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BP-2005-42326 r-ermirx x—t s� zoos--azs26 GIS#: ® 427I N D'/ / 1401 1 Map: j 0079 LOmmon L �Uh O *aMa1i Lot: 000 Sub-Lot: 000 8 TOWN OF DARTMOUTH Category: TO INSTALL 400 Slocum Road,Dartmouth,MA 02747 Project# JS-2006-1535 Phone: (508)910-1820 Fax: (508) 910-1838 Est.Cost: $3200.00 Fee: $30.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Use Group: R4 Contractor. License: Phone#: Lot Size(sq.ft.) 2.11A ROBERT CABRAL HI-125796 (508) 993-5577 Zoning: SRB Engineer: License: Phone#: New Const.: N/A Alt. Const: N/A Applicant. Phone#: Date Typed: 12-06-2005 PAUL & KIMBERLY ALVES (508) 995-6907 OII'NER: ALVES PAUL &KIA-IBERLY ALVES DATE ISSUED: �,�/ 7 5 TO PERFORM THE FOLLOWING WORK: Install wood pellet stove; NEEDS FINAL INSPECTION BUILDING PERmIT Project Location: 18 MEDEIROS LN Approved/Issued By:__ LYNWOOD R. COMSTOCK, LOCAL BUILDING INSPECTOR All work shall comply with 780 CMR 6TH Ed. (MGL Chap. 143) and any other applicable Mass. Laws or Codes and plans on tile. POST THIS CARD SO IT IS VISIBLE FROM THE STREET SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION IS REQUIRED. TIIIS PERMIT WILL EXPIRE PER 780 CMR 111.8 (NOT MORE THAN 3 EXTENSIONS WILL BE GRANTED)OR ON ISSUANCE OF A REGULAR OCCUPANCY PERMIT. I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Buildi g/ n ng Permit. Signature of Owner/Agent: g Comments: PERMIT NUMBER IS REQUIRED WHEN REQUESTING INSPECTIONS RE-INSPECTION FEES MUST BE PAID BEFORE RECEIVING ANOTHER INSPECTION "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)" REPLACEMENT FEE WILL BE REQUIRED FOR LOST SIGNATURE CARE: TOWN OF DARTMOUTH BUILDING RECEIPTS COLLECTOR'S OFFICE Name: , ! ; '' Property ,,, Date: `/ .!7 `. -' ; ' f,'`: ,.-4'' Owner: p.:{ .i i,.. '`• sfj,,€'" /'—'- Job Location: r S ; . _ _ TH COLLECTOR S OFFICE Copy-Collectors Office Plot: -- Lot: :: € : : Phone: ¢ MAJ,13 Desc 'i General Ledger#'s ef.# Amount Lice • . erSU 01000-44105 License&Permits-Building Misc. 01000-44105 - f ' T License&Permits-Electrical 01000-44106 License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 This is not a Permit or License for Building,Plumbing or Gas Received By: , , ail' .;: ' d f RESIDENTIAL 2005 U/ID FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE&NQN-TRANSFERABLE L"":` A RECEIV$D r���n_'�%.,,,,� DARTMOUTH BUILDING DEPARTMENT ,,, ,,,k io _, 400 Slocum Road,P.O.Box 79399 �# \i - -- r' .,.lc, ky,1� f"i $ • e.,a ' Dartmouth,MA 02747 -�' 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT,REPAIR, g t r R RENOVATE a h OF-F-IRCIALDEM O,LSS H©NA I O� O R W. O FM LY- DW ELLNG - ,;:THIS SECTI( FQR•O i !* t i ` 1C r° . :. p .D f _ - _:; : , ? „ V ? { . E S aRECEIVED BY. , � -'DATE.SENT FOREVIEIY ffi TE , .4': +, � -, ,,, f Buidings ISSUE -SGNATURE " BuldngComis lSpectoroOK TO -, im ie D ❑A,ElV Uu _ y, lropaedUse - Zone ek , - lc: ZninDisic sSOD BENOTFD. � � w . a n - THE FOLLOWING ES Uy � D li : r lb Edof DCoCrn, �0 Demoit y CadSnt❑Board of rfi 6 0 davAppea , Heah 1 PI Fire CI Gas 4' a 0 PlaaningBoard* 0 Sewe and 0 Water Cad E O +e Chief., Cut-Off , ;. '�Cut Off Gut Off 'r REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSITANoak* 4 ' -"* :� ..,. . 3 2' - 1lI:E�TA'I.AP, Y •. F .�. ,;.�"�,.s �. ., �' :x. A....,.. DEPART PRO Zoning Review: Signature: Date: Energy Report: Signature: Date: • Fire C ' "f: Signature: Date: oard of Health: Signature: Date: Conservation Commission: Signature: Date: Other: Signature: - Date: ,11 Description of work being performed: 11 " z 7 SE TIQN SII INFORMATIO R NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: El yes 0 no 1.2 Assessors Plat&Lot Number: �- 1.1 Property Address: /' Plat Lot _- _ Nearest Cross Street: Subdivision Name: J 1.3 Historical District 0 yes ❑no Total Land Area q.pFt.: Has application been submitted to the Historic Commission? • / ❑yes ❑no Date: _ .4 Water Supply(MGL c 40 § 54): ,,`Sewage Disposal System: I ❑Munici al 'On Site Disposal System 0 Municipal Private Well P Y P p i 7- ly i C:\bidg.forms\Bldgapp.res.wpd Page 1 Rev.June 26,2003 RESIDENTIAL 2005 ,. ,. ,,i _. .