HomeMy WebLinkAboutbld-23-002657 AG
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"7C; I Permit# CAS
1Amount ID 6 O. op
• MA,r Acn CSC j
;.> Permit expires 180 days from
=`=+;=`" 'issue date
8 0—a 3 -n6002557
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH IRECEIVED
Yarmouth Building Department
1146 Route 28 NOV 14 2022
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261 -
BUILDING DEPARTMENT
Y
CONSTRUCTION ADDRESS: • ✓tea %
ASSESSOR'S INFORMATION:
�II Map: Parcel:
OWNER: JC SOlA€W4 RivAIoG✓i t, ritzI idatd .� s 1 Catlub k Z uct UJ.Yavr,4a y/44 'Sog sG�-Yirs-'
NAME 1 , PRESENT ADDRESS ) TEL. #
CONTRACTOR:
NAME MAILING ADDRESS TEL.#
esidential 0 Commercial Est.Cost of Construction$ i 006
i
Home Improvement Contractor Lic.# Construction Supervisor Lic.#
Workman's Compensation Insurance: (check one)
Wr I am the homeowner 0 I am the sole proprietor 0 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: YWY.tOJL (1C-) �►pl
Lo
(QD(0 re-54' well( Vorwt� M�d6-1 3
ation of Facility i
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 revocation of my license and for prosecution under M.G.L. I Ch.268,Section 1.
II i
Applicant's Signature: _ � Date: Y t I q 22- I
—
Owners Signature(or attachments Date: I(l 14 `t Z/
Approved By: Date:
Building Official sig EMAIL ADDRESS'
Zoning District:
Historical District: 0 Yes 0 No Flood Plain Zone: ❑ Yes 0 No
Water Resource Protection District: Within 100 ft.of Wetlands:
0 Yes 0 No 0 Yes , No
• '' The Commonwealth of Massachusetts
li_40111111/,
Department oflndustrialAccidents
ad 1 Congress Street, Suite 100
Boston, MA 02114-2017
',O.,-SV.', www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information 1 n Please Print Lezibly
Name (Business/Organization/Individual): 7J45c.:4" E A?y
Address: 2 ( CA4Akiii5 LAA
city/State/Zi 7 -
P � 5 %,✓lit l , .�tZl��?_� Phone #: 5 65�' Lv 1 `��5 S
Are you an employer?Check the appropriate box: Type of project(required):
1.D I am a employer with employees(full and/or part-time).* 7. New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling
any capacity. [No workers'comp.insurance required.]
3. I am a homeowner doing all work myself. 9. ❑ Demolition
y [No workers'comp. insurance required.]' _
10 Building addition
4.❑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 11.0 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.E Roof repairs
These sub-contractors have employees and have workers'comp. insurance.1
t
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other�,(/ (,� 5 r0�2_
152,§1(4),and we have no employees. [No workers'comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
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 certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature. Date: 11. I'd J '7 �
..
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#:
safety decal I 5
COPY OF SAFETY LABEL FOR F1100S
This is a copy of the label that accompanies We have printed a copy of the contents here NOTE: Regency units are constantly being
each Regency Small Freestanding Woodstove for your review. improved. Check the label on the unit and if
(F1100S). there is a difference,the label on the unit is the
correct one.
