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54 MEMORIAL DR - BUILDING INSPECTION (3) R s� The Commonwealth of Massachusetts RECEIVED CITY OF Board of Building Regulations and 39SPE sTIONAL SERVIC ' SALEM / Massachusetts State Building Code,780 CMR RevisedMar 2011 Building Permit Application To Construct,Repair,ReZffli{a0rQmt>kA 6 1 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: I Dat Ap.lied: l� 7 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION Property Address: 1.2 Assessors Map&Parcel Numbers 0.�l�l��r;r�! �r Sfltem MA ©1� Lla Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(fl) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP' 2.1 OOwner of Record: mpf (Dill 1�m CJ9I City,State,ZI 1 Name(Print) t &41 nemo+'n 1 'Dr� No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other PI Specify: Brief Description of Proposed Work : t SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Su ression aS Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: $ � ❑Paid in Full ❑Outstanding Balance Due: �1 a4 f 06 ha.eawA�,_ N,&l ueo , o I ,-) i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /����/ a •���� flyby- " An uccl License Number Expiration Date Name of qSL Holder /J6 I (I/^ f � List CSL Type(see below) No.and Street j p Type Description N� Olp�� U Unrestricted 2 Family s u el ing cu.ft. I eA O R Restricted 1&2 Famil Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding qq�t� \ SF Solid Fuel Burning Appliances -I �LJ /�7 55 I Insulation Telephone Email address D Demolition .5.2�'Rreeggistered Home Im�±p;_r,.00ve�menntt Contractor 1(HIC) � 7d3 t i /0 t ItXu ' 1'Q r�U' ���1ov l I M+, �� ti/• HIC Registration Number Expiration Date 110 mYPt i +IiFBeSf11Q. . re _ Email address Cii//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.'Faiture to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ 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 Rfl6i1� CC 1 to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date rSECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION O"er's name below,I hereby attest under the pains and penalties of perjury that all of the information contained application is trand�o the�best my knowledge and understanding. 00 0CC I �//d /O a `� Authorized Agent's Name(Electronic Signature) Date NOTES: 1. 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.1Tiass.gov/oc Information on the Construction Supervisor License can be found at www.111—m ov/dps 2. When substantial work is planned,provide he information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" WARM TRADITIONS STOVE SHOPPE 110 Newbu Street P O BOx 2081 Danvers, MA 01923 978.777.5562 _ Tnis form sat sfies all basic requ cements of the slate's Home Improvement COIInaeteI Law(MGL chapter 142A),but does not include standard langnagetoprotecthomeowners. SeelclegaIadviceifnacessaly. AnypetsoapIanainghomeiurprovementsahouldfustobtainacopyof';A Massachusetts Consumer Guide to Home Imprevement[before agrecingto any work on your residence.You may obta n afree copy by calling the Office of Consumer Affairs sad Business Regulati on, s Consumer Information Hotline at 617-973-8787 or 1-888-283-3'57 or on our w0bsite. Homeowner Information Contractor l[nformation Name Company Namo m i ���•, 10M a CVa11s64j Of �Te_� Street Address(do not use a Post Office Box address) Contractor/Salesperson/owner Name L5 (Y)fa(X�C t�. l'\)e t�J ►Qa t�cu City cam State Zip Code Business Ad ress( ust include stre ddress) Dhytime Phone Evening Phone City/Town State Zip Code q>g- "> 97ay q ->>-7•s5-4,Q 41 Mailing Address(Itdifferert£rom above) Business Phone Pederal Employer M or S.S.Number • Hame Lnpmvement CvntmUorRa&•Number ffipinevn tla[e Lmvtagniret Mntmmtavme lmprovemrntuntenUvv hmm I `��� +�� / n .�a j p rnila rva'.temaon nmm�ar 7 G, The Contractor agrees to do the following work for the Homeowner: escn'be in detail the worlcto completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) 1 nsVai Ic�� 'tu1 ©f C'c e o'Ir�rnp� -F+�e sFand uo%d f ve - 8�t Required Permits-The followiitgbut7dingpermitsarerequired Proposed Start and CompletionScheduIe-The following schedule will and will be seemed by the contractor as•the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of �� "a jV Date when contractor will begin contracted work. MGL chapter 142A) Date when contracted work will be substantially completed. Total ContraetPrice and Payment Schedule q The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: / a5 (*) Payments will bemade according to the following schedule: $ dV upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ j'f�/7 as by _/ / or upon completion of l�r $ by _/_/ or upon completion of $ uponcompletionofthecommet (Law forbids demanding fall payment until contract iscompletedto both party'ssatisfaction) . The following material/equipment most be special $ tobepaidfor ordered before the eoatmetedworlc begins in order to meet the completion•schedule.(") $ to be paid for — NOTLrS:('h Including all finance charges(e'*)Law requires that any deposit or down payment required by the contractor beforeworlcbeg ns may not exceedthe greater of(a)one-third of the total contact price or(b)the actual cost of any special equipment or custom made material which mustbe special ordered in advance to meet the completion schedule. mresswarranty Is an exoresswarranty being orovided bvthe contractor? ❑No❑'Yes(i17 terms of tbewarrnntvmnst be nttncbe_d io the tontrRctt Subcontractors-The contractor agrees to be solely responsiblefor completion of the work described regardless of the actions of any third perty/subcontractoritilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for at ial and and t i e t Contract Acceptance-Upon signing,this document becomes abinding contract under law. Unless otherwise noted within this document the, contract shall not implythat any lien or other security interest has been placed onthe residence. Review the following cautions and notices carefully before signing this contract. ' n Don'tbe pressured into signing the contract Take time to read and fully understand it Ask questions if something is unclear, o Make iggge iace a`---valid Home2mmovereent Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director ofHome improvement Contractor Registration. You may inquire about contractor registration by writing to theDirector at 10 ParlcPlaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. a Does the contractor have insurance? Askthe Contractor for his insurance company information so that you can confirm coverage,or aslc to see a copy of a"proof of insurance"document. e I{nowyour rights and responsibilities. Read the Importautlnfomiation on the reverse side of this form and get a copy ofthe Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement i£it has been signed at a place other than the contractor's normal place of business,provided you notify the contractorinwritingathislhermeiaofficeorbranchofficebyordiaarymailposted bytelegramsentorby delivery,not laterthanmidnightofthe third business day followingthe signing of tins agreement. Seethe attached notice of cancellation form for an explanation ofthis right DO NOT'SIGN ]CH1[S CONTRACT IF 1HERE ARE ANX E LAM<SP.A.CESi l l Taro identical�opiesofthewntraetmostb0completedmdsigaed. Oae�opyshouldgotothelwme . The other copy shouldbekeptbyfeecontractor. Contractor's