�wt........._ = SECTION-��ROPERTYCIWNFRSHIP>tiAidTI�CJRI�EL?AfiEN7" .1 Owner of Record: v - LI 4/ '11 ,-( /vtc 1 lg Medbr6 5 ingz8 g956,967 Name(print) Contact Address Phone Number • 2.2 Authorized Agent: _I Name(print) Contact Address Phone Number x,: SECTION 3=CONSTRUCTION SERVICCS =,- , 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor Aid wA rJ 471`o License Number CS U 7-> 7 C3 Address 7 a 3 3 Ted D f;.r r rn o;;`1.1.1 Np, 0...7 Y 7 Expiration Date Signature Telephone .54-973->J ?/ f,710)/ L10 3.2 Registered Home Improvement Contractor: Not Applicable 0 Are you a Home Improvement Contractor subject to(780 CMR-6)? 0 yes 0 no If no,go to the next section! () Are you claiming exemption from the requirement? 0 yes 0 no If yes,submit the required affidavit! i Company Name ,j j1 gut',_7 / - d„i,-0 Y,,�y Registration Number(if none, state"none") 1( Address '7o 'S ,,.Si- Z� 7,2 �—7 G j Signature / i -i- Telephone 57.1,—f 53--),77\ Expiration Date J/V/ C.-1,3.3 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 Owners Name(print) Signature by signing the above,the home owner acknowledges that there will be no eligibilty 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 governed 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 C:\bldg.forms\Bldgapp.res.wpd Page 2 Rev.June 26,2003 l_ RESIDENTIAL 2005 NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction Supervisor,whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.15) r SECTION 4WORKER'S COMPENSATIONINSIFR$lYC1W > Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached:❑yes ❑no SECTION 5-:DESCRIPTION OF PROPOSED WORK(checkl a livable e ❑ new construction* ❑addition 0 alteration ❑repairs 0 chimney/ voodstove (energy report required) (energy report required) fireplace ❑deck 0 pool 0 accessory bldg. 0 replacement window/door 0 other 0 demolition (shed/garage) no. of windows doors (specify below): (specify below): * If new construction,please complete the following: Single Family: no.of bedrooms no. of baths Two Family: no. of bedrooms unit 1 no. of baths unit 1 no.of bedrooms unit 2 no.of baths unit 2 ❑ Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑ Boiler(heating)-fuel gas(natural or propane), fuel oil, electricity, other(specify): ❑ HVAC(combined unit)-primary fuel,natural gas,propane,electricity,other(specify): O Air conditioning-(separate unit) ❑ None of the above to be provided O Hot Water: Gas Electric Fuel Oil Other B 'ef Description of Proposed Work: M /I i S-7(77Pe_..— __Z--.1,S/L",-// SECTION .6 ESTIMATED CO1, STRUGTI'NtfiS Wiz. .. ..„ g * Item Estimated Cost($)to be completed by permit applicant 1. Building 2. Electrical �--- - 3. Plumbine 4. Mechanical(HVAC) 71k, 5.Total=(1 +2+3 +4) *Estimated Total Z ''--- 7� SECTIO i 7A NEI k1 TH.Q \ Q ;K -.: (to be completed when owner's agent oc cantractor app es otE u i r iit .,f =' (.lease pfnt) A _ "-j, lilt..,�;St ,as Owner of the subject property hereby authorize 43 ch)et-rd a.C(a�_ to ac K my b� • t• ill. relative . ork authorized by this building permit application A., .