28-011 (9) BP-2023-0622
284 SYLVESTER RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
28-011-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0622 PERMISSION IS HEREBY GRANTED TO:
Project# chimney liner 2023 Contractor: License:
Est. Cost: 4596 CORY MCGILL 107658
Const.Class: Exp.Date: 05/25/2023
Use Group: Owner: SAMSON MICHAEL R
Lot Size (sq.ft.)
Zoning: RR Applicant: CORY MCGILL DBA DONE RIGHT CHIMNEY
Applicant Address Phone: Insurance:
PO BOX 1054 (413)340-1399 WCV 01525601
WILLIAMSBURG, MA 01096
ISSUED ON: 05/16/2023
TO PERFORM THE FOLLOWING WORK:
INSTALL CHIMNEY LINER
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House # Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
i0 • • . 59.45,
�
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax:i413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts �`'
� � �L - FOR
Board of Building Regulations anOtand ds,� r�l
Wt Massachusetts State Building Co*, 78 MR '4r J MUNICIPALITY
Building Permit Application To Construct,Repair, Re Or Demo ` R ised ar 2011
q BV L
One-or Two-Family Dwelling •,.,?yq1��Oi�
This Section For Official Use 0 yy���N,�,�
BuildingPermit Number: 6 •)b-- 6�1- Date Applied: �r T�gtis
euio as
/42
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMAION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
284 Sylvester Road, Northampton, MA 01062
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property 1;imensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone?! Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Michael Sampson Northampton,MA 01062
Name(Print) City,State,ZIP
284 Sylvester Road (413)478-8144 N/A
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WOK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units ether El Specify:Chimney re-line
Brief Description of Proposed Work2:Level 2 Inspection completed 04/07/2023.To install(1)pre-insulated 6"stainless steel
tee liner kit,within an existing masonry chimney,connecting to the existing wood stove.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 4,596.00 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: I ,(n
Check No. Chick Amount:t Cash Amount:
6.Total Project Cost: $4,596.00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-107568 05/25/2023
Cory McGill License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
P.O. Box 1054
No.and Street Type Description
MA 01096 U Unrestricted(Buildings up to 35,000 Cu.ft.)
Williamsburg, R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(413)340-1399 ContactDoneRight@gmail.com I Insulation
Telephone Email address I) Demolition
5.2 Registered Home Improvement Contractor(HIC) #178722
08/27/2024
Cory McGill H1C Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
P.O. Box 1054 ContactDoneRight@gmail.com
No.and Street Email address
Williamsburg, MA 01096 (413) 340-1399
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? ' Yes ® No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES POR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Cory McGill i
to act on my behalf,in all matters relative to work authorized by this building permit application.
Michael Sampson Ammummipmema
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties�f perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
f ,
Cory McGill 13S-102.3
�
Print Owner's or Aut zed gent'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.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the 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"
The Commonwealth of Massachusetts
1 *_ I Department of Industrial Accidents
8-7.11I= Office of Investigations
= iki= 1 Congress Street, Suite 100
i_=e. =_�, Boston, MA 02114-2017
•�� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization Name: Done Right Chimney
Address:P.O. Box 1054,45 Main Street, Unit B
City/State/Zip:Williamsburg, MA 01096 Phone #: (413)340-1399
Are you an employer? Check the appropriate box: Business Type(required):
I.0 I am a employer with 3 employees (full and/ 5. ❑� Retail
or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment
2.❑ I am a sole proprietor or partnership and have no 7. ❑ Office and/or Sales(incl. real estate,auto,etc.)
employees working for me in any capacity.
[No workers' comp. insurance required] 8. ❑Noi-profit
3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment
their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing
no employees. [No workers' comp. insurance required]** It. Health Care
4.❑ We are a non-profit organization, staffed by volunteers,
with no employees. [No workers' comp. insurance req.] 12.0 Other Services: Chimney&Hearth
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#I.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Name:Atlantic Charter Insurance Company
Insurer's Address:45 Main Street, Unit B
City/State/Zip: Williamsburg, MA 01096
Policy#or Self-ins. Lic. # WCV 01525601 Expiration Date:06/28/2023
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 and enaes of erjury that the information provided above is true and correct.