r 1
duplIate Serial number 100
LISTED SPACE HEATER,SOLID FUEL TYPE,ALSO DO NOT REMOVE THIS LABEL
SUITABLE FOR MOBILE HONE INSTALLATION/ NE RETIREZ PAS CETTE ETIOUE ' MINIMUM CLEARANCES TO COMBUSTIBLE MATERIALS BACKWALL
DEGAGEMENTS IINIMUMS AUK MATERIAUKCOMBUSTIBLES J
APPAREIL OE CHAUFFAGE AAIBIANT HOMOLOGUE • J
A COMBUSTIBLE SOUDE,CONVENANTAUSSI 100 WITH AIRMATE SHIELD WITHOUT AIRMATE SHIELD < A B E W
C US POUR INSTALLATION DANS UNE MAISON MOBILE l PLEASURE FLUE MEASURE FLUE — 8 ' l0 El
FROM HEATER CENTER-UNE FROM HEATER CENTER-UNE W
MODEL: F'r - F-F•.'il:^.c RESIDENTIAL INSTALLATION USING RESIDENTIAL INSTALLATION USING 0
Intertek TESTED TO:ULC S627. IUL 1462-2011 I UL 737 REPORT NO.6621 SINGLE BMU.CONNECTOR SINGLE WALL CONNECTOR 7 D Z DImm SIDEWALL I A330 /131n IDB35 mm/25 in SIDE-WALL A3M mm ITS In D6M mn/n A
BACKWALL B780 mm/11 in EMS mmI1T5in BACKWALL B 266nM 110.5in E 430 min/17b
INSTALL ANDUSEONLYINACCORDANCEWRMTHENLNUFACTURER'SINSTALLAROMAMOOPEAATINGIMSTRUCTTON9Iii
. CORNER C T06 mmIB In F 610 mmlEl In CORNER C ISO mm/it In F BM mmlal M BACKWALL V ❑
CONTACT LOGLBUILDING OR FIREOFFCNLS A BOUTBLACK ESTRICT BLUED LATION
RANITIONIN YOUR AREA INSTALLATION USING LISTED DOUBLE WALL INSTALLATION USING LISTED DOUBLE WALL -I 0
USE 150 MM(6IN.)DIAMETER MINIMUM I4 MSG BLACK OR 26 MSG BLUED STEEL CONNECTOR WITH LISTED UL103 HTFAC CONNECTOR•NOBLE MORE CONNECTOR-MOBILE HONE HI J
SEE LOCAL
THROUCHIMNEGH
SUITABLE FOR USE WITH SOLID FUELS OR CHIMNEYMASONRY CN CONNECTOR
SIDEWALL A 2M.,m 111 A D 6B6 mm/TJF-
SEE LOCAL BUILDING CODE AND MANUFACTURER'S INSTRUCTIONS FOR PRECAUTIONS REQUIRED FOR PASSING A I in RACRWIL A 330 men t31n D 316 mml&n (3` O D. ❑
CHIMNEY TIROUGHACORBUSTIBLEWALLOR CEILING.CO NOT PASS CNIMNEY CONNECTOR THROUGH COMBUSTIBLE BALKMMLL B 1M mml8 W E 110 mm111.5M gACKYMIt B 125 mmlb In E 190 mm111.5M UI
F11005 WITH WALLOR CEILING.DU NOT CONNECT THIS UNIT TOACHIMNEY FLUE SERVNGAMOTNFAAPPLIANCE. co
CORNER C1M mmI6 N1 F4B0 mm118 in CORNER CT30 mml9 in FGSA mm121n W _ N
AIRMATE SHIELD INSTALLER ET UTILISER SEULEM=NT SOON LES INSTRUCTIONS()'INSTALLATION ET D'UTILISATDN DU FABRICANT. INSTALLATION USING LISTED DOUBLE WALL INSTALLATION USING LISTED DOUBLE WALL — I G LI. ❑
OU CONTACTER LES RESPONSABLES DU BATINENT OU SERVCE-INCEN NE DE VOTRE REGION POUR CONNAITRE CONNECTOR.RESIDENTIAL CLOSE CLEARANCE CONNECTOR-RESIDE TiAL CLOSE CLEARANCE g
LES RESTRICTIONS ET EXIGENCES➢INSPECTION DANS VOTRE REGION UTILISER UN CONNECTEUR DUN DIAMETRF SIDEWALL A 210 min/9 T DEW mm121 In SIDEWALL A 346 mm11161n D WOmmIWU Inla
Q
MINIMAL DE 160 MI6 P01244 MSG EN ACIER NOIR OU 26 MSG EN ACIER BRONZE AVEC CHEMNEE PREFABRIQUEE BACKWALL B126 mm151n E290 min111.En BACKWALL B 125 mm15 In E 290 min111.6in
HOMOLOGUEE UL103 HT LONGUE POUR UTILISATION AVEC COMBUSTIBLES SOLIUESOU UNE CHEMNEE DE WGON. CORNER C 75 mml3 in F ODE mm116 in CORNER C 126 mm15 in F 430 mm117 b ADJACENT WALL
VORIE. INSTALLATION USING USTED DOUBLE WALL INSTALLATION USING LISTED DOUBLE WALL �j
V010.LE CODE W BALLERU LOCAL ET LES INSTRUCTIONSSANTDU FABRIGMT COMCERWMTAAU PRECAUTIONS
EXIGEES POUR INSTALLER UNE CHEMNEE TIIAVERSANT UN MIR OU PLAFOND EN MIITEAAUK COMBUSTIBLES.