Signature meowner's Signature e" Date 'Date f � I Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)ifthey have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract;the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, chapter 142A.. Homeowner's Signature Contractor's Signature, NOTICE:The signatures of the parties above apply onlyho the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A) and other consumer protection laws (i.e.MGL chapter 93A)may not be waived in any way, even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from.all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and worltmanlilce manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for worlonanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold•in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict:a homeowner's basic consumer rights. If yott have questions about your consumer/homeowner rights, contact the Consumer Information T3otline(listed below). Execution of Contract The contact must be executed in dtmlicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the.original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecux. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a j oint escrow account as a prerequisite to contimung the contracted worlc. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of ,A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 orvisitthe OCABRwebsite at it •/1 " Mass.aov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 16 ParlcPlaza,Room 5170,Boston,MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at htrp //www mass.gov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: . hitn'//db state m2 tu/hotneimprovement/]icenseelist.asro For assistance with informal mediation of disputes or to register formal complaints against a business,can: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 509-652-4800,508-755-2548or4.13-734-3114 v��nz.t-itnvzoto The Commonwealth ofMassachusetts Department oflnduslrialAccidents Office oflnvesfigations 600 "Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl flt�xt.�ecro� wr�e ana�emeni-, Ind. Name(Business/Organizationdndividual): -�Qjf} k i%crrl t rad,-}tG{lq Address: I ID r�Eubi-41-t S+mk-t— oAcgl City/State/Zip: L-�?Ove�S, %9PF OIgdb Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1 Q(I am a employer with 1k 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.t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑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' 13.K Other$'I 4e r6letllA�;url 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 anew affidavit indicating such. t(Dontractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. ram an employer that is providing workers'compensation Insurance for my employees. Below is the policy and Job site information. Insurance Company Name: 4)&A&CJ— lo-6 ca(N cf', Policy#or Self-ins. (Lie..#: U)Cpt C � S`J���1� Expiration Date: Lt— i� Job Site Address: V 1��1�(. i(I City/State/Zip: l�l• �IC1�LJ 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 wall 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 cent' under the sin nd penalties ofperjury that the information provided above is true and correct. Signature "� r Date //•30/�/ Phone# g76—.177- 551oa2__ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/Lieense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown 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 apartments 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 till 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 maybe 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permiVEcense 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 homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum 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 evised5-26-OS Fax#617-727-7749 -- �a• __.. VIIIJOp( NO.7q5 Department of Code Enforcement Debris Disposal Affidavit In accordance with the provisions of GL,C. 40, sec, 564,a condition of permit p resulting from this work shall be disuosed of in is that the debris a properly licensed solid waste disposal facility a defingd by Gil.,c. I 11,sec. 150A. The debris will,or has been disposed prat: S e� �nv�rs rti{tS ©IL �i RlCl ll sh° atlr2 mpn Locate— to OfFacili --- -����- ���- �Inn �a- 6►��d__ Location of action/jobsite (Street Address) oe- L Signature of applieanticontractor at Freestanding Side Freestanding Back r ,. 24s' —>, ' 24s' Heat exchanger - Insert Side Hopper on freestanding rubes extract o9910lololam00000000000fs 1112le t-12•-- - model holds enough fuel maximum heat. to burn up to 55 hours" C/L 31%, 17'W C/L ' o000o IV911111EIIIB909B190BOBOBO i i 1 Screw auger ` Ic/e=caner ;o�mem;o„m rmea"cz./-va-1 steadily feeds Damper adjusts fuel for reliable, 0.' g= to variations in Fuel For Thought _i consistent heat. - ,. pellets,altitude Wood pellet fuel is the most efficient and and installation. environmentally responsible way to burn 9"' y wood.It should be noted,however,that pellet quality varies depending on the raw materials from which it was produced,and Ultra Graten' can affect the performance of your stove. achieves nearly Optional FastfireTM 100%combustion. The Advantage II-T is designed to burn self-igniter makes both"Premium`and"Standard"t grade starting fire quick ��t y{�3, S � fuel pellets as designated by the PFI.Your and easy. --;,.}, dealer is an excellent source of information - regarding the various types of pellet fuels approved for your Whitfield pellet stove. ' FREESTANDING INSERT FREESTANDING INSERT DIMENSIONS CLEARANCES Width 24Y" 24a/<" Back 1" 1" Height 31a'A" 19aV (rear) Side 6" 6" Depth 24'/a" 12"(rear) Mantle (NA) 18"Fireplace Insert Overall depth 24a/" EFFICIENCIES S, INSERT SHROUDS FEDERAL EMISSIONS Small 28'/<"X 40Y4" Overall efficiency 79-81% 79-81% Medium 32"X 44" Emission ***0.9 gm/hr. ***0.9 gm/hr. Large 36"X 48" Status Certified Certified CAPACITIES BTU range *7,000-37,000 *7,000-37,000 HEAT-PL LIS Ask about i M W49�f Fuel capacity 60 lbs. 501bs. +41[71 Bum time **12-55 hrs. **10-45 hrs. FM S1 FIRiPROIECHON ' parts o�ld a T a' WAPd The Advantage II-T is approved for mobile home installation.This stove is manufactured and shipped with the Ultra Grate installed,which enables it to burn Your local authorized Whitfield dealer is: both"Premium"grade and"Standard"t grade wood pellet fuel with up to 3%ash content as defined by the PFI. "BTUs vary with pellet type. **The burn time will vary with size and type of fuel being used.Safety tested by: Warnock Hersey,Vancouver,B.C.Approved to:UL1482,UL907,ULCS627, CSAB3—Advantage 6 t U 11-T to ASTM E 1 Results . Whitfield® "^Advantage II-T test results.Results based on EPA test methods.Efficiencies vary with fuel feed rates.Federal Emissions Standard-7.5 grams/hr.particulate. `L Advantage 11-T Door U.S.patent#DES 316,141.Ultra Grate U.S.patent Hearth hroducN #5137010,5383446. t"Standard"grade pellet fuel approved for use when the Ultra Grate is installed Pyro Industries,Inc. in the unit. 695 Pease Road The above dimensions are for general purposes only.See installation manual for Burlington,WA 98233 specific diagrams.Pyro Industries,Inc.maintains an excellent warranty program and trained,fully qualified Whitfield pellet stove service and installation techni- www.whitfield.com cians throughout its entire dealer sales and service network.Pyro Industries,Inc. reserves the right to change products,specifications and prices without notice. 