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23D-025 (3) BP-2024-1433 488 ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-025-001 CITY OF NORTHAMPTON Permit: Solid Fuel Appliance PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2024-1433 PERMISSION IS HEREBY GRANTED TO: Project# PELLET STOVE 2024 Contractor: License: Est.Cost: 0 NORA WINE CSSL-106199 Const.Class: Exp.Date: 08/24/2026 Use Group: Owner: D. IPPOLITO, DENISE Lot Size (sq.ft.) MCKENNEY HEARTH&HOME/MCKENNEY Zoning: URB Applicant: ELECTRICAL CO INC Applicant Address Phone: Insurance: 100 NORTHAMPTON ST (413)586-5351 A106-642-917 HOLYOKE, MA 01040 ISSUED ON: 10/29/2024 TO PERFORM THE FOLLOWING WORK: PELLET STOVE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of IA iring 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: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHANIPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 172_ Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED ci. ' y of Northampton ', ""1: T 2 8 2024 Massachusetts ass, S'�;I • G au �� 'lMENT OF BUILDING INSPECTIONS A. ` •k� r, 1';' ` III DING INSPECTIONS; ��, It O� 4212 n Street • Municipal Building �� \r9.r'y .I =1':it'Tpf ,��A01060 .D ; �;,.�. Northampton, MA 01060 s't jY 0° APPLICATION FOR SOLID FUEL APPLIANCE INSTALLATION Property Information Owners Name: T11S C I MPOl rtu Address: Itct ta—M Si (No.) (Street Address) Phone:Z°3.ct 2 . 2S(d(-Cell: Email: Owners Signature: 3p QA 1r li Date: folk 1 I Contractor's Information (If Applicable) Name: N)0(lli i -\5 Phone: it 1' _ 310 SW Construction Supervisor's License #: C SSL-- I OL 1 141 Expiration: 0424. Home Impr. Contractor License #: g 0 U 13c Expiration: lici2J Stove Information Type of Fuel (check all that apply): Wood Pellet✓ Coal Location: LA V UPc, EA - Freestanding Insert Manufacturer: (AVelu1 Model: leV) • ---- FOR BUILDING DEPARTMENT USE ONLY-------,w L��3(ti/ Permit# et. -2`fG(`f43 Date Applied: Total all Fees: $ I U UCH 7 Building Official: crAl/b ,i/C/2 ] Date Issued: /p -7A -2,11 Signature of Building Official: „reLt....—, The Commonwealth of Massachusetts it Department of Industrial Accidents _y Office of Investigations ''+it1= Lafayette City Center 1 t� 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): McKenney Electrical Co. Inc. Address: 100 Northampton Street City/State/Zip: Holyoke, MA 01040 Phone #: (413) 536.5551 Are you an employer? Check the appropriate box: Type of project(required): 1.UI I am a employer with 5 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' P tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no Solid fuel appliance install employees. [No workers' 13.®Other pp 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 a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Green Mountain Insurance Company Inc. Policy#or Self-ins. Lic. #: A106-642-917 Expiration Date: 07/2025 Job Site Address: City/State/Zip: 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 penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: (413) 536.5551 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 1❑Board of Health 2❑Building Department 3❑City/Town Clerk 4.0 Electrical Inspector 50Plurnbing Inspector 6.0Other Contact Person: Phone#: McKenney Electrical Co.Inc. Sales Receipt DBA McKenney Hearth&Home 100 Northampton Street Mc kienlieY Holyoke,MA 01040 Hearth C!flame Date Sale No. P:(413)536.5551 www.mckenneyhearthandhome.com 9/7/2024 5090"2-1-- Sold To Customer Phone Denise Ippolito 203.592.2465 488 Elm Street Northampton,MA 01060 Customer Alt. Phone P.O. Number Payment Method Description Qty Rate Class Amount Ravelli#RV-80,Pellet Stove Body I 5ki� inn �t��; : �9cni) #014.US.007A,add side kit List:$4,499.00,04.2023 SN# (')Special on in stock item only. Ravelli#070.kit2.bco.White covering kit,RV-80 Classic I 0.00 Stoves (100 List$0.00 with stove purchase Powersmith#PAVC102,4 gal.ash vac 1 0.00 Vacuum 0.00 10A motor, 10'hose,w/acc.pack.List$ 129.00,02.2023 AJM#EK3636CTBLK,1 cut hearth pad 1 ;99n(1 Stoves 399.00 Ember King 36"D x 36"W,type I.List$429.00,08/2024 Miscellaneous parts,vent pipe.(RAVOEI,VPSA03,3UPPTB,3UPP45EB,VPWS03,3UPP12AB. I 695.00 VentinL, 695.00 3UPP36B,3UPP9OEB,VPWPT03,3UPP24,VPJC03) Install- labor,pellet stove(Standard install).Deliver stove,install on hearth pad,or correct floor I 895.00 Labor 895.00 protection.Install required pellet pipe.Connect thermostat(surface mount wire)and test.Building permit additional.Properly grounded outlet must be located within 5'of stove location.Labor only cost, parts additional. (INSTALL 10.14.2024) Building Permit,2024 I 95.00 Stoves 95.(10 McKenney Hearth&Home will obtain permit for solid fuel appliance installation.Customer is however,responsible for arranging final inspection/signoff with town. Non-Refundable deposit on special order item. _Linn I)r(Th.i i -I.000.0O Building permits are required for installation on wood/gas/pellet stoves. Subtotal S4,679.00 Customer is responsible for permit application if one is not provided for you. Sales Tax (6.25%) $293.06 On parts only,refund within 10 days.Store credit up to 30 days.Must provide original receipt. Total S4,972.06 Returns not accepted on electrical parts or 25%restocking fee(assessed on part returned). 1' Commonwealth of Massachusetts Construction Supervisor Specialty �t Division of Occupational Licensure Board of Building Re ulations and Standards Restricted to: . 1, Constructs . . ifl r Specialty CSSL-SF-Solid Fuel Burning Device CSSL-106199 76 ' 11 pares:08/02/2026 NORA E WIN i1: w ,'I 28 CENTER$IRE i I p ' j 1 AGAWAM M 0100 1) - . ' ??• '-4a1 ` .,O �pI 61id4:/ Failure to possess a current edition of the Massachusetts State '. Building Code is cause for revocation of this license. Commissioner C ewers— Contact OPSI:(617)727-3200 or visit www.mass.gov/dpl/opsi �^ 'ill Ilu ; THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtop Strut - Suite 710 Boston, Massachusetts 02118 4 Home Improvement •ntractor Registration Jr.' r l Type: Corporation �;v.. ist�'ation: 200135 MCKENNEY ELECTRICAL CO, INCi E piration: 02/05/2025 U/B/A MCKENNEY HEARTH&HOME -„ MIR , i 100 NORTHAMPTON STREET q Fnfr� pl. HOLYOKE, MA 01040 r <{! \r /��' 'II II, Update Address and Return Card. 11 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Co7paation Office of Consumer Affairs and Business Regulation • Reuisti ofl i Xoiration 1000 Washington Street -Suite 710 200135'":. .41 02/06/2025 Boston,MA 02118 MCKENNEY ELECTRICAL CO N G`,t D/B/A MCKENNEY HEARTHS,HME '-F III. NORA WINE , , 100 NORTHAMPTON STREET' 4,,,,,,e+'t,,,i'70-ei�rdk' HOLYOKE,MA '1_14g .,, s - I : - •ecretary _ - ., _'ut signature III 111 'illI n :: lo 1.