CONNECTOR-ALCOVE CONNECTOR-ALCOVE
NE FARES PAS TRAVERSER LE DE CHEMNEE DANS UN NUR OU PLAFOND EN MATERAUX CORBUS. �EMNLL G MO mm111n I BM mm 21 I In SDEW 31 min
ALL G3n 113 1636 nm1151n WITHOUT BACKWALL H iD mm17 In J 3M mm113.5R1 BACKWALL H 125 mm16 In J 290 mm1116M ® j ❑
AIRMATE SHIELD TALES.NE RACCORDEZ PAS CE POELE A BONS A UN CONDUIT DE CHEMNEE DESSERANT UM AIME APPAREL. 0
MINIMUM ALCOVE CEIUNG HEIGHT:215 AAM M/7 FT MUM ALCOVE DEPTH H 5MM/34 IN. 03 F El
CLEARANCES FOR IOR12UNTAL CONNECTOR TO DEANS 4M MMl Ir FLOOR PROTECTION' g
TIE SPACE BENEATH THE NEATER MUST NOT BE OBSTRUCTED.OPERATE ONLY WITH FIREBRCKS N RACE PROTECTION DE PUNCHER.
FOR USE WITH SOLID WOOD FUEL ONLY USE OF OTHER FUELS WY DAMAGE HEATER AND CREATE A HAZARDOUS CONDITION.DO ROT OBSTRUCT COMBUSTION
AIR OPENINGS OPERATE ONLY WITH FIREBRICKS IN PLACE RISK OF SMOKE AND FLAME SPILLAGE,OPERATE ONLY VATH DOORS FULLY OPEN OR FULLY CLOSED. K 406 mm116 in re ❑
IF INSTALLED IN A MOBILE HOME OPERATE ONLY WTI DOORS FULLY CLOSED-OPEN FEED DOOR TO FEED FIRE ONLY.WHEN OPERATED WIN DOORS OPEN THE --PI M L 230 mml BA •In COMWLMM RRBMNSm NNW abEd 1r Worm) Q
MANUFACTURER SUPPLIED SCREEN MUST BE USED.DO NOT USE ORATE OR ELEVATE FIRE BUILDW000 FIRE DIRECTLY ON HEARTH.CO NOT OVERFRE-E HEATER M HIDmm IN' b BMNMNI6M 1'dW Rn)bURMItlb IMM tea al
OR CHIMNEY CONNECTOR GLOWS YOU ARE OVERFIRNG.INSPECT AND CLEAN CHIMNEY AND CONNECTOR FREQUENTLY UNDER CERTAIN CONDITIONS OF USE 0 I. 014 ORR
CREOSOTE BUILDUP WV OCCUR RAPIDLY.KEEP FURNISHINGS AND OTHER COMIUSOBLE MATERIAL AWAY FROM HEATER.REPLACE OLASSONLYP IM NDOCERAM W q O
OLASS.COMBUSTIBLE FLOOR MUST BE PROTECTED BY NONOONBUSTMLEWTERAL EXTENDING BENEATH THE HFATERAND TO THE FRONT AND ROESAS NNCATED Os m Y Q
OR TO THE NEAREST PERMITTED COMMASTIBLE MATERIAL W •AMCNMb.M/TWA M pewtIIWMIWfpMMBW f
OPTIONAL CO OFELEC:FAN,ELECTNCAL RATINO.IOLTS 115,NH;RAMPS,SCREEN DOOR IN pa(457EM1)NnlrrS 5pn MAIM tIMMga
DANCER:RISK OF ELECTRC SHOCK.E HONE INSTALLATION:
POWER BEFORE SERVICING UNR DO NOT ROUTE POWER CORD UNDER OR IN FRONT OF APPLIANCE ❑
COMPONENTS REQUIRED FOR MOBILE HOME ION:OUTSIDE AIR KIT AND ONE OF THE FOLLOWING DOUBLE WALL CONNECTOR N FRONT paMap95Mr WNAMrpo1M. w
IN CANADA: LISTED SECURITY MODS DP OR OLIVEROLNE MACLEOD PRO-VENT PV DOUBLE WALLED CONNECTOR WITH LISTED CHIMNEY SYSTEM SECURITY MODEL LL
SHOO,CC EXCEL 1100.