01998,Pyro Industries,Inc.All rights reserved.Part#40020031 Rev.A PRODUCT 209 WARM TRADITIONS STOVE SHOPPE 110 Newbury St.(Rte 1 South) volEIR 3661 P.O. Box 2081 Danvers,MA 01923 978.777.5562 TO TOM......COTE 10-uR,TE14........................ ......... JOB NO ............... 54 ..MEMORIAL.......DR. ................ Joe NAME ..... .......... .............. ............. S.A.L..EM. ....M.A.._0197.CY .............. Joe LOCATION..........9.78-.9.7.9..-97.2.4.................. TERMS �'+.»''.2'.ua x-*�'i*3:-., r�r „-4;:�,.dES[RIPTfO1V„• '�.�.-,."'x, ::-I wsy .:'� �.v =PRICE - . AM9W111T CLEAN... AND..._I_NSTALL...._CUSTOMER"S ADVANTAGE IIT FS PELLET STOVE .............. . oZ7g �� clean....3tove...;and tes-t... at shop $ ......2.6.5i 00...... 1 Cor.e...._foundation _ 2..50� 00._.. Instal-1.. 1abo. :_. 900; 00...... i i Mat.eri.a.ls: .. x 5 __.pe.l.l.e.t. ve.n.t.._... 90 00...... 0 a... ............90.....e.lb.ow .......... ........ ... ............... ...... ... 8.0'..0.0..... 1... ...............upven.t.....adap-t.e.r.................................... ........... ....... _. _.14.0' 00. i i 1 ..._star..t.e.r.. ada.pt.er ............ ........ ... ....... ... ............ .__25'-0.0..... 1 ...... x 2_'__.pe.l.let. ven.t....... _. .... .......... . ...... 50' 00. 1 ...............Thimb.le... ........... .. .. .............................. _. 80'.0.0..... o ' 1 ..........4,...5 end_ cap ..._.. __.. 65100 l tube..._silicone.... .................................... 181 g0__ Sales....tax on....$5 a8. .00 _...Tota1...Due ........... $ 1497' 25..... .............. BUILDING. PERMIT ._ . .............. ..... .. .... i i WARM TRADITIONS STOVE SHOPPE A Division of AQUA TERRA PR OPER TY MANA GEMENT,INC Construction Supervisor Contractors License #CSFA-105711 Robert Raucci T Massach,iseti - Board of B..:'d;ng Cmstnictinn Supcniwi i S '�,censc: CSFA-105711 1.� h ROBERT G RAUIPCI ` 123 NORTH BROADWAY' _ HAVERHH,LMA 01832 02/13/2016 :]or-;.c..',-ar,Nr Home Improvement Contractors License #170349 Aqua Terra Property Management, Inc. r'kn.c/LI Office of Consumer Affairs&Business Regulation h, §f0OME IMPROVEMENT CONTRACTOR 2egistration: 170349 Type: :T I-xpiration: 10/12/2015 Corporation AQUA TERRA PROPERTY MANAGEMENT INC. ROBERT RAUCCI 110 NEWBURY ST 11C DANVERS, MA 01923 Undersecretary 110 Newbury Street #11C P.O.Box 2081 Danvers,MA 01923 978-777-5562 M VVIIl{, vrn� a vv avrn-w n r ve rnraa.PA rn v n uv�vvnaruvvwm. I I PRODUCER 09/05j2014 978 8874900 FAX 9'78.837.2404 THIS CERTIFICATE IS ISSEDU AS A MATTER OF INFORMATION / _ Edwa . . rd F. Sermott Insurance Agetxy, Inc. ONLYANDCONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. 0. Box 457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I -------'--- -------- ' Topsfield, MA 01983 j INSURERS AFFORDING COVERAGE NAICIt INSURED pqu8 Terra Property MariagenienE, Inc,- I m 14- ,+ Acadia Insurance _ _� 31325 QBA Warm TraditiwTs Stove Shoppe 1: P Union Insurance Co P 0 Box 2081 -- --- .--- ---- - ---�- ------- w'.l — Danvers, MA 01923 '---------------------..___-__—_-- -- __ COVERAGES_ 7HE POLICIES OF INSURANCE LISTED BELO',4 HAVE BEEN ISSUED TO THE INSUREC NAMED ABOVE FOR THE POLICY PERIOD IND!CATEO.NOTWITHSTANDING-7 ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE IPSURANCEAFFOP,DED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL T11E TERMS,EXGL SON°AND CONDITIONS�F SUGH POLICIES AGGREGATE LIMITS SHORN MAY-IAdE BEEN REDUCED BY PAID CLAIMS. hNSRA�Ti -. -_ . L N) TYPE OFINSURANCE - T-POL -- -__ POLIC`(NLMBER - ! �MM ! 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( [ T I$ _ ANf AUTG IER IL TO II L'Y q n t � L—_�—E.cessruMBFEL,.nLMel rry CU.4033576 04/14/2Q14 04/14/2015 IE�rI usreEa� �r _ 1,000,00_ FX!QCCUR 000,000 c 1 WCA033559 4 x _ I orstsvnu�utt I AND EMPLOYER€N� ILITT-- YIN j — — 0a/14/2015 X AND EMPLOYERS' 4 14 zala , Aa PERIME 111 IhEF N r.-xErl t --� L EAcr a r: r j, 500,00 A IOFF' t IyinN Ee Ilf D� @7antletorylr-IiHi I IWI ! �EI EASE E„E F F s 500,0001 - ---- - -- PEr P:,ILFV�e ! - Iw rL F-E Pou Yr I T SOO,OOO j I I DESCRIPTION OF OPERATIO JS l LOCATIONS)VEHICLES EXCLaIONS AOUED BY E;V{IORSEMENT I SPEf,1Al.PROY510M1b I CERTIFICATE HOLDER _ CANCELLATION .� SHOULD ANY OF THE ABOVE DESr,RISE.1 POLICIES SG OANCELL EDBEFORE THc F).PIRAMON DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10- DAfSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,RUT FAILUIE TO DO SO SHALL Thomas Cote IMPOSE NO OBLIGATION OR LIABIL IT OF ANV KIND UPON'THE INSURER,ITS AGENTS OR 54 Memorial Drive REPRESEWn0VE5. _ Salem, MA 01970 AUTHORIZED REPRESENTATIVE _ Peter Sennott AAM ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORO IMPORTANT If the cenrficate no'der is or.ADDITIONAL.INSURED,the policy(es)must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If F-UER0GA7IpfN IS WAIVED, subject to the terms and cend;tions or the policy, certain policies may rec uire an endorsement. A statement on this certificate does not confer rights to the certificate ho'der in lieu of such enciorsement(s). I DISCLAIMER This Certificate of Insurance does not constitute a contract between rice issu,rig insurer(,,;), autronzed representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, e)dend or alter the coverage a'torded by the policies listed thereon. I ACORD 25(2009101) �" rj L * GA& 0/Au F ' /� � .dale Zoawd of✓tJru/� R u"m6 and,f mwardb William F. Weld 'Aza(ooP'Mm a AZ& C AO -Oazfanv (iovc•rmtt Otte N SW inon/ ��ce - m f30f Kcillalo I:sutsumi ox, '116mee�m 020,08 Chainnmr (fi 1 7) 727.12M Orolcs J. Dinezio Adminisir for April 19, 1991 Pyro Industries, Inc. 11625 Airport Road -Fvcrcll, WA 93204 Attention: Dr. O. J. Whitfield Subject: Massechuscns Al pruval Siaihs of.Certaiq of Pyro Industries Wood Pellet Slo.vC.Sastcros Dcar Dr. Whitfield: At its March 26, 1991 monthly meeting, the ORRS voted approval of certain wood Pcllct bm nine; Stoves alld healers for use in Massachusells • the following inlnrnurtion identifies ihesc products and any vuicd slipulalions an(ttor requirements. I'1ru huluslrig I c_of pverctl. Nya.-OAuminn Whilfield Automalic Feed, Thermosialically Conlrolled, Mechanically and Nawrtllc Uralicd Wood pellet Bunting Room I Iruers: I) ADVANTAGE n-'r (frecsianding :slid Iiteplace inset mo(lels): 2) RENAISSANCE; 3) PRODIGY The cited wood pellet burning appliances,as specificd in the application nn icrials dated February 6, I(Y)I,arc approved for use in Massachuselts subject It, confornnuu'e with all other applicable State and Federal regulations as well as any re(ItHicnncns ul ttre Mannlmimu - whcrc mcchani(Al%, venled cquipn,c•nt is specified by the Manufacturer fur Ihruugh the side wall \,(slung of such appliances,such venting systems shall be installed in accordance will, llle Manutacwret's insialhtion m:uwal. As part of the approval of these wood pellet burning healing appliances, it is required that these prrducts he installed in accordance with all applicable sections of the Fifth Edition of the State Building Code (the Code) and that specifically, clearances to combustible construction shall be in accordance with the requirements of Section 3409.4 of the Code; i.e., Section 3409.4 does allow for reduced clearances to combustibles "'hell exposed combustible construction is protected with 1loncomhusiible materials affording the necessary life protection resistance; additionally, clearances may be reduced to the manufacturer's tested clearances when such clemanccs are identified on the listing label of such products. 