�.,_.j�1►/_, , •�• /`2 Signature of Owner Date SFf'TION 71i-t1W ERtAT3TH(}RT7Ri?. t;k` tine i,A";•.7 U I, .s ,as Owner/Authorized Agent hereby declare that the statements and information on e foregoing ap ication are true and accurate,to the best of my knowledge and belief. Signed unde he p ins an pena i s f perjury. ) i ®, 02 Signa re f Owner/Author' ed gent C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev.June 26,2003 RESIDENTIAL 2005 SE ON �8 INSPECTOR'SREVIEW/coMMENTS 1. Date plan reviewed: /c 2. 30 days to review period expires: 3 OK to issue date: /Z/ /Ak 6-- 4. OK to issue subject to requested submittals(see project review worksheet): Date: 5. DENIED(see project review worksheet): Date: 6. HOLD reason: Date: 7. HOLD subject to Zoning Board of Appeals action: Date: 8. Comments: 9 Inspector's Signature: i�� � ��� Date:/1 / SEC ii N 9NOTIFICATION Applicant informed of,Do _ ' ate: 0 6 Tim � Al" Clerk Comments: / (i9 �SCTIOIV 14 OF CEIINSPECTOR'S.NOTES Total Permit Fee: $ C31 Less Application Fee: $45760 ,CC, Remaining Balance: $ TOTAL FEE: 1,36 ®(j Gross Area-New Construction total sq. ft. Gross Area-Alteration total sq. ft. Permit Issued To• /471 L594/e_ 74/r7C1.-! Jle7e. cam (_ . � -.x � SE(gIION 11 ADDITIQNAL COMMENTS/SKETCHES ild 15ree., - \ -- -- �r9® Iry C:\bldg.forms\Bldgapp.res.wpd Page 4 Rev.June 26,2003 'ermit No. BP-2005-42326 Project Location: 18 MEDEIROS LN Commonwealth of Massachusetts 4171 00 TOWN OF IARTMOUTH Map.:�n= .... 079 . 400 Slocum Road,Dartmouth,MA 02747 I ot: „ 06.: Phone: (508)910-1820 Fax:(508)910-1838 uhlot.. 000& -7; BUILDING PERMIT ro, t 06 r Est Cost 3200 00 FIELD INSPECTION ee� $30 00 C` ist Cass ,0 Ilse Group ,..R4 .ti. Contractor License: Phone#: ''''Size lt, ROBERT CABRAL HI-125796 (508) 993-5577 9 ) 11A{ Lot ; s ''''', SRI3 Engineer: License; Phone#: N/A � New G�nst , ▪Al# Const /A Applicant: Phone#: ▪Ceiling: PAUL& KIMBERLY ALVES (508) 995-6907 p OWNER: Floor: � t ALVES PAUL &,KIMBERLY ALVES /7/a Glazing DATE ISSUED: / `� TO PERFORM THE FOLLOWING WORK: rnePrib+� ( �'j�(j�� Install wood pellet stove; NEEDS FINAL INSPECTION t�LS t! DATE C7441 TIME TYPE OF INSPECTION&REMARKS INITIAL i -/7 �' l� /r""�/'/ J�11- �.(p�iG e� CLj/ -� 4 l�.�1..�V�„/�L/L�/.�.e �Lif - RESIDENTIAL 0 FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE&NONTRANSFERABLE • , n•-lyye►--�r rr' ,:�y it " r`i' !t' 9D "`.� h.�, , DARTMOUTH BUILDING DEPARTMENT '4".'., (scf -) • 400 Slocum Road,P.O.Box 79399 k,,i, .,nr� �t: 18 ^ 3 Y"` Dartmouth,MA 02747 1 5 ,w' v . , 1 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE-ONLYm RECEIVED BY: 7' � LSE1i DATE SENT FOR REVIEW: _ -t2 � -M DATI ` �'�' Yam ... ' I?ATE OKTO ISSUE-SIGNATURE , - '. .., ,::Building.Commissioner/Inspector of Buildings40 . - Zoning District: Proposed Use: :Zone 0 C 0 B 0 A 0 V Outs d o e THE FOLLOWING AGE IES SHOULD BE NOTIFIED ' ,, "` ,te if; ,. ,t ❑Board of oard of ❑Con Corn. .- ❑Demo tat. D DPW �•Ji 'er"�'' 'or` Appeals Health Affidavit Card Sent m. �� u 6 oil. ' '. PP 6 ix t se a a ura- i 4 _ F x .` .,� ., ,Tx va i.• -Y 'a+�.,r4, fish 0 Fire ❑Gas 0 Planning Board* 0 Sewer`Card 0•Water Cars k� FI 0 w ,- Chief. Cut Off g r I Cut Off 4 � ;CutOff -'LL N. .. *'REQUIRES INSPECTOR'S REVIEW BEFORE'THE ISSUANCk.6 1E i,i 4. ` _ k ~-r t DEPARTMENTAL°APPROVW-�w4,. -u k Zoning Review: Signature: Date: Energy Report: Signature: Date: Fire C 'ef: Signature- Date: oard of Health: Signatu . )►V t Ui. rJ c ��J Date: //A J;.AT:<, Conservation Commission: Signature: Date: Other: Signature: Date: Description of work being performed: - / f( L. _;: -i , . ,,, SE TIONI SLI ,IN ,0 11ON , w, ...-.. NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: 0 yes 0 no / 1.2 Assessors Plat&Lot Number: .1/1.1 Property Address: ' ,• Q Plat 7 Lot - Nearest Cross Street: Subdivision Name: /7/ fr7q.5 1.3 Historical District 0 yes 0 no Total Land Area q.