Signature: Date: 1 I I 12Z3
Phone#: (413) 340-139
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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
ww',v mass gov/dia
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: +(v3ry� ►p, O
The debris will be transported by: art. 9,114 Chovy..t'
The debris will be received by: v(dt1/4 "`-""1c,U
Building permit number:
Name of Permit Applicant CO/Vk MC[li11
OS-\,O'1b23
Date Signature of Permit Applicant
INSTALLATION INSTRUCTIONS Phone:888 900 8106
4& FOR BEST-Flex Models "L", "H", "S", & "E" Fax:888-392-4432
STAINLESS STEEL CHIMNEY LINERS Web:www.NewEnglandChimneySupply.com
NE EN
`.adiiij11111,
Si 34 Commerce Street,Williston VT 05495
BEST-Flex Models
eesr
L 5 H ,99 S ,77 & it E FLEX
New England Supply STAINLESS STEEL CHIMNEY LINERS PRODUCTS
BEST-Flex Models"L","H","S",&"E"Stainless Steel Chimney Liners are manufactured by New England Supply Inc.Located in Williston,VT.
The BEST-Flex lining system is designed and UL listed to be installed inside masonry chimneys.BEST-Flex liners are used to vent the gases and by-products
produced by appliances that burn oil,gas,or solid fuels.
All appliances require certain venting specifications and the liner is not to be sized less than specified in the appliance manufacturer's instructions. For the best
operation refer to the appliance manufacturer's instructions to determine any special necessities for that specific appliance.
The installer must contact the local building and fire code officials for a variety of reasons:
• The installation may require special inspection requirements.
• Building permits may be required before installation.
• Compliance with local building codes.(Authorities with local jurisdiction such as Inspectors,Municiple Building Departments,Fire Departments,and
Fire Bureau's have precedence over national codes).
For proper results and operation use only materials or components specified in these installation instructions. Using parts or materials not specified may result
in undesireable effects. The lining system safety,code compliance,warranty and performance may be compromised if the installation instructions are not
followed
BEST-Flex Stainless Steel Chimney Liners are tested and listed by Underwriters Laboratories.
• In the United States they are tested to UL 1777 and can be installed in NEW&EXISTING masonry chimneys.
• In Canada they are tested to ULC S635 and are to be installed in EXISTING masonry chimneys.
PRODUCT INFORMATION FOR BEST-Flex CHIMNEY LINERS
• The BEST-Flex Stainless Steel Flexible Chimney liner is designed to reline existing chimneys or to be used as a liner in new construction.
Manufactured with the highest quality,mill certified alloy.BEST-Flex Stainless Steel Flexible Chimney Liner has a high acid fighting capability. Listed
by UL Laboratories to UL 1777&ULC S635 standards for zero clearance installation.BEST-Flex can be used to vent wood,wood pellet,coal,non-
condensing gas and oil,making it the choice for venting all standard efficiency installations.UL listed BEST-Flex is available in 3"to 12"diameters
(13"above is not listed)to cover a wide range of requirements found in the field today.
• The unique manufacturing systems used to make BEST-Flex utilizes a continuous strip of stainless steel,7-ply interlocked and crimped to produce
a gas and water tight lining system of superior strength and durability.BEST-Flex can be curved to go around offsets in chimneys and can be factory
ovalized to custom sizes to fit most any installation requirement.Unless specified by the manufacturer,the liner is not to be field ovalized. The
corrugated construction allows for expansion&contraction during the heat-up&cool-down periods,which removes any stresses on the system.
• BEST-Flex can be insulated with either a vermiculite based poured insulation or with a foil-faced ceramic wool blanket to meet UL 1777&ULC S635
standards for chimney exteriors with zero clearance to combustibles.
• BEST-Flex Stainless Steel Chimney Liner comes with a Life Time Warranty for all fuels,with appliance efficiencies at 83 percent or lower.
MATERIALS REQUIRED FOR BEST-Flex STAINLESS STEEL LINER INSTALLATION:
Liner Model-"L", "H", "S", &"E" •
TT/TB-Two piece or one piece tee 0 ,
TEC-Tee Cap ..
EA/EF- 15°-90°elbow -_. ---..-
C/CC-Coupler
Screws/Rivets -
OPTION A IP.7'`"�'x OPTION B
TP-Top Plate " TPCC-Liner Cap
TC-Top Clamp • 1OF OR TPC-Top Plate !it
SC-Storm Collar
CL-Liner Cap(square/round)
INSULATION MATERIALS REQUIRED(if applicable)
Emil Description T
LI2 Liner Insulation 1/2" Foil Faced Ceramic Wool Blanket
LM Liner Mesh Protective Wire Mesh Sleeve `'
FT(2", 3") Aluminum Foil Tape
LMC(large/small) Mesh Clamp - ,t `
BMIX BEST Mix tAiw��u�iii ?°%