'rhese approvals arc for those wood pellet sloveslhcaters as described in the cited applicaliun materials and any change in name,design,equipment,installation or intended use will require Pyro Industries, Inc. to submit These products again to the CNISI3 for consideration of approval. Pyro Industries, Inc. is cautioned that any recommendation fur approval by the Consuuclio❑ Nlalcrials S:dety Board ((,,MSB) and any actual approvals granted by the State Board of Building Regulations and Slandards (S33BRS) are based on an approval process consisting of an evaluation of only the safety aspects of product design, construction, installation procedures and intended use, based on the application materials suhnlirted. Neither life CMSB nor the SB13RS evaluate product efficiency or the advisability of using one product as opposed to any other product and therefore approve as discussed herein is nut ul he utilized in advutisine or promotion of said products. Very truly yours, S' �jf�OA OF B ll. N (i,RI GULAIIONS ANT) SIANDARDS �120-i C:7 � Ln Chilies J. Din ci Administrator CJ DA ntr CC: Mr. Charles R. Brewster, Jr., Caner, MA 02339 i . '� �lre -C�o��rya�oouvea�i n��,22aQaacicuaella STATE BOARD OF BUILDING REGULATIONS AND STANDARDS 5 tf(;ove F. ts'eld Governer CODEWORD Kentaro Tsutsumi Chairman December, 1991 Charles J. Dinezio Administrator PELLET STOVES - AT ISSUE With the high cost of sources of energy and the heating season upon us once again, many people are looking towards alternate or supplementary methods of providing warmth for themselves and their families. Passive wood sloes (devices that need to be manually stoked) have been a favorite over the years, both for their handsome appearance and for their wry supply of heat. The pellet stove has evolved from these earlier solid fuel burning models. Pellet stoves allow a person to fill a storage bin that is attached to the unit with fuel. The fuel (pellet) is then auger-fed to the burn chamber at a specific rate to keep the fire and heat roaring. This, of course, frees the person who would normally tend the fire to perform other tasks, such as sit back and enjoy the flame. The December, 1990 issue of CODEWORD announced the approval of certain direct vent versions of a solid fuel burning device that uses corn as its source a fuel. Certainly, this is an innovative method for dealing with heating issues in terms of the environment (less destruction of trees) and in terms of the costs (of wood products). Although many pellet stoves are fueled by wood products, they, too, can be operated with creative alternate sources such as corn kernels, rice coal or even walnut shells.(The type of stove would dictate the type of fuel.) However.with innovation sometimes comes problems, at least for regulators. All new ideas are subject to improvement as lessons are learned through operation. The test methods identified in the appendices of the building code are designed to help avoid expensive lessons. These tests are meant to challenge the operation of devices as they normally would perform when installed. The listing laboratory then labels the product to assure the buying public that some type of performance test was administered and the results were favorable. We all recognize the seal of Underwriters Laboratory (UL) as the most common marking. When a new product such as the pellet stove is introduced to the market, testing becomes a problem. The standard tests for solid fuel burning appliances are intended to test passive devices, not actively-fed models. Although in some respects this may not be a great concern, it does raise at least one issue: how does the unit respond to negative pressure (not currently part of the required testing process). Thus, in the interest of public safety, the Board of Building Regulations and Standards has voted to take steps to address this matter. The following article details the path that the manufacturer, consumer and building official must take when selling or installing a pellet stove in the Commonwealth for the cited periods of time. In the future, proper testing may make much of this procedure unnecessary. Until such time, the following action is required. Publication No.17,007.10-t 100.12 91-.21-C.R. Approved by:Philmore Anderson M.State Purchasing Agent PELLET STOVE BUILDING PERMIT REQUIREINENTS FOR THE FALL 1991/WINTER 1992 HEATING SEASON NOTE: THE FOLLOR7NG INFO&WATION IS ISSUED IN LIEU OFA MEMOPUNDUM DATED 11/13101. SENT TO PELLET AIANCFACTURERS SEEKING APPROVAL FOR SALE AND INSTALLATION OF PELLET APPLIANCES IN MASSACHUSETTS. Pellet stoves/heaters/fireplace inserts are heating appliances that burn wood pellets, but may also he designed to burn rice coal, kernel corn, walnut shells, or other pelletized types of solid fuels. Such appliances typically possess numerous electro-mechanical devices that are subject to potential failure or abnormal operation. Because the existing Building Code requirements for solid fuel burning equipment did not anticipate pellet stove technology (the existing Code requirements - Section 3409 -were written some 10 to 15 years ago and were intended to deal largely with "passive", as opposed to electro-mechanically "active", solid fuel burning equipment), the State Board of Building Regulations and Standards (SBBRS) at it's December 10, 1991 meeting has approved an "AFFIDAVIT PROGRAM" for pellet appliances for the Fall 1991/Winter 1992 heating season. In summary, each pellet appliance manufacturer must provide an affidavit to the SBBRS and to the manufacturer's sales representatives. To obtain the necessary building permit, the end-user shall provide to the local building department a copy of the affidavit referring to the specific pellet appliance which is to be installed. Pellet appliances, in addition to being UL 1482 or ANSVUL 737 labeled (which have been traditional requirements of the Building Code for all solid fuel burning appliances - Section 3409.2) will either: a) have been tested to ULC S627 or ASTM draft standard E-91, revised draft 5/28/91. in a "negative pressure" environment and have demonstrated acceptable performance under such test conditions (acceptable performance includes satisfying requirements for minimum CO release into the test enclosure and additionally; demonstrating that burnback into the fuel hopper does not occur for either normal or abnormal operating states in a test enclosure at "negative pressure% relative to bulk air pressure); OR b) if not so tested, the manufacturer shall provide a carbon monoxide (CO) gas alarm with the sale of the pellet appliance. These requirements are imposed on pellet appliances because there exists the possibility that should mechanical draft in the pellet stove fail and the building in which the pellet appliance is operating is tightly constructed, the pressure in the building could be lower than the bulk atmospheric pressure - particularly if the building has bathroom, kitchen or other exhaust fans operating. Under such conditions, a pellet appliance might backdraft into the building, or even burnback into the fuel hopper, where, depending on the manufacturer, from 