�Ft.: Has application been submitted to the Historic Commission? 0L` / ❑yes ❑no Date: .4 Water Supply(MGL c 40 § 54): 1.5 Sewage Disposal System: 0 Municipal t Private Well 0 Municipal ®°On Site Disposal System i //9 -2-(_-( / 5/43..a-6____ C:\bldg.forms\Bldgapp.res.wpd Page 1 Rev.June 26,2003 d'Ae €6,,,,,„,..ig.ag ar,..A.,./..ext .. _�'-"' Board of. Building g Regulations and Standards el '= One Ashburton Place -Room 1301 ,'` r Boston. Massachusetts 02108 Home Improvement Contractor RI:gistration Registration: 125796 Type: Pries to Corporation ASHAWAY EARTH & CHIMNEY INC. • Expiration 3/ar�oas ROBERT C'BRAL ." .... - .._... 703 STATE 'D. _ _ - - - - -. - DARTMOU , MA 02747 - - -' -- i Update Ac dress and return cai d.Mark reason for change. I Addres; I Renewal (J Employment Lost Card Board of Building -• ,!aliens and Standards `' I License nr registration valid for individul use onl y Yii HOME IMPRO . ENT CONTRACTOR,lit' before the expiration data r'found return to: 4':'j� Registration: 1JSygg Board of Building Regniatio;s and SMndards ' Expiration. 3/ /mg One Ashburton Place Rm 13 it ... .Type: P vote Corporation Boston,Ma.0210$ ASHAWAY HEARTH• .CHIMN INC. ROBERT CABRAL ►03 STATE RD. • Ce " IARTMOLITH,MA 02747 •_ _ _ _ _ Administrator Not valid without sip .� r ��- nature • .-- - The Commonwealth of Massachusetts --_ l Department of Industrial Accidents Office of Investigations -��r� 600 Washington Street v likCr• W, _=E_J= I- Boston, MA 02111 ,v'� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� ` n Please Print Legibly Name (Business/Organization/Individual): A 5 1'l G.L\i C G.rf k 6- C,CA ; iliby i Address: 76 3 SM-k. 12'O A91-i rrI v�1--1 Pf�. e-� City/State/Zip: 4r1WIQ-4r H 61.2.7,/ 7 Phone#: 5Z k - Y 53_J -77 Are you an employer? Check the appropriate box: Type of project(required): 1.N I am a employer with Z 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. + 7. n Remodeling ship and have no employees These sub-contractors have 8. n Demolition K-_' working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition p o workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.® Other251 ii *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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: i e .i .).'rs Policy#or Self-ins. Lic. #: 7+ 3 S5 11(;t n 3 -7 d a - ( / Expiration Date: `� l ;y 0 / / Job Site Address: /t -e G/-z e—a 69 _ City/State/Zip: l}r{,�y,`„„'l) 'fA i .. 7 V 7 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 a penalties of perjury that the information provided above is true and correct Signature: / ''Z Date: #A2 ilt_i Phone#: s V — 9 3 __ J 5-7 7 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apai talents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia EXHAUST VENTING VENTING: APPROVED MATERIALS The stove requires a venting system, approved for pellet stoves by a certified testing lab. Approved pellet stove venting materials are: 1) PL vent, a double wall vent with a stainless steel liner; and 2) Single wall rigid or flexible stainless steel pipe. PL Vent and Single wall vent is available through manufacturers such as: Energy Vent LTD, James A. Ryder, Simpson DuraVent and Selkirk Metalbestos and is carried by many local pellet stove dealers. In this manual approved venting will be referred to a "PL vent" or "Single wall vent". All single wall vent adaptors must be stainless steel. NOTE: TYPE "B" GAS VENT MUST NOT BE USED IN ANY PELLET STOVE INSTALLATION. Examples of venting system components follow: . t w 'zl rn • s High temperature ceramic roping reduces potential fly ash escaping through joints. Stainless steel inner liners resist corrosive flue gas damage to the system.. cTIV Flex pipe is 430 stainless steel, 4 ply construction with a total thickness of approx. .07 inches. TOWN LIF RECORD PLAN A Copy En This EndcmAA Plan Must Be1 rlt € Zile Durinut gab/Z. Hastings Installation manual ;V Page4 laieL v g i TYPICAL PL VENT COMPONENTS 4 3 i-s £yam'`' , ,1. ,a4-;1;4::...1..,'; .."',"-‘,it7i,_:;:-.?:..::-&--:.:1;?.': RAIN CAP VERTICAL OR WALL THIMBLE CHIMNEY SUPPORT BRACKET HORIZONTAL ADAPTER 1 ft Z` :- ka k v.