The URL can be used to link to this page

BP-50557FEATURES* • Stainless steel combustion chamber, MINIMUM OPENING REQUIRED • No refractory bricks, allowing a better heat transfer - Depth : 20" • Combustion is controlled with an automatic regulator Width : 30" • Large pyroceram glass door 23" x 12" Height : 23" • Two heat -activated fans with speed control (125 CFM each) w • Completely assembled��rs�: • Easy to install • Powder coated finish • Limited Lifetime Warranty (Please ask your dealer for details) OPTIONS* • Doors come in black, gold vein or charcoal • Moldings come in antique brass, brushed stainless steel, charcoal or black • Decorative corners, in sets of two, come in black, antique brass or charcoal SPECIFICATIONS* • Maximum BTU: 75,000 (estimated) • Square Feet: 2,000 ,< • Volume: 3.0 cubic feet= r.r. Tested & Approved: EPA 28, ULC S628 and sk" 12 UL 1482-1996 Emission hate: 4.3 g/hour Burning Rate.. 0.97 kg/hbur • Log Size: 18 inches Pending Patent #20050284462 X. EPA certification number: 657 Y 4 * Information subject to change without further notification RESIDENTIAL NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that anly licensed Construe SECTION.2 ='PROPERTY :OWNERSHIP/AU THORIZED 'AGENT.. - ; Own cord: �3 1,LLtA-1J g%A�c.,e S 09- L?G 179r Name (print) Contact Address Phone Number 2 Au horize 2. t nt: ✓ 2CvCAC� Name (pint) ContactAddress Phone Number 04— dZ� ECTION. 3,-.CONSTRUCTION SERVICES, ...:: ". 3.1 Licensed Construction Supervisor. Not Applicable ❑ Licensed Construction Supervisor: License Number: Address: Expiration Date: Signature: Telephone: �.2 Registered Home Improvement Contractor. , �L/�S'S3 �l : Not Applicable ❑ 4 /094V i? Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ Yes ❑ No If No, go to the next section! Are you claming exemption from the requirements? ❑ Yes ❑ No If Yes, submit the required affidavit! Company Name: f/L 'X44t 5 1 Registration Number (if none, state "none"): lLj�j 3� ss: %Y!-�w /ice ,� Aa 775 Signat V Telephone: Expiration Date: io 4 Z 3.3 For Residential Remodel Work Only PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND: QUESTIONS OR COMPLAINTS call or write: Home Improvement Contractors Registration, One Ashburton Place - Room 1301, Boston, MA 02108, 617-727-8598 ❑ 1 am a Homeowner performing all the work myself. Owners Name (print): Signature: By signing the above, the homeowner acknowledges that there will be no eligibility to the Guaranty Fund Date. 3.4 Homeowner Exemption - One & Two Family Only FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Supervisors: Except for those structures govemed by Construction Control in Section 116.0, effective July 1, 1982, no individual shall be engaged in directly supervising persons engaged in construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or structures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing Construction Supervisors. 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 engages 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 home in a two-year period shall not be considered a Homeowner. If you are applying under this section sign below: Signature: Your signature carries certain responsibilities, including but not necessarily limited to, general liability Supervisor, whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 to R R5.2.15) 2: 25 - , , .WORKERS COMPENSAT{ON!1NSURANCE AFFIDAVIT MGL c 15 . _ _-:> -•,;; SECTION 4.. _ _ _. ( § ) 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 K.(C_heck.all appLlcIOW5 SCROOFPROPOSEDMORSECTJ.IN able ❑ Deck ❑ Pool ❑ Repairs ❑.Alteration ❑ Chimney/Fireplace ❑ WOOdlstove/Pellet Stove ❑ New Construction* ❑ Accessory Bldg. ❑ Roofing/Siding ❑ Other, (Energy report required) (Shed/Garage) (Spe6fy below) ❑ Addition ❑ Replacement window/door ❑ Demolition (Energy report required) No. of windows _ Doors (Specify below) *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 of Bedrooms 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 ❑ Air conditioning - (separate unit) ❑ None of the above to be provided ❑ Hot Water: Gas Electric Fuel Oil Other Description of proposed work: ''eAA d2 Iry e,ie-,_r_ . /X.,"7V /1- 1% .. ;�"._ ,. ,;a �F.:±,_a_.. .:2 a, ,�. —: -.-wTP'ri=A /"�1 [+Tt]t'If+T1A\f•P�f1�T `. _ � - ,_,. __ ,6,. .... ,.. ..„. Item Estimated Cost ($) to be completed by permit sipplicant 1. Building 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5. Total (1 + 2 + 3 + 4) • r+ `?' SECTION ZA.,,OWNER AUTHORIZATION , t on..n 9 ermit �,..R,........; `comple tea "when owner's'agent:b"rctrac'tofr'applles'for°bulldi p- ) S gnature of Owner/Authorize nt Date 7"4� Inspector's Signature: /L Date: .� - lcf Applicant informed of above: Date: ( Time: p;� � � r Clerk: Comments: r Less Application Fee: f Remaining Balance: $ Total Permit Fee: $ . Other $ Amount $ TOTAL FEE: . © Gross Area - New Construction total sq. ft. Gross Area - Alteration total sq. ft. Permit Issued to: _'I'NI-T LI-L by a o O 8 vAA/ r..<y S"i o lvE - zA1,r Cn T To E"t'e /j 7--e— %�� A 0 I''t n. c Qt Energy Report: Signature: Date: —7 Date: 1.1 Property Address: / �l ��,� �l! C Q - 1.2 Assessors Map & Lot Nurniber: Nearest Cross Street: Map 7 / Lost Subdivision Name: 1.3 Historical District ❑'Yes ❑ No Total Land Area Sq. Feet: Has application been submittted to the Historic Commission? ❑ Yes ❑ No Dater 1.4 Water Supply (MGXivate 54): 1.5 Sewage Disposal Sy�te: ❑ Municipal Well ❑ Municipal SiteDisposal System ® CONSTRUCTION PLANS ❑ SITE PLAN 0 ENERGY REPORT..! 455