BLD-23-001024 a - p ti-- '0 d26/Z2
ONE & TWO FAMILY ONLY- BUILDING PERMIT
Town of Yarmouth Building Department ,•- "''r
1146 Route 28, South Yarmouth,MA 02664-4492 •
411
508-398-2231 ext. 1261 Fax 508-398-0836 '
Massachusetts State Building Code,780 CMR o
Building Permit Application To Construct, Repair, Renovate Or Demolish • .°
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Bt) --a-3 064)2,14 'DateApplied:
i vE
��' � � =' ElVED
Building facial(Print ame) Signature Dat
SECTION 1: TE INFORMATION AU,7 2 4 2022 ,
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
37 Arrowhead Drive,Yarmouth Port BUILDING DEPARTMENT
1.1 a Is this an accepted street?yes 17 I no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (lvi.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑✓ Private Zone: _ Outside Flood Zone?
Check if yes❑ Municipal On site disposal system Ei
SECTION 2: PROPERTY OWNERSIUP'
2.1 Owner'of Record:
Guido DiPietro Yarmouth Port,MA,02675
Name(Print) City,State,ZIP
37 Arrowhead Drive 978-870-7729 guido.dipietro@dell.com
No.and Street Telephone Email Address
SECTION 3;DESCRIPTION OF PROPOSED WORD2(check all that apply)
New Construction: Existing Building Owner-Occupied❑✓ i Repairs(s) 0 I Alteration(s) 0 { Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units 1 Other 0 Specify:Wood Stove Insert
Brief Description of Proposed Work2:Installation of a new Napoleon Oakdale Wood Burning
Insert into an existing masonry fireplace.
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs:
(Labor and Materials) Official Use Only
I.Building $8700 1. Building Permit Fee:S, Indicate how fee is determined:
2.Electrical $ Standard City/Town Application Fee
0 Total Project Cost(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $ '
4.Mechanical (HVAC) $ List: ' On Ill
5.Mechanical (Fire . •
Suppression) $ Total All Fees:$ -
6.Total Project Cost: S 8700 Check No. Check Amount: Cash Amount:
0 Paid in Full 0 Outstanding Balance Due:
•
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No,and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP R Restricted 1c4:2 Family Dwelling
IVI Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name HIC Registration Number Expiration Date
Na.and Street Email address
City/Town, State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.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 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
P Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) t:f (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft,) 3c Habitable room count �--
Number of fireplaces 1, Number of bedrooms 3
Number of bathrooms .3 Number of half/baths
Type of heating system tot i ', r,c-r ,✓- Number of decks/porches i
Type of cooling system Enclosed Open ✓
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
§TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-22311 ext..1261 Fax 508-398-0836
Office of the Building Commissioner
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4.
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 37 Arrowhead Drive
Work Address .
Is to be disposed of oat the following location: No Debris
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
Signature of Application Date
Permit No.
The Commonwealth of Massachusetts
:, 2 Department of Industrial Accidents
Office of Investigations
r
Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lesibly
Name (Business/Organization/Individual): Guido DiPietro
Address:37 Arrowhead Drive
City/State/Zip:Yarmouth Port, MA, 02675 Phone#:978-870-7729
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I 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. 7. El Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 11.❑Plumbing repairs or additions
3.I: I am a homeowner doing all work
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4) and we have no 13.❑■ Other Wood Stove
employees. [No workers'
comp. insurance required.]
*My 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 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 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 wider 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 certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: i :f __
Date:
Phone#: 978-870-7729
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
lDBoard of Health 20 Building Department 3DCity/TownClerk 4.0 Electrical Inspector 5E1Plumbing
Inspector 6.0Other
Contact Person: Phone#:
2.0 pre-installation preparation EN
Clean all ashes from the inside of the existing appliance opening. Ensure the chimney and appliance are free of
cracks, loose mortar, creosote deposits, blockages, or other signs of deterioration. If necessary, have repair work
done by a qualified professional before installing the appliance.
Do NOT remove bricks or mortar from the appliance. In case of an outside air inlet or ash dump, fill with
fiberglass insulation. Adhere to minimum clearances as illustrated.
2.1 minimum clearance to combustibles
MINIMUM CLEARANCES
A Sidewall 12" (30.5cm)
B Mantel 16" (40.6cm)
12" (30.5cm) Projection
C Top facing 16" (40.6cm) ,.,fill
\�'T,BIF MArJTI
D Side facing 6" (152mm) /
E Hearth (front) Canada 18" (45.7cm) 1
USA 16" (40.6cm)
F Hearth (side) 8" (203mm) SURFACE
c
MINIMUM APPLIANCE OPENING
G Width (rear) 23" (58.4cm) \�!
H Width (front) 28" (71.1cm) S,oE,WA F \ .
I Height(front) 22" (55.9cm) A .�
J Height (rear) 19" (48.3cm) N�Nt E
ANC r.M4 11�EE HE
K Depth 18" (45.7cm) aR°TE^TOR;p,
L Hearth depth Canada 22" (55.8cm)
USA 20" (50.8cm)
M Hearth width 46" (116.8cm)
N Facing width 54 1/2" (138.4cm)
141111111141114111:11.1411.1111441114111141144111.4111111111.441.
Contemporary 45 1/2"
0 Facing height (115.5cm) °°M6uS a
Traditional 44 1/2"
E MtiNTE
(113 cm) /
Contemporary 45 1/2"
ti� n 8
P Mantel (115.5cm) °trB4.�
Traditional 44 1/2"
(113cm) 0
Contemporary 29 1/2"
Q Height of top (74.9cm) ' . R
surface Traditional 28 1/2"
(72.3cm) 1
410
R Side facing 13 1/4" (33.6cm) y0P T
S Hearth (side) 9" (22.8cm)
T Sidewall 13" (33cm) F{�R;°GMN.),
EtiEAt
W413 fool .'D.'04.28 21 I 9
EN pre-installation preparation
2.2 hearth extension /floor protection
Hearth extensions/floor protection must be made of non-combustible materials.They must meet the following
specifications:
• Minimum extension to the front of the insert:
- Canada: 18" (45.7cm)
- USA: 16" (40.6cm)
• Minimum 8" (203mm) extension to the sides of the insert
• Minimum 0.5" (13mm)thickness
• Minimum (K*) 0.84 thermal conductivity factor; and
• Minimum (R*)0.59 resistance value
See chart below for more information.
CONVERTING MATERIAL SPECIFICATIONS TO R OR K VALUES
R =Thickness/K-Value
K=Thickness/R-Value
COMMON K and R VALUES CHART
MATERIAL K-VALUE R-VALUE
Per inch Per inch
Micore 300 0.43 2.33
Wonderboard(cement board) 1.92 0.52
Common Brick 5.00 0.20
Cement Mortar 5.00 0.20
Ceramic Tile 12.50 0.08
Marble 11.00 0.09
Air Space(ventilated) 0.70 1.43
Sand and Gravel 1.70 0.59
Drywall (gypsum) 1.00 1.00
Rockwool or Fiberglass Batts 0.30 3.33
With K values, the lower value is a better insulator. With R values, the higher number is better.
K-Value Example:
A wood stove may call for thermal protection which has a K factor of 1 or less. A product
such as Micore 300 Board from USG has a K-Value of approximately .43 per inch.
Therefore, a 1/2" (12.7mm)thickness of this board would have a K-Value of.86, which
meets the requirement of our example stove.
R-Value Example:
This appliance calls for thermal protection with an R-Value of 0.59.This same board above
is rated as having an R-Value of 2.33 for a 1" (25.4mm)thickness. Therefore, 1/2" (12.7mm)
of the Micore 300 Board would have a R-value of 1.165, which meets the specifications for
this appliance.
bV''.-2GC D;'04.-&.21
1 .0 general information EN
1.1 dimensions (complete with cast surround)
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W415-2007/D/04.28,21 I 5
E general information
1.2 specifications
Emissions 1.21 g/hr
Efficiency Overall LHV HHV
71.60% 77.07% 71.63%
Viewing area (Contemporary model) 273.7 sq. in (1765.8 sq. cm)
Viewing area (Traditional model) 278 sq. in. (1793.5 sq. cm)
Chamber(D.W.H) 13 3/4"x 20 7/8"x 11 1/2"
(349.3mm)x(530.3mm)x(292.1mm)
Capacity 1.8 ft3 (0.05 m3)
Approx.area heated** 1500 ft2(139.4 m2)
Maximum heat output*** 55,000 BTU/Hr
Heat output* 14,492 -47,887 BTU/Hr
Duration low fire** 8 Hours
Weight complete 400 lbs(181.4 kg)
Weight of bricks 80 lbs(36.3 kg)
Weight without cast surround
(complete with door)and bricks 250 lbs (113.4 kg)
Minimum stack height**** 15 feet(5.4m)
Efficiency standard B415.1-10
*As tested using test method ALT-125
*"Figures will vary considerably with individual conditions.
