HomeMy WebLinkAboutBld-20-003241 O .
Office Use Only
. } Permit#
Oi H Amount V—
'e WATT n 3St
<„w„�, ' Permit expires 180 days from
.:= C3U)—au— 3,.`� ( issue date
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(508)f 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: �G n�4J�1 KS 6 rroc ' i Y v oR(O l S
ASSESSOR'S INFORMATION:
Map: __!'YJ�L Parcel: C
OWNER: ,P LK gra.. > — eLt Qh f c� Co? ' U!iS i J 3
NAME , PRESENT ADDRESS TEL. #
CONTRACTOR: �E v 411- l►'t(� 14 ( ��toP A cOB— b -S%�5
J FY\f� O co LAD EL.#
esidential D Commercial �Est.Cost of Construction$ 5 CO
Home Improvement Contractor Lic.# t-5e1 �}`01 Construction Supervisor Lic.# 1 0 C4-1-7S
Workman's Compensation Insurance: (check one)
C I am the homeowner Vfam the sole proprietor I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy# Y'1 aL—
WORK TO BE PERFORMED
Tent Duration (Fire Retardant Certificate attached?) Wood Stove I/De 164
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: l dl .O 26Ve as2sA t C e-'iot 4 I r v-T oclS4
Location of Facility
I declare under penalties of perjury that the statements herein contained 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 vocation of my license and for prosecution under M.G.L.Ch.268,Section 1.
Applicant's Signature:« Aeirt, /7 Date: / a �
I _
Owners Signature(o achment) Ppa � I J� t Date:
Approved By: Date: /�747,/
Building fficial(or designee EMAIL ADDRESS:
Zoning District:
Historical District: Yes No Flood Plain Zone: Yes No
Water Resource Protection District: Within 100 ft.of Wetlands:
Yes No Yes No
6. 1 -ex tercrc 11'9
•
The Commonwealth of Massachusetts
_,c, ,_GJ
= Department of Industrial Accidents
.:ir'►l_ 1 Congress Street, Suite 100
44- Boston,MA 02114-2017
5,
www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Aoulicant Information I PIease Print Legibly
Name (Business/Organization/Individual): icy \ CJ qR ( rotvcq SLO )
Address: `6Lk C) 1 � LS /A-
1
City/State/Zip: ISOtiU D OThk)hone#: 66 2-- 18/*-5 5
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with employees(full and/or part-time).* 7. 0 New construction
2.f a sole proprietor or partnership and have no employees working for me in 8. Ei Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. ❑Demolition
10 0 Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.0 I am 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'comp.insurance.*
I
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[t ther i(1 �I ekQ4 IV15G�
152,§I(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that check box#1 must also fill out the section below showing their workers'compensation policy infbrmation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such.
*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ''n IN
Policy#or Self-ins.Lic.#: Expiration Date: rrN.0 --
Job Site Address: 1�Gr'vt�� � �[ City/State/Zip: tVrrlm.4-kk (YV 0A075
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 certify under the pains and penalties of perjury that the information provided above is true and correct
Signature:44,e I7 ' / Date: jo)- /S / 9
Phone#: 2 8 9— 5c
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#:
All C1eain
Chimney
Sweep
All Clean Chimney Sweep
154 Durfee Street
New Bedford MA 02740
I hereby authorize Michael King of All Clean Chimney Sweep to act on my behalf
in relation to the stove installation for the property located at,
7 Randolph Rd,Yarmouth MA 02675
This may include authorizing town permits, inspections, and other documents
relating to the aforementioned installation on my behalf.
Alex Bercelis
Printed Name
Signature
. //1 f' �'/J/!//l'////'/'I//./i
Office of Consumer Affairs & Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE: Individual
Registration Expiration
139909 09/03/2021
MICHAEL KING
D/B/A ALL CLEAN CHIMNEY SWEEP
MICHAEL W. KING
154 DURFEE ST L , �
NEW BEDFORD, MA 02740
Undersecretary
Commonwe.ilth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction-Supervisor Specialty
CSSL-100475 Expires: 06/14/2020
y .. a.
MICHAEL W KING 4 d- , •
, YaK
154 DURFEE STREET
�v W
NEW BEDFORD MA 02740
Commissioner
fiaMaPhR `C rrndUVIV(BoCCQ--‘ i S
Owner's Manua
Installation and Operation
INSTALLER: Leave this manual with party responsible for use and operation.
OWNER: Retain this manual for future reference.
NOTICE: SAVE THESE INSTRUCTIONS A WARNING
HARmAN® Please read this entire manual before
installation and use of this pellet fuel-
burning room heater.
Failure to follow these instructions could
BUILT TO A STANDARD, NOT A PRICE result in property damage, bodily injury
or even death.