20 to 150 pounds of pellets may he stored (note that even if the pellet appliance does not rely on mechanical draft, these "negative pressure" issues still exist). From the perspective of the local building departments, it will only be necessary to advise applicants seeking a permit to install a pellet appliance that he must get the required affidavit from the manufacturer, and that the affidavit must be filed with the permit application. There are two (2) types of affidavits, titles are shown on the next page. PAGE 2 PELLET STOVE REQUIREMENTS - CONTINUED FROM PAGE 2 One affidavit is entitled: SOLID FUEL BURNING PELLET STOVE AFFIDAVIT FOR PELLET STOVES SATISFYING "NEGATIVE PRESSURE" TESTING (FALL I"IfIVINTER 1"2 HEATING SEASON) the other is entitled: SOLID FUEL BURNING PELLET STOVE AFFIDAVIT FOR PELLET STOVES SOLD WITH CARBON MONOXIDE (CO) GAS ALARMS (FALL I"11WINTER I"Z HEATING SEASON) Please note that the affidavit dealing with CO gas alarms, refers to requirements found on "page 1" of that affidavit (page 1 of this affidavit is simply the instruction sheet on how to properly complete the affidavit). As this is an important issue that may affect many building officials in the coming months, we have reproduced below that portion of the instruction page addressing CO gas alarm requirements. (Note that it is the responsibility of the manufacturer to choose an appropriate gas alarm.) REQUIREMENTS (CO GAS ALARMED PELLET APPLIANCES): For the Fall 1991/Winter 1992 heating season, if"negative pressure" listing testing, per the methodology of ULC S627/CSAStandard B366.2,STANDARD FOR SPACE HEATERS FOR USE WITH SOLID FULLS. Section 12.3, or via the requirements of draft standard ASTM E-91, revised draft 528/91, STANDARD SAFETY SPECIFICATION FOR ROOM HEATERS. PELLET FUEL BURNING TYPE, Section 11).1.5, has not been performed on product inventory intended for sale in this heating season, it will still be required that pellet stoves, as solid fuel burning devices, be tested/listed to UL 1482 and/or ANSUUL 737, as applicable (per Section 3409.2 of the Fifth Edition of the Massachusetts State Building Code): additionally. it will be necessary that manufacturers provide a carbon monoxide gas alarm, with the pellet appliance - the selection of the CO gas alarm shall be the responsibility of the pellet stove manufacturer, but said gas alarm will possess CO detection capability/sensitivity consistent with generally accepted national standards relating to safety, and be of such a design that a sufficiently audible alarm is sounded in the event of excessive backdrafting or in the event of burnback; both types of events causing excessive CO release to the habitable space of the building. The CO gas alarm shall be located either in the room in which the pellet stone is operating or shall otherwise be located to ensure early warning in the event of abnormal pellet stone operation (the gas alarm installation shall be per the alarm manufacturer's instructions and otherwise he in accordance with all applicable local, State and Federal requirements, and any additional requirements imposed by the pellet stove manufacturer). Should the gas alarm be energized via battery, the alarm should. if possible, be designed to warn the user of low battery voltage, or weakened charge. The pellet sto%c manufacturer shall provide the gas alarm and any and all necessary gas alarm instruction materials, as part of the equipment and materials furnished at the time of sale of the pellet stove. Pages four (4) and five (5) that follow are samples of the affidavits that a building official must receive when an individual is applying for a permit to install a pellet stove. Please remember that this action is only required for pellet devices, not for passive devices that would be labeled through the normal testing procedure. PAGE 3 _ J�ii�6 Ur 0ft7Y/l 1lillium F. Weld �.jmolt f5t 1�y/0M� Tdr dta��le (-Ae��`.'"� Governor (/7M sy�fd/1I/t!W[4n ✓ a" ;/LpryAa 0/ G Kentaro 'knlsumi � 02108 Chairman 6171 727.331Nt Charles J. Dinezio SAMPLE Administrator SOLID FUEL BURNING PELLET STOVE AFFIDAVIT FOR PELLET STOVES SATISFYING "NEGATIVE.PRESSURE'TESTING t FALL 19911%lNTF.R 1e92 HEATING SEASON) "In the State Board of Building Regulations and Standards: Date_ __Iv_ I, as on behalf of a manufacturer of solid fuel burning pellet stovesAteaters?rc place inserts(circle appropriate products), hereby certify that the following pellet heating appliances, by explicit model Identllkdlon; model(s): have been tested.or IestedAisted(circle appropriate information)per the"negative pressure"tat requirements of either ULC 5627/CSA Standard B366.2,or draft standard ASTM E-91, revised draft 5B8,91.and found to satisfy the applicable criteria of ULC 5627lCSA Standard B366.2 or draft standard ASTM E-91, raised draft 5/18191; additionally,burnback did not occur either during normal or abnormal"negative pressure"testing. MANUFACTURER: SIGNED: TYPED OR PRINT NAME ABOVE-- TITLE-- On this day of . 19_,then personalty appeared before me,the ahove named and made oath that the above statements by him/her.arc true. BEFORE ME- NOTARY PUBLIC MY COMMISSION EXPIRES: 19 PACE 4 ' fie �i am�rtaou,�rea�i a�,�'�i!�aaa:c�uaett6 o ffMw h1A (Ale /a/-,?Ime jale G` �'/• J P :Bva�vi �{ .i&4 ink :lLea�ju?�-a-Qnm,,s,'.a�_ Anala �63 11'illium F. Weld t/ ��f'�',��"�/a� -/" CAW Governor Gee h l lour gkr e - ROOM fJOf Kentaro 'Isulsumi �• ✓ff�da�4 � 0.2f08 Chairman ;fil'i 7-17-.12(Itl Charles J. Dinezio Administrator SAMPLE SOLID FUEL BURNING PELLET STOVE AFFIDAVIT FOR PELLET STOVES SOLD WITH CARBON MONOXIDE(CO) GAS ALARMS (FALL I"tA"NTF.R 1"2 HEATING SEASON) To the State Board of Building Regulations and Standards: Date 19_ 1, as on behalf of a manufaaurer of solid fuel burning pellet stovewbeatenlTtre place inserts(circle appropriate products), hereby certify that the following pellet heating appliances,by explicit model identification; mndel(s): sold, for use in Massachusetts,are equipped With a carbon monoxide gas alarm, in accordance with the requirements specified on Page I of this affidavit. MANUFACTURER: SIGNED TYPE OR PRINT NAME ABOVE-- TITLE.- On this day of , 19_ then personally appeased before me,the above named and made oath that the above statements by him/her.arc true. f BEFORE ME-- NOTARY PUBLIC MY COMMISSION EXPIRES: 19 ' PAGE 5 _ Inchcape Testing Services t4aninekile,yry Ptofemsionol Services Lid. Warnock Hersey 211 5choaihouse Street Coqu111am, A.C. V3K 4A0 Canada Telephone (M04) 520-3321 Fat (604) 52t-9186 P.EPORT OF A STANDARD TEST PROGRAM CONDUCTED ON A WOOD PELLET TYPE FUEL BURNING APPLIANCE MODEL ADVANTAGE PLUS CLIENT: PYRO INDUSTRIES INC. 695 PEASE ROAD BURLINGTON, WASHINGTON 98233 REPORT PREPARED BY: INCHCAPE TESTING SERVICES NA LTD. WARNOCK HERSEY FUEL BURNING EQUIPMENT DEPARTMENT 211 SCHOOLHOUSE STREET COQUI'I'LAM, B.C. V3K 4X9 REPowr No.: 416.