-�y' 3i ,; "hs.�,f g 4 t *M�a a.:,„,, 4Y r , > "yet - y r wT`+ t Y .: '.s. .ti s., ''4' t* .ice �0 r, -. xYy�.� N S ac+,�<+ ,mow " ADJUSTABLE LENGTH SINGLE TEE SINGLE REDUCTION DOUBLE TEE PIPE w/TEE CAP TEE w/TEE CAP w/TEE CAP 0 arx x --gg v s � .3 .f: G:} if at- ei e � t'aaC P L a 3^t S , .rp�,t, .�D '� 'b :1� 8 Yam. me M o„ x , v! PIPE ADAPTER INCREASER 45°ELBOW 90°ELBOW I Hastings Installation manual Page 5 r VENTING: DETERMINING MATERIALS TYPE OF MATERIALS: 1. PL Vent must be used for venting all Freestanding stoves. 2. Exception: Single wall stainless steel may be used inside a fireplace or fireplace chimney. (No clearances to combustibles are needed on single wall stainless steel adaptors, rigid or flex • pipe installed within a fireplace or inside a chimney.) 3. A clean out "tee" (PL Vent or "Quick-Connect Exhaust") must be installed directly to the stove and at the bottom of each vertical run of the exhaust system. These tees are to assist in periodically cleaning the pipe. Single or double clean-out tees may be used. The exhaust system must be installed so the..entire system can be cleaned without disassembly. NOTE: ADHERE TO THE PL VENT CLEARANCES TO COMBUSTIBLES AS REQUIRED. STRICTLY OBSERVE THE PL VENT MANUFACTURER'S SAFETY SPECIFICATIONS. QUANTITY OF MATERIALS: 1. It is recommended that the vent system be installed with a minimum of three feet (3') of vertical rise above the stove exhaust port. FAILURE TO PROVIDE THE NATURAL DRAFT THAT RESULTS FROM A VERTICAL RISE MAY RESULT IN SMOKE BEING RELEASED INTO THE HOUSE WHEN ELECTRICITY TO THE UNIT IS INTERRUPTED WHILE BURNING OR SMOLDERING PELLETS REMAINS IN THE BURN GRATE. 2. Additional vertical exhaust venting should be provided when using: a. More than one (1) elbow or tee; and/or b. Horizontal runs of over three (3) feet. 3. For a venting system ending in a horizontal run, the exhaust pipe must be terminated by a listed end cap or a PL vent elbow (45 or 90 degrees). Note: End caps or elbows must vent exhaust gases away from the building. 4. For termination above the building roofline a rain cap is required. 5. The exhaust pike on all stoves is 2.95" O.D. to accommodate a 3" stove pipe adaptor. Your installation may require the use of 4" vent. (3" to 4" adapters are available for both PL Vent and Single Wall Vent.) Use the following guidelines: Hastings Installation manual Page 6 I V VENTING: THROUGH COMBUSTIBLES D M NOTE: A A f//B NOTE:A / D C B // A B ' ��� / ipI F-I � /j \ 0 , // P E M Figure 2 Figure3 Corner Installation Through the Wall Installation 0 Note A: Double wall PL vent requires a minimum of three inch (3") clearance to combustibles and the use of a listed wall thimble, fire stop or roof flashing where applicable. ATTENTION: We strongly recommend using a battery backup system if the stove is installed using horizontal venting only. This prevents any smoke from entering your home in the event of a power failure. Legend for Figures 2 through 5 A. 45 degree elbow I. PL Vent Fire Stop B. Thimble J. Roof Flashing C. PL Vent Section K. Storm Collar • D. Stove Exhaust Pipe L. Rain Cap E. Air Intake Damper M. Outside Air Pipe F. Air Vent Damper N. PL Vent Section G. 90 degree elbow O. Wall Band --. H. 45 degree elbow P. Outside Air Inlet Cover 1. PL vent may be installed directly through a combustible wall, ceiling or roof according to PL K. vent manufacturer's instructions. (See Figures 2 and 3). 