MO e S : • Do not store or use gasoline or other flammable vapors
P35i Pellet Insert and liquids in the vicinity of this or any other appliance.
• Do not overfire-If any external part starts to glow, you
are overfiring. Reduce feed rate. Ovefiring will void
your warranty.
• Comply with all minimum clearances to combustibles
: as specified. Failure to comply may cause house fire.
A WARNING
HOT SURFACES!
Glass and other surfaces are hot during
operation and cool down.
•. 1 I .
Hot glass will cause burns.
• Do not touch glass until it is cooled
Pellet NATIONAL • NEVER allow children to touch glass
Fuels FIREPLACE
INSTITUTE O-TL
Institute .u...,�.,,•.,•.•.. • Keep children away
Ur
• CAREFULLY SUPERVISE children in same room as
stove.
ACAUTION • Alert children and adults to hazards of high temperatures.
High temperatures may ignite clothing or other
Check building codes prior to installation. flammable materials.
• Installation MUST comply with local,regional,state and • Keep clothing,furniture,draperies and other flammable
national codes and regulations. materials away.
• Contact local building or fire officials about restrictions
and installation inspection requirements in your area.
NOTE
ACAUTION To obtain a French translation of this manual, please
contact your dealer or visit www.harmanstoves.com
Tested and approved for wood pellets only burning of
any other type of fuel voids your warranty. When burning Pour obtenir une traduction frangaise de ce manuel, s'il
higher ash content pellets more frequent cleanings may vous plait contacter votre revendeur ou visitez www.
be required. harmanstoves.com
Save These Instructions Harman® • P35i Owner's Manual_R57 • 2010-_• 03/19 3-90-775
2 Listing and Code Approvals
A. Appliance Certification E. BTU & Efficiency Specifications
MODEL: P35i Pellet Insert EPA Certification Number: 964-14
LABORATORY: OMNI Test Laboratories, Inc EPA Certified Emissions: 1.5 g/hr
REPORT NO. 135-S-25-6.2 *LHV Tested Efficiency: 78%
TYPE: Solid Fuel Room Heater/Fireplace **HHV Tested Efficiency: 69.5%
Insert ***EPA BTU Output: 9,600-28,800
STANDARD(s): ASTM E 1509-12, ULC-S628-93, EPA ****BTU Input 12,800-38,400
Method 28&5G Vent Size: 4 Inch
- — Hopper Capacity: 41 Lbs (19-1/2" Hopper)
62 Lbs(23-1/2"Hopper)
The P35i Pellet Insert is certified to
comply with 2015 particulate emission ' EPA \� Fuel Wood Pellet
standards. Not approved for sale after CERTIFIED
Weighted average LHV efficiency using data collected
May 15, 2020. during EPA emissions test.
**Weighted average HHV efficiency using data collected
NOTE: This installation must conform with local codes. during EPA emissions test.
In the absence of local codes you must comply with the ***A range of BTU outputs based on EPA Default Efficiency
ASTM E1509-2004, ULC S628-93, (UM)84-HUD and the bum rates from the low and high EPA tests.
*"'**Based on the maximum feed rate per hour multiplied by
B. Mobile Home Approved approximately 8,600 BTU's which is the average BTU's from
This appliance is approved for Installation in mobile/ a pound of pellets.
manufactured homes. The structural integrity of the This wood heater has a manufacturer-set minimum low bum
mobile home floor, ceiling and walls must be maintained. rate that must not be altered. It is against federal regulations
The appliance must be properly grounded to the frame of to alter this setting or otherwise operate this wood heater
the mobile home, and must never be installed in a room in a manner inconsistent with operating instructions in this
designated for sleeping. The unit must have provisions for manual.
an outside air source when installed in a mobile home.
This wood heater needs periodic inspection and repair for
C. Glass Specifications proper operation. It is against federal regulations to operate
This appliance is equipped with 5mm mirrored ceramic this wood heater in a manner inconsistent with operating
glass. Replace glass only with 5mm mirrored ceramic glass. instructions in this manual.
Please contact your dealer for replacement glass if needed.
D. Electrical Rating
120 VAC, 60 Hz, 3.6 Amps (Start-up); avg. 1.5 Amps
(Normal Run)
4 Harman® • P35i Owner's Manual_R57 • 2010-_• 03/19 3-90-775
B. Clearances to Combustibles - Masonry or D. Minimum Opening for Masonry and
Manufactured Fireplace Manufactured Fireplaces
THE CLEARANCES SPECIFIED ARE FOR YOUR SAFETY!
THESE CLEARANCES MAY ONLY BE REDUCED BY
MEANS APPROVED BY THE REGULATORY AUTHORITY.