-1244-00 ADDENDUM TO REPORT NO. 5515 (DEC./91) CLIENT NO.: L00102 DATE: ` I N1 1'196 l �j Inchcape Testing Services NA Ltd. -- Inchcape Testing Services 211 Schoolhouse Street Coquitlatn, B.C. V3K 4X9 Canada Telephone(604)520-3321 Fax(604)524-9186 REPORT OF A STANDARD TEST PROGRAM CONDUCTED ON A ROOM HEATER, PELLET FUEL-BURNING TYPE MODEL WP7 ADVANTAGE PLUS INSERT CLIENT: PYRO INDUSTRIES INC. 695 PEASE ROAD BURLINGTON, WASHINGTON 98233 U.S.A. REPORT PREPARED BY: INCHCAPE TESTING SERVICES NA LTD. 211 SCHOOLHOUSE STREET COQUITLAM, BRIITISH COLUMBIA CANADA V3K4X9 REPORT NO.: 476-1365-00 (MARCH 1997) ADDENDUM TO REPORT NO. 5515 (DECEMBER 1991) AND NO. 476-1244-00 (MAY 1996) CLIENT NO.: L00102 DATE: MARCH 1997 Look For These Inchcape Marls As Evidence Qf Compliance. Vw� _" S Pyro Industries Ltd. Page 8 of 8 Report No. 476-1365-00 March 1997 CONCLUSION The sample model WP7 Advantage Plus Insert, pelletize wood-fuel burning appliance, for use with pelletized wood fuel, was found to comply with the requirements of ASTM E1509-93 Room Heaters, Pellet Fuel-Burning Type, ULC S628-M93 Fireplace Inserts and ULC S627- M93 Space Heaters for Use with Solid Fuel for listing in Canada. It also met the requirements of UL-1482-1994 standard for Space Heaters, Solid Fuel Type for listing in the U.S.A. Inchcape Testing Services NA Ltd. has verified the drawings (Appendix A) of the Pelletized Wood-Fuel Burning Appliance as being representative of the installation and the appliance tested. The model WP7 Advantage Plus Insert, Pelletized Wood-Fuel Burning Appliance, manufactured by Pyro Industries Inc., after incorporating the listed alterations, is therefore eligible for listing and labelling under the factory inspection program of Inchcape Testing Services NA LTD. INCHCAPE TESTING SERVICES NA LTD. WARNOCK HERSEY Tested by: �1 — Fred suda Supervisor Certification Division Reviewed by: an W. Chang, P.Eng. Manager Gas & Plumbing Testing FY/mld . r 0/ Yale ty �• ,. " tale �3d ��ue/drsr� �alio+ra and,�ta+rdisads William F. Weld iC(o°a�nrao�C A to 611�� Governor �Ot Kentaro Tsutsuml J&aadw6eeZ 021TS (617) 727-3200 Chairman Charles J. Uinezio SOLID FUEL BURNING PELLET STOVE AFFIDAVIT Administrator FOR PELLET STOVES SATISFYING'NEGATIVE PRESSURE TESTING (FAIL i99VIVINTER 1992[MATING SEASON) To the Slate Board of Building Regulattceu and Standards: _ Date 01/21/ 1992 G Drew McDaniel as Assistant Manager, Sales & Marketing onbehallof Pyro Industries , Inc. a menufaaurer of solid fuel burning pellet atumOmtenl6ce piece inserts(circle appropriate products). beeeby certify that the following pellet heating appliance.by explicit model Identification: - model(,), WP2 - Advantage Freestanding and Insert WW1/WW1A - Renaissance and Erin, Freestanding _ WP3 Prodigy I and Prodigy IL Freestanding have been toted.or estdAist (circle appropriate information)per the negative prawre tat requirements of either ULC S627XSA Standard B366.2,or via methodshequirements of similer oationaI. remgniad atandards,and found to satisfy the applicable criteria of ULC S627/CSA Standard B366.2 or other nationally recognized standards;additionally,burnback did trot occur either during normal or abnormal"negative Pmnufe testing. MANUF•ACURER; P ro Industries , Inc. SIGNED: TYPED OR PRINT NAME ABOVE Andrew K. McDaniel TmE Assistant Manager, Sales fi Marketing On this JCW—h day of .19-IL11 then personally appeared before me.the above named MMRICUA V. VALGMA and made oath that the shove statements by himlber,are true NOW Ptblc S1ATE OF WA%i NGTCN My COl"ITIMM wo BEFORE ME Decembw 29e IM NOTARY PUBLIC /�� MY COMMISSION EXPIRES: OA:2� Jf1 19� e�e.tnt Page 2 of 2 G7 � � a�� A4; ,qoa4,d1d� pp�� pp � a d William F.Weld �.�yief0�y,,lJ�p��x J&e ingtte �",/J- , Governor one eJVd/f�n 9" - Rao:: %of Kentaro Tsutsumi 0.2f08 Chairman (617) 727-3200 Charles J. Dine2io SOLID FUEL BURNING PELLET STOVE AFFIDAVIT Administrator FOR PELLET STOVES SATISFYING'NEGATIVE PRESSURE'TESTING To the State Board of Building Regulations and Standards: Date 8-25 1993 1, Drew McDaniel ,a National Sales Manager onbehalfof Pyro Industries , Inc. a manufacturer of solid fuel burning pellet slovesNaters ire place insets(circle appropriate products), - hereby cersify that the following pellet holing appliances,by explicit model identinallon; model(s): WP4 - Quest Freestanding and Insert- have been les�edI o testedAisted circle appropr Ic in(ormalion)per thc'negalive pressure test requirements of either ULC S627/CSA Standard B366.2,or draft standard ASIM E-91,revised draft Sf2WI,and found to satisfy the applicable criteria of ULC S627/CSA Standard 13366.2 or draft standard ASTM E-91,revised draft Sr=l;additionally,bumback dial nets eavr either during normal or abnormal'neplive pressure taxiing. MANUFACTURER: /JPyro Industries�, Inc. SIGNED: %litilL� /�cl� TYPEDORPRINTNAMEABOVE: Andrew K. McDaniel TITLE Nat6'io;ial Salesp Manager On this A dry of 191,then personally appeared before toe,the above named a4 A-4 KPP and made oath that the aboea statements by himl6es,ate true. MIAAICF1q V. VifllDMt► 1,11711131Y PIA110 BEFORE ME: SM OF MY CGffllftlral� DBCNT1bw 29. 199b NOTARY PUBLIC / MY COMMISSION EXPIRES:-- rtpraa Page 2 of 2 �fte "L�o�r��woze:e o���ac,lucae�• �'ty6 a�fd,�laerdnrde William F. Weld ,/lte�am.ao� ,dale 0/pte6 Oman,? Governor G / 9" - Room m0e Kentaro Tsutsuml �ia 'A Aadd� =08>08 Chairman (11517) 727.32OO Charles 1. Dine2io SOLID FUEL BURNINC PELLET STOVE AFFIDAVIT Administrator FOR PELLLT STOVES SATISFSTNG"NEGATn•E rRE.SSURE'TESTING To the Slate Board of Building Regulations and Standards: Date 9-�1 O ty 96 0 1, Bob Wilson as DLret=t4r--Qf—S&LflS onbchairor Pyro Industries , Inc . a manufacturer of solid fuel burnin pcnet stov mat<n/Toe place inserts(rirde appror^ale products). Mreby«rilry Thal the following pellet heating appliances,by e:plicll modd Idenlificnllon; model($): WP-9 Quest WP-7_ Advantage Pllr.s have bee tes�oJ, r Icsted/listed (circle appropriate information)per the-negative pressure"Our requirements of either ULC 5627/CSA Slandard 13366.2,or duh standard AS I M 1: 91,rrvhril dram 51111/91,and round to satisfy the applicable criteria of ULC 567.//C7A itandard 111(r• ' of drift nan-L-d AS IM r4 91,revised draft Sf=l;additionally,burnback did not occur either dwinr nointal or abu:nwal'rrgative pressure luting. MANUFACTURER( yr0 1[ u:- ^rleSs It1C. SIGNED: TYPED OR rRINT NAM • OY •• 13 W11SUn TITLE Director of Sales On this 10 day of S' CDiM ber , l9 �1 tbcn penonally appurcd before me, l,J p above named ova Q' BF n((aa and made oath that the above stalemenls by him/her,are true. NfYTa elr O'Z. -+04— DITORE ME .Z \ -Dr J NOTARY IWBIJC , 1 MY COMMISSION EXrIRFS: —1�� Ma.nut Page 2 of 1 Willlam F.Weld Governor '� ° v L� �> r�adE�rsxloa. ✓�laotr - �ao>' Kentaro Tautsumi , .A�traddaa ORl08 Chairman (617) 727-3200 Charles J.Dinesio SOLID FUEL BURNING PELLET STOVE AFFIDAVIT Administrator FOR PELLET STOVES SATISFYING'NEGATIVE PRESSURE TESTING To the State Board of Building Regulations and Stsndsrda: 8—4 lq 95 Date _ I. Joe Canova Product Manager onbehalfof Pyro Industries, Inc. a manufacturer of solid fuel burnin Iles st eat ire place insect (circle appropriate products), hereby«rlly that the follonint pellet healing appliances,by eeplich model Identification; model(} WP5 - Cascade Freestanding have bee ter_led, oLK fxwwl eirck appropriate information)per the'negative p ctsure lag requirements - of either ULC S627/GSA Standard B366.2,or draft standard ASTM E•91,revised draft StMI.and found to Witty the applicable criteria of ULC S627/CSA Standard 0366.2 or draft standard ASTM E•91,revised draft SfM];additionally,bumbaet did not occur either during normal or abnormal'negalive pressure testing. . MANUFACTER:_ Pyro Industries, Inc. SIGNED•.