2. The PL vent system must be properly sealed and secured as per PL vent manufacturer's specifications. An airtight seal is necessary in connecting the vent to the stove. Using a PL Vent y (® pipe adapter, secure the PL vent with at least three sheet metal screws and high temperature silicone adhesive, (RTV), or metal tape at each joint. Hastings Installation manual Page 8 ft..-- f- L ,,,,--K} 24',MIN 4 J NOTE: A L. I 12" NIIN 24" MIN G H `___-___ ._ ' ` 0 tr HwuMUIPLUuw)¢a r wxwauuuuuuru r 4 b Q NOTE: A m-o. -4*. r �b N E t5, .[ 1--- P `11S'1 li .1-1 I Figure 4 Figure 5 Exhaust Venting Under The Eaves Exhaust Venting Through Ceiling and Roof Note A: Double wall PL vent requires a minimum of three inch (3") clearance to combustibles and the use of listed wall thimble, fire stop or roof flashing where applicable. i i 1. When terminating the exhaust system under the house eaves, 4) the end of the vent (Figure pipe system must be at least twelve inches (12") from the wall and 24" below the eave, a 90 degree (G) and a 45 degree elbow may be used(H). 2. When extending through the roof, (Figure 5) install a PL vent fire stop (I) in the ceiling or in the eaves if the eaves are boxed in. Install roof flashing (J) and a storm collar(K). Extend the PL vent at least twenty-four inches (24") above the roof and terminate with a PL listed rain cap (L). Hastings Installation manual Page 9 I 0 VENTING: INTO AN EXISTING CHIMNEY The stove may be connected to an existing Class A chimney or a masonry chimney which meets the minimum requirements of NFPA 211. 1. If the stove's exhaust is connected to a masonry chimney, the masonry chimney must be free of cracks that could leak exhaust gases or fly ash. A relining of the chimney with either PL vent or single wall stainless steel pipe may be necessary to bring the chimney into compliance. 2. When chimneys are relined, a chimney chase cap that reduces the outlet of the chimney to the size of the reliner is required. Extend the exhaust vent above the chimney chase cap and finish it off with a rain cap. A single wall reliner must be insulated to maintain adequate exhaust temperatures when outside temperatures drop below freezing. MASONARY MUD 1f��1 THIMBLE MENEM 11 � I I PL ADAPTER 1•••1 111111•11111•1111 ill •1 •••• PL VENT ADAPTER_"'_� '---I 411111116111.21111 1111�_�1 3"MIN CLEARANCE •••• 0 3"NUN CLEARANCE ���1 PL"TEE" .---I INIMIIIIIMINII �� ' . •••• F.7*. 111113111 �•••1 I I 4g�� U —'•___ a -1 I_ -- ,_ 11a. I ADAPTER _--_ PL VENT ADAPTER Figure 6. Figure 7. Venting into Masonry Chimney Venting into Class A Chimney 3. Venting into the side of an existing masonry chimney must be done through a masonry • thimble. When wall penetration is necessary to access a masonry chimney, use a listed PL (0vent wall thimble. (Figure 6). 4. When venting into a Class A steel chimney, (Figure 7), use an appropriate PL Vent adapter. Hastings Installation manual Page 10 ► !- U s 4 R 'N.N.N.NNNNA,t -....__Q r JJJ4141.111,1414.1114111411y J ,2,d� I4 - S 401-4 1\ / 1 — ;-2.-CR \ ii li - ___ Legend i P. Positive connect plate Q. Stainless Flex or PL Vent R. Existing Chimney Damper S. PL Vent or Single Wall Vent T. PL Tee or Single Wall Tee U. Chimney Case Cover V. Combustion Air Pipe W. Combustion Air Shield Figure 8. Venting to the Top of Chimney 1. When installing as a hearth mount stove into a fireplace the unit must be relined and must • terminate above the chimney chase top. An approved flex liner or PL vent must be used. Hastings Installation manual . Page 11 I I VENTING: TERMINATION REQUIREMENTS In determining optimum vent termination, carefully evaluate external conditions especially when venting directly through a wall. Since you must deal with odors, gases, and fly ash, consider aesthetics, prevailing winds, distances from air inlets and combustibles, location of adjacent structures and any code requirements. 