A
47 I
Mantel I Face Trim •
A
Illllllllg III III III G
3 IIIlll1111 111 III 111
'w L11111111I711111l111
w •
D• 1 /
III
�A • •lam AI. Location inches Millimeters
I I G Minimum Width 24 609
I I H Minimum Depth 14-1/2 368
a
•i I .
.
1
III I Minimum Height#1-70-774235 23-1/2 597
�-p—. E I Minimum Height#1 70-774195 19-1/2 495
Location Inches Millimeters E. Mantel Projections
A Insert to combustible sidewall 13 330 e j—it.
B Surround top to face trim 0 0
C Surround side to face trim 1 25
D Insert top to(max) 12"mantel 12 305
C. Floor Protection Requirements I
q K
Location inches Millimeters
E Door opening to front 6 152 Q T
F Door opening to side 6 152 .1 0 0 0 0 0 0 0I
Hearth extension must be of a non-combustible material. • •
It must extend beyond the appliance according to the
measurements listed.
Minimum Size Hearth Extension is 16" Deep By 32"Wide.
a
r-
. 11110111 —
The Maximum mantel depth (J) is 12" (305mm) with a
minimum vertical height(K)of 12"(305mm).
10 Harman® • P35i Owner's Manual_R57 • 2010-_• 03/19 3-90-775
D. Existing Fireplace Installation: Be sure to design the venting so that it can be easily cleaned.
The damper area must be sealed with a steel plate and it is Check with your local authority having jurisdiction to
recommended that Kaowoll, mineral wool, or an equivalent determine if this venting method is acceptable. Some
non-combustible insulation be placed on top of the sealed Provincial, State, or Local codes may require a full liner run
area to reduce the possibility of condensation. Insulation to the top of the chimney. Be sure and check your local
alone should not be used to seal the damper opening. For regulations before planning the installation. In this method,
quick and easy installation, purchase the steel Harman the proper flashing and rain cap are also required.
Block Off Plate, 1-00-25625.
You will also need to wrap the venting section between A WARNING
the insert frame and the damper sealing plate. This is to
prevent overheating of the fireplace cavity, which may Fire Risk.
cause damage to the insert's motors and other electrical
components. Inspect Chimney
The connector pipe should extend through the sealing plate • Masonry chimney must be in good
and smoke chamber and into, or beyond the first flue tile. condition
IN CANADA: This fireplace insert must be installed with • Meets minimum of NFPA 211 standard
a continuous chimney liner of a minimum 4" diameter • Factory-built chimney must meet
extending from the insert to the top of the chimney. The requirements of UL103 HT
chimney liner must conform to the Class 3 requirements of
CAN/ULC-S635, Standard for Lining Systems for Existing
Masonry or Factory Built Chimneys and Vents, or CAN/ When venting in this configuration,a rain
ULC-S640, Standard for Lining Systems for New Masonry cap and proper flashing must be installed on
Chimneys. the top of the chimney to prevent flooding
and damage.
a`,
c
J
a)
7 ►
u_
a>
s
11.
1�.
IIIIIIII
3-90-775 Harman® • P35i Owner's Manual_R57 • 2010-—• 03/19 15
E. The top of the chimney must also be sealed.
Otherwise,it can become a nesting area or a
NOTE: When installed in a rear vent configuration, the water trap.
maximum BTU may be reduced due to elevated ESP
temperatures associated with the horizontal exhaust stream.
IIigillI!gllI,
41--j-ill
If g
materialpassin,thethrough proper thimblecombustiblem the fro
lt.. 1
! likia :
.76,„7. ,.. ,.:
-i'i117 III' I vent manufacturer must be used.
iil
If installing using the optional zero clearance cabinet, Part
#1-00-774257, the venting will need to exit through the top111 Vertical Venting may be
of the cabinet. The vent can be vertical or horizontal after used in a constructed chase
leaving the cabinet. Once clear of the cabinet, a 90 degree providing all clearances to
elbow can be installed for rear termination as shown. Do combustibles are met.
not allow vent pipe seams to fall within the cabinet wall. Use
proper wall thimble as supplied by the venting manufacturer.
If finishing the interior with stone or masonry, the venting
can be installed without the appliance. Install the cabinet Proper wall pass-thru device
and secure the venting using the Flue Rough-in Support as recommended by the
#1-00-774283. venting manufacturer.
Notice the side edges of the surround contain slotted i
openings. These openings allow room air to be drawn An
'into the rear of the cabinet and circulated through the , - .
heat exchange and back into the room.These openings "can not be blocked. If finishing with stone or masonry ► i eihe` 3"Clearance
keep the masonry a minimum of one inch from the ammumiiw \
sides of the surround. Mortar can be used to give a 1 Vent pipe seams must be
more finished look. accessible.
Zero Clearance Cabinet
shown with Flue
Rough-in Support
16 Harman® • P35i Owner's Manual_R57 • 2010-_• 03/19 3-90-775