�b.t, TYPED OR PRINT NAME ABOVE Joe Canova T1TIE Product Manaoer on this 4th da a August 1995,then petaneallya PPcarcd before me,the abwe"Mm Joe Canova and made Oath Illal the stove statements by hint her,are mat NOT PUMC VALE OFFWASHOMM _ BFiORE mra iRACIE LYNN OSTMAN My Acoohdmerd Ettptaa Nov 22.W NOTARYPUBUC MY COMMISSION ETR ( �j� '�l'J[ 19 Qr] r/Patn ...L_L Pate 2 012 Stove Installation Assembly Your WhiKield Advantage May Ile Installed As: • A freestanding unit will, a pecleslal pl;tr ed un a nonrnnihustihln flnui pad. • A mobile home heater placed on a non-c cindruaildo Iluor ,d Ivith a source of outside air, bulled down and electrically grounded to the chassis of the tonne. Floor Protection -- --_- - - - Yo m Whiffield pellet stove musf he Z- -- - - im:t IIIed nn a nun combustihlc fn?rinc- livr• Iluur pad of minirnum 3/8' Ildck- ness material or a masonry hearth. The hearth or floor pad must extend a miri- 6" imum of 6" in front of and from each side of the stove or to the neares! per nutted combustible material if le:,s Ihan 6 s Floor/Hearth Pad Clearances to 11„1► Combustibles -- — 1" JIB The following minimum clear- 1" antes to combustible materials \ must be maintained. Keep all combustibles at least 18" (hori- zontally) away from the glass windows. ID �i , 6" ;I (ALCOVE CLEARANCES) Maximum Alcove depth: 24", i Minimum Alcove height: 47-1/2" Minimum Alcove Width: 37" STOVE INSTALLATION ICONFIGIURATIONS YOUR W1111 FIGLU QUEM HAV BF 1+\r.5 F 11,11.1► AS: A freestanding unit with a pedestal placed on a non-combuslible floor pad. • A fireplace insert set into a masonry or factory built fireplace. • A mobile home heater placed on a non-combuslible floor pad, with a source of outside air, bolted down and electrically grounded to the chassis of the home (see page 22). FLOOR PROTECTION Your Whitfield pellet stove must be installed on a non combustible protective floor pad of minimum 3/8" thickness material or a masonry hearth (figure 12). The hearth or floor i pad must extend a minimum of 6" In front of and from each side of the stove or to the nearest permitted combustible material (if less than 6"). beMf h"mM I"of M,bn. „ - r4!'bM MM dM MM. 1 r r :I i� - Nmcn"IneI�N •t Figure 11 - Floor Protection Requirements CLEARANCES TO COMBUSTIBLES Diu;`+= t to I,G l y The following minimum clearances to combustible materials must be MaintelnerL Keep all combustibles at least 16"(1totizontally) away it urn the glass windows. Mir J nuln I! Alcove depth: 24". Minimum AIcovo height: 47 1/2". 4-A.; c• r771 i , Figures I: Clrnr:mc�,� � , : n,l .,...ill•.I '1.d • inlc . z 13 I Section 4: Floor Protection & Clearances Floor Protection The Whitfield Prodigy II Pellet Stove must be installed Floort least 6"from the face of the rotector must extend on a noncombustible protective floor pad of minimum i P 3/8"thickness material or on a masonry hearth.The a hearth or floor pad must extend a minimum of 6"from stove, and 0"to the sides and the face of the stove OR TO THE NEAREST PER- rear of the stove. MITTED COMBUSTIBLE MATERIAL IF IT IS LESS I THAN 6" from the back or sides of the stove. (See if Figure 1). j Noncombustible �I Floor Protector ;r. Clearances to Combustibles —The stove must be installed with the following mini- mum clearances from the side and back wall to the fj nearest combustible materials. (See Figure 2). Figure 1 - Floor Protector Size �I i Q0 I r 1 i i 'i 118" I 1 .__ _ W I <6 >r < 6" 6" Y i ,fir 1 �t1 11=- �6' �6. I Figure 2-Clearances to Combusible Materials I I 4 INSTALLATION NOTES Proper planning for your double wall pellet vent installation will result in greater safety,efficiency,and convenience, saving both time and PELLET VENT INSTALLATION money. Use only authorized SIMPSON DURA-VENT PELLET VENT AND OPERATION INSTRUCTIONS ®' '1 (SPV) listed parts. Do not install damaged parts. INCLUDING MASONRY RELINING 1. WARNING: When passing through ceilin s and walls, make sure all aa AND CATHEDRAL CEILINGS MHa20 g combustible materials and building insulation products are a minimum of 3" away from pipe and fittings. 2. When exiting through walls, make sure NFPA rules are followed for A MAJOR CAUSE OF VENT RELATED FIRES IS FAILURE TO distance from windows and openings. These rules are shown on page 5. MAINTAIN REQUIRED CLEARANCES (AIR SPACES) TO 3. Do not mix and match with other products or improvised solutions. COMBUSTIBLE MATERIALS. IT IS OF THE UTMOST P p IMPORTANCE THAT THIS DOUBLE WALL PELLET VENT BE 4. Practice good workmanship. Sloppy work could jeopardize vour pellet INSTALLED ONLY IN ACCORDANCE WITH THESE vent installation. iNSTRiiCTIONS. 5. Never choose a vent with an inside diameter that is smaller than the Read through all of these instructions before beginning your installa- appliance flue outlet. tion. Failure to install as described in this instruction will void the 6. Multi-story: Where pellet vent passes through the ceiling. use SIhIPSO.N Mar flu l;: user's warranty, and may have an effect on your homeowner's DURA-VENT firestop/support assembly. insurance and UL listing status. Keep these instructions for future refer- 7. Pellet vent placement: When deciding the location of your stove and erce. Tais booklet also contains instructions for installing a venting system vent,try to minimize the alteration and reframing of structural comoonenr< wit^in an existing masonry chimney, and for installations passing through a of the building. S. Sections of pipe are connected to each other by pushing t!-.cni fir-,; AN IMPORTANT MESSAGE ABOUT CLEARANCES together and twisting. Screws are not required. If screws are desired. `nr SlIMPSON DURA-VENT'S double wall pipe is listed by Underwriter's 3"thru 6"diameter pipe, use 1/4"sheet metal screws. Urde. ao :u Laboratories as a vent for I fisted pellet stoves. The minimum clearance stances, penetrate the inner liner with screws, from pipe to combustibles is 3". Never fill :any required clearance space 9. Never install single-wall pipe to pellet stoves. with insulation or any other materials. Combustible materials include 10. Do not connect B-Vent pipe with aluminum liners to vent pellet vent lumber, plywood, sheetrock, plaster and lath, furniture,curtains,electrical appliances. wiring, and building insulation of any kind. 11. Inspections: The use of pelletized fuel does not eliminate the need for PELLET VENT TESTING inspection and cleaning: During the heating season, inspect monthly by Pellet vent is tested and listed to U. L. Standard for sate low tempera- removing the vent cap or the top of the chimney system (where the pellet ture venting systems, Type L, and produced under the factory inspection stove has been adapted to an existing chimney system) and with a flash- and follow-up program of Underwriters Laboratories, Inc. Pellet vent is light,check for sat aria creosote deposits. Tu remove the vent caps, twist rated for flue temperatures up to,but not to exceed 570 degrees F. 1/8 turn and gently pull them loose from the pipe. in the case of an existing chimney system, remove the lid of the chimney cap and the spark arrestor. TOOLS AND EQUIPMENT YOU MAY NEED pipe by pushing male and female eye Protection Non-hardening Waterproof Mastic TABLE 1 ends of pipe together and Screwdriver Tape Measure PIPe SIZE OPENING twisting until pipe is in locked TapeMeasure Saber or Keyhole Saw position. INCH 9 5/8 X 9 5/8 Hammer Gloves D. When the pipe passes PERMITS • INCH 10 5/0 X 10 5/8 through the firestop at ceiling, Contact your local building code or fire officials regarding permits,restric- s INCH 11 5/e X II 5/8 tighten bolt and clamp around tions, and installation inspection in your area. 6 INCH 12 5/8 X 12 5/8 pipe' GENERAL INSTALLATION INSTRUCTIONS E. ALWAYS MAINTAIN 1. Follow the stove manufacturer's instructions. 