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' ✓ ""-� `:: � Department of Community Development
� 75 South Frontage Road
���� ��'����� .;; Vaii, CO 81657
Tet: 970.479.2128
www.vailgov.com
Development Review Coordinator
TRANSM ITTAL FORM
Use this form when submitting additionai informatian for planning applications or buitding permits.
This form is also used for requesting a revision to building permits. A two hour minimum building review
fee of$110 wiil be charged upon reissuance of the permit. ,
........................................................................................................................................................................................................................................................................................................................................................
ApplicationlPermit#(s) information applies
to: � A�ftention: �Revisions
� � �� � � �Response to Correction Letter
�attached copy of correction letter
�Deferred Submiital
(�O#her
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[ Project Street Address: ��
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iNumber) (5treet) (Suite#) i!...................................................................... ..............................................................:
Building/Complex Name: ��'� ����� /���t�G�S escriptian�f TransmittaU List of Changes, Item ttached:
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:Appficant Information
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:°(architecf,con{ractor,owner/owner's rep}
-Contact iJame: N ��/����
5 Address: o � '��� �� �
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;City l�/� State: �C'� Zip: f �
;Contact Name: �����.� �t<.S L���rJL� ;>'(use additional sheet if necessary)
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;Contact Phone: i Buiiding Permits:
/� Revised ADDITIONAL Va[uations (Labor&Materials)
;Contact E-Mail:����� �C�/lf7`'t.t�y�fU�al���Z-�{DO NOT include original�aivation)
? I hereby acknowledge that{ have read this application,filled out �Suilding: $
` in fufl the information required,completed an accurate plot plan,
i and state that all the informatio required is correct. I agree to ::Plumbing: $
; comply with the informatio nd o#plan to comply with al[Town `
ordinances and state 1a fo b � is structure according ;Electrica(: $
; to the town's zoning a divi " n des, design review ap-
� proved, Inter tiona i}din esidential Codes and other �Mechanical: $
? orc{inances f own a icabte thereta.
;X `Total: ��
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�OwnedOwner's Representat e Signature{Required) ` �
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i.......................................- -............................................................................................._......._.......................................s Date Received:
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For Office Lise Onlv: ��� � � �o��
Fee Paid:
Received From: A� � /�
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CC: Visa/MC Last 4 CC# exp.date:
Authorization#
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1 Product Specific & Important Safety Information
A. Fireplace Certification B. Glass Specifications
This fireplace system has been tested and listed in ac- This fireplace is equipped with 5 mm ceramic glass. Re-
cordance with UL127 and ULC-S610-M87 and (UM)84- place glass only with 5 mm ceramic glass. Please contact
HUD standards for installation and operation in the United your dealer for replacement glass.
States and Canada as described in this manual.
Check with your local building code agency before you NOTICE:Thisinstal/ationmustconformwifhlocalcodes.lnthe
begin your installation to ensure compliance with local absence oflocalcodesyoumustcomplywiththe UL127, (UM)
codes, including the need for permits and follow-up in- 84-HUD and NFPA211 in the U.S.A. and the ULC 610-M87
spections. Be sure local building codes do not supersede and CAN/CSA-B365/nstallation Codes in Canada.
UL specifications and always obtain a building permit so y�/qRN/NG! Risk of Fire! Hearth & Home Technologies
that insurance protection benefits cannot be unexpectedly disc/aims anyresponsibilityfor, and the warrantyand agen-
cancelled. cy listing will be voided by the fo/lowing actions.
Heat&Glo is a registered trademark of Hearth & Home DO NOT.•
Technologies. • insta/l oroperate damaged firep/ace
Model: Northstar EPA Certified • modify fireplace
oodburning Fireplace • instal/ other than as instructed by Hearth & Home
Laboratory: OMNI Test Laboratories, Inc. Technologies
Report No: 061-S-50-2 • operate the fireplace without fu/ly assembling all
components
Type: ood Fireplace • ove�re
Standard: UL127 and ULC-S610-M87 and • insta/l any gas log set
(UM) 84-HUD, Manufactured • insta/l any component not approved by Hearth &Home
Home Approved. Technologies
• install parts or components not Listed or approved
EPA#and Original Date: 571 4-1-03 Improper instal/ation, adjustment, alteration, service or
3.25 grams per maintenance can cause injury or property damage. For
EPA Certified: hour assistance or additional information, consu/t a qua/ified
Efficiency: up to 77.8% insta/ler, service agency or your dea/er.
BTU output C. Non-Combustible Materials
with EPA test fuel: 51,400/hr. • Materials which will not ignite and burn, composed of
with Cord Wood: 70,000/hr. any combination of the following:
Heating Capacity: up to 3,500 sq ft - Steel - Iron
Chimney Size: 8 inches - Brick - Tile
- Concrete - Slate
HHT SL300 Series - Glass - Plasters
DuraVent DuraPlus • Materials reported as passing ASTM E 136, Standard
Max Wood Length: 24 inches Test Method for Behavior of Metals,in a Vertical Tube
Furnace at 750° C
Fuel: Cord Wood
Shipping Weight: 650 Ibs WARNING!Risk of Fire!
Firebox Size 2.7 cubic feet Hearth & Home Techno/ogies is not responsib/e for
discoloration, cracking or other materia/ failures of
finishing materials due to heat exposure or smoke.
• Choose finishing materials carefully.
4 Heat& Glo • NORTHSTAR •480-2360 Installation Manual • Rev H • 8/20/14
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