IN USA: LISTED DOUBLE WALL CONNECTORS SECURITY MODEL DP,SELKIRK MODEL OS,OLIVER MACLEOD PRO VENT PRSIMPSON DURA
VL VENT MODEL O ,OSW SUPER PIPE L TO
METAL-FAB DOUBLE WALL CONNECTED TO ONE OF THE FOLLOWING COMPATIBLE CHIMNEY SYSTEMS Z ❑
SECURITY MODEL S1100 OR MODEL ASHY,SELKIRK MODEL SSII,OLIVER MACLEOD PRO JET 3103,SIMPSON DURA PLUS, MODEL SC OR
METAL-FAB TEMPGUARD.AMERI.TEC HS, ICC EXCEL 1100 USE CHIMNEY COMPONENTS AS SPECIFIED IN INSTALLATION INSTRUCTIONS. j
AUTEUR MNIWLE DU RAFOND DE L'ALLOVE:21514 17 PL PROFONDEUR WXIPLLLE OE L'ALCOVE:BN W I M PO CA U T I O B s
DEGAOEEEHT ANIMAL DU PLAFOND POUR UN WXNECTSR HORIZONTAL:NA 11111111P0.
L'ESPACEAUQESSOUS DU POELE HEDOIT PAS ETREOBSTRUE.URISERSEULEMENT AVEC LES BRKIUES RFFRACTAIRES EN PLACE HOT WHILE IN OPERATION DO NOT TOUCH. KEEP CHILDRE K POUR UTIUSATCNAOECBDISSOUDEBEULEMENTLVT1Lasn0NDAUTNESW W REUSTMLESPEUTENDOO ET AERLEPDELECREENUNEFRRDITIONOANGEREUSE CLOTHING AND FURNITURE AWAY.CONTACT MAY CAUSE I.
NE PAS OBSTRUER LESOUVEATURESOAIR DE COMBUSTION.UULISER SEILEWRTAVEC LAPORTE FEAMEE-OUVH P R LA RTE DECN MEN AROEEEIT POURAUI EA O.
LE FEU SEULEMENT NE PAS UTILISER DE GRILLEA BUCHES NI SURELEVER LE FEU.NEWER LE MODE BON OIRECTENENT SUR L'ATRE NE PAS SURCHAUFFER-SI
LEPOELEOU LECDNNECTEUR DECHEWNEESE NET AROUGIR,LOUSSUNCIIAUFEZ NSPECIEIETNETTOYr1FREQUEMMERI LAOHEMNEE ET LECDNNECTEURBN SKIN BURNS.READ NAMEPLATE AND INSTRUCTIONS. a CA
CERTWNES CONDITIONS D'UTUSA110K UN E DEPOT OE CREOSOTE PEAT SE FORMER RAROEIFNCHERGARDE/TES'RUBLES ET AURNES WTERIAUA COMAUSTBLFS ATTENTION LL O
ELDIOMES DV PoELE REIPLACEZ LAVITRE SEULEMENTMP OU MIRE EX NEOCEPAM LE PUNCHER COMEUSiBlE00T EmE PROTEGE PAR DES WTERAUA ROB
COMBUSTIBLES DEPASSANT DU OESSOUS,DU DEVANT FT DES carts DU POELE,TEL QU'NDNUL OU JUSQU'AU WTERAU COMBUSTIBLE LE PLUS PRES PERMS 0
COMPOSANTSEN OPTION:VENTILATEUR,ALIMENTATION ELECTRIOUE:III VOLTS,INN;RAM. Z 40
DANGER RISQUE I/ELECT NILSE N.DECONNECTER LAUMENTATWN ELECTRRUE AVANT OF FAME L'FSTRETEN DU POELE NE PAS INSTALLER LE CORDON CHAUD DURANT LE FONCTIONNEMENT.NE TOUCHEZ PAS Q
ELECORKDE SOUS ON DEVANT LAPPAREL S f N
COMPOSAXTS EXCES POUR INSTALLATION DANS UNE RAISON MOBILE'.KRDE PRISE EMIR EXTERIOR ET LIN DES CONNSTEURS DE CHEMNEE A DOUBLE RIROI * 0 ELOIGNEZ LES ENFANTS,LES VETEMENTS ET LES MEUBLE' IL
SUNANTS'. 0
AU CANADA:CONNSTEURSDECHETBXEE HOMOLOOUESA DOUBLE PARDI:SECURITY MDDNEOP,WOLNER MACLEOD PRO-VENT RV,AVEC SYSTEME DE CHEMNEE LE CONTACT PEUT CAUSER DES BRULURES DE LA PEAL'
EXCEL/I .ISEZLAPLAQUESIGNALETIQUEETLESINSTRUCTIONS FO
AUX ETATSUNIS:CONNECTEURS DE CHEMNEE NOMOLOdtAS A DOUBLE PER01 SECURITY MUOBE DP SELKIRK MOOD.DS,OAVEA MACLEOD PRO WHIT SMI:
SIMPSON DURA VENT MODELS DVL GSW SUPER PIPE L METAL-FAB A DOUBLE PAROI.CONNECTS A GUN DES SYSIEIES DE CHEMNEE COMPATIBLES-FAD 10 S: 0