3" CLEARANCE FROM A. Choose a stove that is listed by a recognizecJ testing laboratory. COMBUSTIBLE MATERIALS. Where the chimney passes through B. Connect only one flue per appliance. additional Floors and ceilings.. aiw•ays install a firestop spacer. C. Follow the stove manufacturers instructions and safety manual for F. After lining up for hoie i., roof, use same inet`Iod as 1(13); cut either a round or square hole in thc,oof. Always cu; ,role 3" !artier than the diameter of the pipe. Instal! the upper edge an-1 >. cs of f':a;hing under the yhh� SHINGLES OVERLAP IN APPLY NON-rs•iw / `� HARDENING N.: TC7 =UGC ai PLASHING r \ 72' MIN j' AT THIS ,AINL , I 1 CAP AND ri¢r.v Sw E. I \ STORM .+o:✓�o.r v I COLLAR NOT nrt I rv.-csr SHOWN FO i nrt •mrn CLARITY rvv cm 1 � Fig I maximum efficiency and safety. Overfiring can damage the stove and peliet Fig 2 vent. 2. If Flue vent is on top of the stove: (See the example in Figure 1) roofing materials and nail to the roof along the upper edge. Do not nail the A. Place the appliance according to the manufacturer's instructions. lower edge. Seal all nail heads with non-hardening waterproof mastic. B. Drop a plumb bob to the center of the appliance flue outlet and G. To finish, apply non-hardening waterproof mastic where the storm mark center point on the ceiling,cut a square hole in the ceiling for the collar will meet the vent and flashing; slide storm collar down until it sets firestop support assembly. Refer to Table I for the dimensions of the hole. on the Flashing, put the cap on and twist to lock. (See the example in C. Connect (SPV-CO)pipe adaptor to stove: Attach each section of Figure 2) 3 4 TABLE 2 3. If the flue exit is on back of stove and Interior Installation is VENT SIDE ROUND THIMBLE SQUARE T..SM9LE desired: (See the example in Figure I INCH AND 4 INCH 7 1/2 INCH VIA. 9 INCH x 9 !NCH 3)• 5 INCH AND 6 INCX 1 9 1/2 INCH DIA. 9 INCH x 9 INCH A. Place the appliance according to the manufacturer's A support/wall strap must be placed at 4-foot intervals along the lux instructions. vertical run. Assemble pipe in the same manner described in paragraph 2 of WnM B. Connect a (SPV-CO) pipe the general instructions. If it should work out that an adjustable length AwmR adaptor to the back of the stove �� and attach a tee to stove i (SPV-PA) is required in the horizontal run, and the adjustable length must p le enter the wail thimble, the diameter of the center hole in the wall thimble adaptor, align, push together and must be enlarged by 1/8" to accommodate the adjustable length. twist to lock. D. Seal the -alvanized sectinr +'the w211 thimble to the exterior wall C. Continue to assemble pipe Fig 3 in the manner described in para- v�:.:_ -:iiHBLE graph 2. 4. If the flue exit is on back of SQUARE stove,and exterior vertical installs- ROUND m awvll lion is desired: (See the example in +VK 21 INTERIOR Figure 4): INTERIOR --1 A. Place the appliance accord- ing to manufacturer's instructions. Ire-�. B. Cut a square opening in the i O EXTERIOR wall in accordance with the di- EXTERIOR _ mensions in Table 2. Note that the wall thimble may be round with no /BLACK Fig 5 BLACK insulation,or rectangular with with non-hardening mastic. Fig 4 insulation. The black portion of 5. If the Flue exit is on back of the stove, and a horizontal-through-the-wall the thimble is to be attached to the installation is desired: (See the example in Figure 6). interior wall, and the galvanized portion is to be attached to the exterior A. Place the appliance according to manufacturer's instructions. wall. The wall thimble is designed to accommodate a maximum wall B. Install the wall thimble as described in paragraph 4. thickness of 7". Refer to Figure 5. C. Connect the pipe adaptor to back of stove and attach sufficient pipe C. Connect a pipe adaptor(SPV-CO) to back of stove. attach to penetrate wall thimble and extend at least 6" beyond the exterior wall. enough pipe to penetrate and extend 3" beyond the exterior wall. Attach a Install a house shield (SPV-HS) as shown in Figure 5. The house shield is regular tee or horizontal clean out tee,and proceed up the wall. Attach a optional.Attach a horizontal vent cap. The vent cap should be at least 6" combination tee support/wall strap just above the tee. from the wall. 6 D. Follow the below listed (8") 8884, in the existing ceiling support box, as shown in Figure 7. Note 6 rna 140e.M NFPA rule for distance of exit fermi- that the close clearance adaptot only coonects to Simpson Dura-Vent nal from windows and openings: chimney systems. NFPA 211 6-35 Termina- D. Connect the appropriate size chimney adaptor to the close clear- Lion: 6-3.5 Mechanical draft systems ante adaptor. need not comply with 6-3.1 and 6-3.3 E. Connect the appliance to the chimney adaptor using a pipe adaptor, provided they comply with the fol- lengths of pipe as required,and an adjustable pipe length. lowing. Slide the adjustable length down �avrm (a).The exit terminal of a over the top pipe section,position �ao"rK mechanical draft system, other than a rxlsmc ur.-rEUS m the installation vertically plumb, vandirect vent appliance(sealed combus- a°"-ouwcT SYSTEM then slip the adjustable length up twnc: NUMMUM tion system appliance),shall be 1 and twist lock it to the chimney Fig 6 located in accordance with the foi- ff'1, adaptor. Once all the components lowing: tt are firmly seated and properly (1). Not less than 3 ft. (.91 m)above any forced air inlet located within ' - .10 ft. (3m). AnnrTnstE aligned,carefully drill three 1/8" �`'� g diameter holes through the outer �EriGte — Pr:L'.T vE"T-ro- (2). Not less than 4 ft.(1.2m) below, 4 ft.(1:2m) horizontally from or I PIPE CHWY nmPTU sleeve only in the center of the slots ft. 304mm above an door, window or ravit • air inlet into an buildin SECTION ELF, aw-u ( ) y gravity y g. located at the bottom of the adjust- and-, / Part:, VENT able length pipe. Do not penetrate (3). Not less than 2 ft. (.61m) from an adjacent building and not less Fig 7 SYSTEM the inner liner. Use (3) 3/8"length than 7 ft. (2.1 m)above grade when located adjacent to public walkways. sheet metal screws to secure the 6. If it is desired to attach to an existing 6", 7" or 8" Dura-Plus or DCR adjustable lengti; pipe. The completed installation will look like Figure 7. chimneyi either roof supported, or ceiling supported: (See the example in Figure 7). A. Remove any existing connector pipe,adaptor or connector going into the ceiling support box. B. Visually inspect with a flashlight the condition of the interior of _ the chimney for cleanliness and structural integrity. All evidence of soot and creosote must be removed from the existing chimney system. If you doubt your ability to accomplish this,contact a professional chimney sweep. Do not use chemical cleaners. Do any required maintenance on the existing chimney system at this time. C. Install a close clearance adaptor(available in the Dura-Vent chimney product catalog - product stock numbers(6") 8674, (7") 8774, or 7