm 3.5"/89mm Alcovew/Double-Wall A B N/A D E N/A Connector 14"/356mm 17"/432mm 6"/152mm 7"/178mm 3 Figure/4. Clearance Diagrams.All specifications applicable to both top and rear exit configurations. e i. r.1 r." r.x:v.-ty .7:. Fk.+t,.w M"n' twtt namC nv- ....s.*nr«arn=e a fl ?hh 7r UNPROTECiEDWAISr11 ; 4 . � n K „,, iANaetr'tl �+ 1 6731mmj I oe mm J -� 1gmm 1e1/2m C i i Y 791/s' B 1 I ' ^t I 486 mm I �. C ET-slots —8Inn lard' SOB mm ��= 317 mm %I, Dr yv ,«-N„„w„ tns:i '1, . :..:"a rt nwt r-'-r . .i,, ',roKmn? 7.0A114-�z--t0'y _"'er'�..: