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BP-91689Encore'FlexBurn'2040 Non-Catalytic/Catalytic Wood Burning Stove For use with either 6" or 8� flue collar/chimney connection Unprotected Surfaces Protected Surfaces Stove Clearance Stove Installed Stove Stove Installed Stove Parallel to Wall in Corner Parallel to Wall in Corner' Top Exit, 8" single Side To Rear Corners Side To Rear Corners wall connector without (A) 19" Shroud (B) 20" (C) 18Y22" (D) 5 Shroud (E) 7" (F) 12" shields, vertical flue col- lar heat shield installed (483 mm) (508 mm) (470 mm) (127 mm) (178 mm) (305 mm) Top Exit, single -wall (G) 19" (H) 10" (1) 18Y2" (]mm) (K) 6" (L) 12" chimney connector, heat (483 mm) (254 mm) (470 mm) (1 (152 mm) (305 mm) shield2, vertical flue col- lar h.s. installed Rear Exit (M) 22" (N) 12" (P) 11" (Q) 12" No flue collar heat (559 mm) (305 mm) n!a ' (279 mm) (305 mm) n/a shield Top Exit, double -wall chimney connector', (G) 18" (H) 7" (I) 12'' (J) 4" (K) 5" (L) 5" vertical flue collar heat (457 mm) (178 mm) (305 mm) (102 mm) (127 mm) (127 mm) shield installed Clearance to Combustible in Front of Stove All Installations (S) 48" (1219 mm) The provided rear shroud must be used in all installations. The flue collar heat shield must be used in all vertical installations: 1. A ceiling heat shield 24" (610 mm) in diameter and suspended 1" (25 mm) from the ceiling must surround the pipe in installations where chimney penetrates the ceiling. 2. The connector pipe heat shield must extend 36" (914 mm) above flue collar. 3. Using listed double wall oval to round adapter when installing optional 8" oval flue collar. G" Chimnev Connector ONLY Top Exit, single wall 6" connector without (A) 19" (B) 15" (C) 18Y22" (D) 5" 7" (F shields, vertical flue col- - (483 mm) (381 mm) (470 mm) (127 mm) (117878 mm) (3055 mm) lar heat shield installed 12 Encore° FlexBum* 2040 Non-Catalytic/Catalytic Wood Burning Stove z —4k of+hor P" nr R" fli to rnllnrlchimnev connector B ��- C E —® C D ®— F Top Exit Installations, vertical collar heat shield, and chimney connector heat shields or double -wall connector. H 4 �G Rear Exit Installations. K 'J L �®-- i i EI E i L : EDTI(3E112 pRF3FRT ©�i/NERSHIPt4U .lO 2.1 Owner Record: Name (print)Contact Address Phone Number 2.2 Authorized Agent: Name (print) Contact Address Phone Number t � 3.1 Licensed Construction Supervisor/Specialty License. License Number: Company Name/Contractor Name: le. e�1x Address: Expiration Date: Signature: Telephone: t 3.2 Homeowner Exemption One & Two Family Only Section 110.R5.1.3.1 Exception FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT Exception: Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section; provides that if a Homeowner ena9ges a person(s) for hire to do such work, that such Homeowner shall act as supervisor. For the purposes of this section only, a "Homeowner" is defined as follows: 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 dwelling, attached or detached structures accessory to such use and/or farm structures: A person who constructs more than one dome in a two-year period shall not be considered a Homeowner. f you are applying under this section sign below: Signature: Up * e �£1 05 t E�TIOAf= 11itiK - r �3 Worker's 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 171 Deck ❑ Pool ❑ Repairs ❑ Alteration ❑ Chimney/Fireplace Lpla stove/Pellet Stove ❑ New Construction* ❑ Accessory Bldg. ❑ Addition ❑ Roofing/Sidient window/door (Energy report required) (Shed/Garage) (Energy report required) No. of windows Doors r ION (specify): debris removal (per MGL C.40 Sec 54): ❑ Dumpster an site ❑ Durnpster On Street e:. Location: *If new construction, please complete the following: Single. Family: No. of Bedrooms No. of Baths Two Family: No of Bedrooms Unit 1 No. of Baths Unit 1 No ofBedrooms Unit 2 No. of Baths Unit 2 ❑ Furnace (hot air) - fuel gas (natural or propane), fuel oil, electricity, other (specify): ❑ Boiler (heating) - fuel gas (natural or propane), fuel oil, electricity, other (specify): ❑ HVAC (combined unit) primary fuel, natural gas, propane, electricity, other (specify): ❑ Air conditioning - (separate urit) ❑ None of the aboa^ h ftd 0 Hot Water: Ga Electric Fuel Oil Other ill . B� CaNSTRidC Item 1. Building d bEstimated Cost ($) to be completey permit appliicant 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5 Total (1 + 2 + 3 + 4) 0 S CTf�t� is i}1 MEN 11tiTFfQL t ATitsfN s t v _..� 9 . �:...: ,. p_ .:.. ,tl when owrl�r`s agent or confract2slre t1��-'fotJiutdin �rrnt � . (Please Print) - SX t7 �� i IL®L� C z R as Owner of the subject property hereby authorize ✓% t to act on my behalf, in all matters relative to work authorized by this building permit application. eSig]natu!reof` Owner ki Date `'--SEGT!_CiN 7B = [�k1dRIERfi4UTk1E3�t1ZED-/GENT DECt.ARAT,O(� 1 as Owner/Authorized Agent hereby declare that the statements and:iinformation on the foregoing application are tillue and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Signature of Owner/Authorized Agent Date Less Application Fee: $25.00 Remaining Balance $ Total Permit Fee: $ Other $ Amount $ Gross Area - New Construction total sq. ft. Gross Area - Alteration total sq. ft. Permit Issued to: /7