1. Exhaust must terminate at least four feet above combustion air inlet elevation. 2. Do not terminate vent in any enclosed or semi-enclosed area, (i.e. Carports, garage, attic crawl space, etc.) or any location that can build up a concentration of fumes. 3. Vent surfaces can get hot enough to cause bums if touched by children. Non-combustible shielding or guards may be required. MINIMUM distances of fresh air intake FROM exhaust termination point: See Figures 9 and 10 Any outside air intake must be at least: (FIGURE 9) 4' (1.2 m) BELOW a door, window, cavity, or air vent 4' (1.2 m) HORIZONTALLY FROM a door,window, cavity, or air vent 1' (305 mm) ABOVE a door, window, cavity, or air vent A LLLLLLLLLLLLCchatLLLLCLLLLLLLLLLLLLL LLL.LCLLLLLL jv■ LLLLLLLLLLLLLLLLLLLLLLLt LLLLLLLLLLLLLLI..t.LLLLLL 1 }' 1 1 1 Ll i 1 1 I Al 4' m..:;1111.t:.::.6 I EXHAUST �tt�t l�tt1nit�a ••■'WINDOW TERMINATION i ' 1 111 { tiLlriLillti ► itiL�\,._.._.__ 4' 4' { 1 t I { t1 1 t I t t� i I11 F I II l t i t 1 1 1 1 1 4 1 l t t i i t I i l I l0.1 .� 1 { t l t ! it � ! {, � iJ �liIj1l111 �T� FRESH AIR t ► i t L t i t { { INTAKE I r t t i i t i • t t ` 1 1 I I { 1 1 1 I I t f of tt i t�111f1 i it { tttit ri� it 'DOOR Figure 9. Venting: Termination requirements Plain View 4 (All dimensions show Minimum distances.) Hastings Installation manual Page 12 • -=- 'ERMINATION LOCATION MUST BE AT LEAST: (FIGURE 10) (305 mm) ABOVE the ground level (2.1 m) FROM a public walkway (305 mm) FROM The wall penetration point (610 mm) FROM any adjacent combustibles such as: Adjacent buildings, fences, protruding parts of the structure, roof eaves or overhangs, plants, shrubs, etc. CLEARANCE TO WALL PENETRATION POINT . — 1' "iAffr it CLEARANCE TO PUBLIC WALKWAY 7' 4 '� I CLEARANCE TO COMBUSTIBLES II I — 1' ' PUBLIC WALKWAY '' E'EN l' \G: TERMINATION CLEARANCE REQUIREMENTS SIDE VIEW (All dimensions show MINIMUM distances) Hastings Installation manual Page 13 ELECTRICAL CONNECTIONS (• 1. The Hastings is provided with a grounded electrical power cord that can extend from the rear of side. This should be connected to a standard 120 volt AC electrical outlet. The current requirement is approximately 3 amps. (5 amps with igniter running) 2. The power cord must be carefully routed to avoid contact with any hot or sharp exterior surface areas of the stove. (Figure 11 B) Any stove installed in a mobile home must be electrically grounded to the steel chassis of the home and bolted to the floor in Model compliance with, and according to building code requirements. 3. In Canada. the electrical installation must meet the applicable requirements for CSA C22.2. Wiring Schematic • II Control Goad IMI r 1 Thermo Wires Black S Volt DC otelr120 Volt ACTerminalBlock ommon Common C —1 il White 0 White Brovn j R oot G Fire Room Fan Brorvi F— �� S NO h 'ewe 0 0 Gray Ma Colors White Black j Vacuum a Pink Svitch (:)- Gray NO 1- range Auger 2'Gray Orange 3 Pink Red ��� Red 1 �Skitch R Yellow an me 4•Blue e Qange (Cr- � NC 5-Yellow MUIR 6-Red 7-Orange CombuAion Fan 8•Gray a•Growl N. i .8ro ,I 10-Brow" 12•Black Black Blue e Pin Out on Versa Grate Motor Molex Connector Wire� � t I Side i 1 I 2 i 3 I 4 5. 