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Home My WebLink AboutBLD-23-001525 01.Y`�R C G / q/2 a/2� !Office Use Only • • % �L / G J Permit# J� Ic ) ount 0D ODI, 1 '0�"` ,Permit expires 180 days from l issue date 61-D--Z3—ij/5Z5_ EXPRESS BUILDING PERMIT APPLICATI E ' E I VE D TOWN OF YARMOUTH Yarmouth Building Department SEP 2 2 2022 1146 Route 28 South Yarmouth, MA 02664 B1J T T By: (508) 398-2231 Ext. 1261 C CONSTRUCTION ADDRESS: /'7 0 ►"� �1Vc M ASSESSOR'S INFORMATION: Map: Parcel: OWNER: I`ve t And t.5- h 170 C4(t 5 ti rid S y4•via f t Mot Soi(31c(fr77 ( ✓ NAME PRESENT ADDRESS TEL CONTRACTOR: NAME MAILING ADDRESS TEL.#` Ai-Residential :1 Commercial Est. Cost of Construction$ a"f 00 1-51) Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) 1.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: /4 f rtAti t)r li !o w h A V e 'j 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 revocation of my license and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Off Date: Owners Signature(or attachment) i Date: cc-gg �� 7. Approved By: Date: 2_ ` .L Building Offi ' or ' ne EMAIL AD SS: 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 0 No 0 Yes 0 No _ '� The Commonwealth of Massachusetts - _ Department of Industrial Accidents 1. e- 1 Congress Street, Suite 100 rr'; \tt_f��= Boston, MA 02114-2017 lir �••`NM 's www.mass.gov/dia \Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LegibIy Name (Business/Organization/Individual): 3-,. AiAd.u- S. ,, Address: /7 0 Cc,(>r Sc( 2-J • City/State/Zip: S CIA+wic ifh N4 c Phone #: St>4d 3' F77 Are you an employer?Check the appropriate box: Type of project(required): l.❑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. D Remodeling any capacity. [No workers'comp. insurance required.] 9. _ Demolition 3.0 I am a homeowner doing all work myself. [No workers'comp. insurance required.]t 10 ❑ Building addition 4.XI 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.Q Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 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 certi d it_._ ._....________„.....s...,„s....„erains and penalties of perjury that the information provided above is true'and correct. Signature: ))7Date: 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#: SPECIFI CATIONS q Maximum Heat Output: 60,000 BTU per hour of Depth: 24.81"(63 cm) cordwood (based on independent laboratory test results). Front Door Size: 22"wide x 11.5" high (55.88 x 29.21 cm) Size of Heated Area: Up to 2,000 square feet. Chimney Liner Size: 6" (152 mm)diameter Firebox Capacity: 2.4 cubic feet or 48 pounds of wood (The amount and weight of wood contained per Metal Chimney: 6"(152 mm) inside diameter cubic foot of firebox volume can vary from 15 to 36 lbs. per cubic foot depending on type of wood, moisture Masonry Chimney: 6" (15.2cm) inside diameter content, packing density and other factors. As a (Round flue) constant for comparison and test purposes, we are assuming 20 lbs. of seasoned hardwood per cubic foot 8"x 8"(20 x 20cm)(square of firebox volume). flue) Maximum Log Length: 22" (55.88 cm) Flue Exit: Top exit only Actual Weight: 550 pounds Height: 23.12"(58.72 cm) Castings Finish: Painted Matte or Porcelain Width: 31.38"(80.31 cm) Enamel [816] 32 118" SURROUND IMPORTANT:DIMS CAN BE+_1/8" 15191//16" BRACKET WIDTH 31 3/8" INSERT OA WIDTH IF SCREWS ARE THE HIGHEST POINT,THEY [678] I WITHOUT SURROUND ARE INCLUDED IN THE MEASUREMENT. 2811/18" [611] BRACKET WHEN FIREPLACE DIMS ARE TIGHT ITS ,I 241/16" BEST TO MEASURE THE ACTUAL INSERT. -1a r,.. ,, [421] IIMA .3 16 9/16" 1111 _SURROUND FORWARD a ___ [830] (324] `_�__ 24 13/16" 12 3/4" SURROUND BACK __A k\ 11111�!/= [185] 7 5/16" CENTER OF FLUE COLLAR 1198] WHEN SET VERTICAL 47 3/16" [112] 4 7/16" CENTER OF FLUE COLLAR 1.11=11_- WHEN SET TO 30 DEGREE I ii ___ [780] ill [601] 3011/16" .4 2311/16" r---71 _ 30" TOP EDGE OF FLUE �I`O Id815//16" [589] COLLAR WHENN 2461/2" II I [20] 1 13/16" 23 3/18" TOP EDGE OF voi— HEIGHT OF SURROUND FLUE COLLAR II _ _ Ifl2�■ „�. BRACKET j WHEN 30 DEGREE Figure 1 — Clydesdale Dimensions pg. 7 Hearthstone Quality Home Heating Products Clydesdale Model 8492 Hearth Requirements & Floor -- Protection 1, Combustible flooring must be protected with a covering of � � f �. ,2031 noncombustible material can (slate, marble tiles, other `` = � 11.111, 1�__ � can be used for this purpose).The floor USA l 8.0 "___ noncombustible mate at the minimum as follovt�se Insulation below the the non-combustible !' 6 CANADA protectionmust extend the material must be R1.5 insulation below hearth protection OR Ni^Q �� JIB bottom of insert installei minimum 7" above hearth protection mi—Q _with RO insulation (13.25"if measured from bottom of fuel opening). b b Z 'o°p U Masonry Fireplace must be built to NFPA211 23 3/16"MIN standards. 13"MIN DEPTH `Measured from fuel door opening. R1.5 insulation below hearth protection OR bottom of insert installed minimum 7"above hearth protection with RO insulation. \ . . ' '/ Figure 3—Hearth Requirements 911/16*MAX LINTLE t AT 241/2"MIN HEIGHT r 1 711/16"MAX LINTLE _ 21"MIN AT 23 3/16"MIN HEIGHT —± i Z : _s I --- 2411 MIN - 31 *MIN Figure 2-Minimum Fireplace Dimensions 1 {. Clearances to Combustibles All measurements From sheet metal shroud unless otherwise 417; noted 16.4 [2591 UNPROTECTED 10.2 8"DEEP MANTLE SHIELDED 8"DEEP MANTLE ,203 8.0 "' `�� SIDE TRIM 12791 1 UP TO 4"PROTRUSION 11 pl IN___FRONT OF GLASS PAN_E. SIDEWAL. _ I �I illillin_100 Iil 13 13..22 5 i O II ii IF 0 R VALUE UNDER FLOOR PROTECTION_..-- Measuredi from bottom Mantle Shield 94-79700 is available to of fuel loading opening install to achieve shielded mantle clearances. pg. 12 Hearthstone Quality Home Heating Products Clydesdale Model 8492