SECURITY MODELS 51100 OU NOODLE ASNT SELIORRMOOELESSIL OLNER MACLEOD PROJET 3101,SIMPSON OURS PLUS,GSW MODELS SC OU METAL-FAB TES. MANUFACTURED BY/FABRIOUE PAR:
GUARD,AMERI-TECHS, EXCELHB.SIMPSON OURS PLUS ETC.UTILISER LES COMOSAMTS DE CHEMNEE SPECDES ION ➢S LES INSTRUCGONSINSTALLATION FPI FIREPLACE PRODUCTS INTERNATIONAL LTD. RN
CC
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MADE IN CANADAIFAIT AU CANAOA VENTURE St �jZEGEN Y
908-281c DELTA,BC VOG 1H4 T/
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Regency F1100/F3100 Freestanding Woodstove I 5
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Product Details
Ensure your new stove provides top-notch performance with this fireplace connection kit!The US Stove CLK-25 Fireplace Insert Direct Connection Kit has
been designed to be used with heating appliances vented through a masonry chimney that burns home heating oil,natural or LP gas and solid fuels(pellet,
wood and coal).Compatible with any appliance that has a 6 in.flue,this reliable fireplace connection kit is a great addition to your maintenance routine.
• Fireplace connection kit compatible with any appliance with a 6 in.flue
• 25 foot,6 in.stainless steel liner
• Liner,rain cap,top cap and appliance adapter included in fireplace connection kit
• Multiple kits can be joined for taller chimneys
• US Stove fireplace connection kit for use with heating oil,natural and LP gas,wood,pellets,and coal
Specifications
Specification Description
Brand US Stove
Product Weight 34 lb.
Product Length 6.5 in.
Application/Use Used with properly sized flue liner
Compatibility Any chimney
Country of Origin Imported
Finish Stainless Steel
Indoor and/or Outdoor Indoor
Inner Diameter 25 ft.
Installation Orientation Vertical
Material Stainless Steel
https://www.tractorsupply.com/tsc/product/us-stove-25-ft-fireplace-insert-direct-connect 11/14/22,9.34 AM
Page 3 of 7
Maximum Diameter 6 in.
Maximum Temperature Varies
Minimum Diameter 6 in.
Minimum Product Length 25 ft.
Number of Pieces 4
Outer Diameter 6 in.
Product Height 25 ft.
Product Width 6.5 in.
Special Feature(s) Can be used with any chimney
Thickness 0.50 in.
Product Type Accessory
Wall Tyne Stainless Steel
US Stove►Fireplace Insert Direct
S.--
Connection Kit,6 in.,Cap Included, GET
it
o.o(o) Add to Cart
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Questions&Answers
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Search questions and answers
Reviews Questions Answers
Questions
1-9 of 9 Questions Sort by:Newest questions.
Dave n11358 1
My stove vents into the lined chimney through a 6 inch clay tile will the liner fit through this thimble to connect with the wood answer
" ' •" —"" " " "imney side of the flue.
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