6 7 8 9 10 11 .12 Black Black a Green • Hastings Installation manual Page 15 CLEARANCES TO COMBUSTIBLES (O The stove must be installed on a noncombustible floor protective pad or hearth. A UL listed floor pad is recommended. Use the following information to construct a non-combustible floor pad if preferred. Match the K-Factor of the floor protector material to the chart below to determine the minimum material thickness needed. If Micore CV-230 (the approved floor protection material) is unavail- able, see Figure 11 C for other floor protection materials and their required thicknesses. • 2" Required i Thickness 1' is I In inches i I 0 .25 .43 :5 .75 8 1.0 K FACTOR (0 * Micore CV230 has a K factor of.43 Figure 11 C Material Type Reqd K Factor Minimum Actual Sheets/Layers Thickness Thickness Cement 2.04 4.74 4.75 Den-Shield 6 sheets of 7/16" 1.1 2.55 2.625 Foam Glass .34 .79 1.5 Homasote N.C.F.R. 3 layers of 1/2" .59 1.32 1.5 Micore CV-230 2 layers of 1/2" .43 1.0 1.0 Micore CV-300 3 layers of 3/8" .458 1.06 1.125 ' Millboard .84 1.95 2.0 .1 Wonderboard 6 sheets of 7/16" .98 2.27 2.625 Micore CV-230 is the approved and tested floor protection material. If you need to use a floor _ protector other than Micore CV-230, see the above chart of equivalent floor protection materials. K factor is listed for each material type. The minimum thickness is derived from the graph above. When you install a material listed above, the column labeled "Actual Thickness" gives you the actual thickness of the material you will be using when you utilize the required number $ of sheets or layers of material. All thickness listings are in inches. Hastings Installation manual Page 16 AMMO" FLOOR PROTECTION Hearth models may be placed directly on the noncombustible hearth of a fireplace. Floor protection is required for the area directly under the stove and extending 6" beyond the front of the stove as shown. 0" I I 1 � I 6" Figure 12 Floor protection (Top View) Hastings Installation manual Page 17 C/ MINIMUM CLEARANCES (INCHES)TO COMBUSTIBLE MATERIAL Figure(s): From: 14, 16B Sides of stove 4" 14, 16A, B Back of stove 4" 13 Corner of stove 4" • 13 Vent pipe 3" 15 Stove to mantel 12" 15 -- Floor protection: Front(from faceplate) 6" 12 Floor protection: Sides & back of stove 0" 16A Alcove: Vertical to Combustibles 16" 16B Alcove: Sides 4" 16A, 16B Alcove: Back 4" 4"REQUIRED TO ACCESS CONTROL BOARD �4„ ON THE REAR RIGHT SIDE OF STOVE =_I 1_ 4" 7 _i / \ <j// '\ /: \,7--/ L_ _.1 , \\\ % rd iA" Figure 13 (Top View) Figure 14. (Top View) $ Clearances: corners of stove Clearances Sides and Back I Hastings Installation manual Page 18 I i i T ' - Floor Pad and Mantle Clearances Alcove Installation(Side View) Figure 15 Figure 16A t I 1 12" 16" 1 I Nif 1 1.111'11111171f1:1111'11M1f1:1!� ii O 1_1 v � i 6,fgib 11 immiimm 1 • __ ..._,.._ 1 -- Ili I k II iiiIii i J 41i L2.4"_i Alcove Installation(Top View) It Figure 16B Hastings Installation manual Page 19 --- — Mobile Home Installation �• Unit must be installed in accordance with the: Manufactured Home and Safety Standard (HUD), CFR 3280, Part 24 III 1114 111'11`f!11'IIII I'111"ilil l'i 1111`111111111 1111 I ! -;-C 311 ‘,Wr— FLOOR PROTECTION y I I I FLOOR METAL CHASSIS II 1 I �� X Y Figure 17. [he stove has been tested and listed for mobile home installations. In addition to all previously detailed requirements, mobile home installations must observe the following: (Figure 17). 1. WARNING: DO NOT INSTALL IN A SLEEPING ROOM. 2. WARNING: COMBUSTION AIR MUST COME FROM THE OUTSIDE OF THE MOBILE HOME! FAILURE TO DO SO MAY CREATE NEGATIVE PRESSURE \\'ITHIN THE MOBILE HOME AND COULD DISRUPT PROPER VENTING AND OPERATION OF THE PELLET STOVE. 3. CAUTION: THE STRUCTURAL INTEGRITY OF THE FLOORS, WALLS, CEILING AND ROOF MUST BE MAINTAINED. • Hastings Installation manual Page 20