'*"Wolf Steel Ltd. estimated realistic BTU/hr with cordwood logs and regular refueling.
*`*'' Required in order to achieve proper draft.
1.3 general instructions
• Before beginning your installation, consult with your local building code agency or fire officials and insurance
representative to ensure compliance.
• Non-toxic smoke will be emitted during the paint curing process to help dissipate the smoke open a window
near the appliance.
• Remove any dust or debris off the top of the appliance before firing the appliance as the paint will become
soft as the appliance heats up and will harden as the appliance cures.To cure the paint on your appliance,
burn your appliance moderately hot during the first few fires.
• To keep the gasket from sticking to the appliance as the paint is curing, periodically open the door every
5-10 minutes.
• For the first two weeks, use generous amounts of fuel and burn the appliance with the damper wide open
for an hour as the appliance goes through a process of eliminating moisture in the steel and firebricks.
The initial heat output will be reduced while the moisture is bring drawn from the appliance and it will be
necessary to build several hot fires to remove this moisture.
• DURING THIS PROCESS DO NOT OVERFIRE THE APPLIANCE. REDUCE THE AMOUNT OF AIR
COMING INTO THE APPLIANCE IF THE APPLIANCE OR CHIMNEY BECOMES RED.
6 I '.vet"5-200 :o/ .."27
.'Q'� TOWN OF YARMOUTH
- BUILDING DEPARTMENT
NAT4 niest,', 8 1146 Route�&, South Yarmouth,MA 02664 508-398-2231 ext. 1261
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
DATE:
JOB LOCATION: 37 Arrowhead Drive, Yarmouth Port, MA, 02675
NAME STREET ADDRESS SECTION OF TOWN
"HOMEOWNER" Guido DiPietro 978-870-7729
NAME HOME PHONE WORK PHONE
PRESENT MAILING ADDRESS 37 Arrowhead Drive
Yarmouth Port MA 02675
CITY OR TOWN STATE ZIP CODE
The current exemption for `Homeowner' was extended to include owner—occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license,provided that suet
homeowner shall act as supervisor, (State Building Code Section 110 R5.1.3.1)
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 attached or detached structure assessory to such use and/or farm structures. A person who
constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall
submit to the building official, on a form acceptable to the building official,that he I she shall be responsible for all
such work Performed under the building permit. (Section 110 R5.1.3.1)
The undersigned `homeowner' assumes responsibility for compliance 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 Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures and
requirements. q , an PP
HOMEOWNER"S SIGNATURE / 14114/4''/
APPROVAL OF BUILDING OF14ICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL
Ch.142. Yes No
If you have checked ves,please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity 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.
`,.p ' Check one:
Signature of Owner or Owner's Agent `,,Owner Agent
h:homeownriicexemp
ONE or TWO FAMILY— BULDING PERMIT
APPLICATION REGULATORY APPROVALS NOTICE
Address of Proposed Work: 37 Arrowhead Drive, Yarmouth Port
Scope of Proposed Work: Installation of a new Napoleon Oakdale Wood
Burning Insert into existing masonry chimney
Date: ` 1 11??-
Based on the scope of work described above, the applicant is required to obtain approval sign-
offs from the following departments as checked-of below:
Health Dept. —508-398-2231 ext. 1241
Conservation —508-398-2231 ext. 1288
Water Dept. —99 Buck Island Road, 508-771-7921
Old Kings HWY. Hist. Comm. —508-398-22631 ext. 1292
Engineering Dept. —508-398-2231 ext. 1250
Fire Dept. —Kevin Huck/Scott Smith, 96 Old Main Street, SY
Note: Please call Fire Department for an appointment. 508-398-2212
X Other
Appropriate plans and/or application shall be provided to each departments checked-off above.
Each of these regulatory authorities has their own requirements outside the jurisdiction of the
Building Department. All applicable approvals shall be obtained prior to submitting a building
permit application to the Building Dept.
Thank you for your cooperation.
Receipt Acknowledgement:
-t V-29 1)--)-
Applicant's Signature Date
Rev.Jan. 2019