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Home My WebLink AboutGas Line to Stove 2003 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext.382 Mechanical Permit Permit Number: M2003-0128 Date: 22-Jul-03 Map/Lot: 084/116-000 Owner ID 115003 Job Location: 16 PEACHVALE D IVE Unit Job Description: Install gas line to range Owner: Contractor: Robert J and Linda E Rys Spicer Gas 36 Thames Street 16 Peachvale Dr Groton Ct. 06340- Uncasville CT 06382 Telephone: (860)445-2436 Lic/Reg Type/No. G1 308503 Exp Date: 31-Aug-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $500.00 Mechanical Fee: $10.00 Construction Type: 5B Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5 Other Value: $0.00 Other Fee: _ $0.00 Comments: Total Value: $500.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.08 Total Fees: $10.08 It is the owners responsibility to schedule the following inspections(minimum 48 hours notice required): ❑ Footing - Prior to pouring concrete ❑ Rough HVAC ❑ Backfill-Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab-Prior to pouring concrete ❑Chimney-One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany Gas piping and test Building Official's Signature: Town of Montville Building Department Permit# 310 Norwich,New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family LP-Gas Permit Application Form Job Location 1( P'� i4„,t e.- )r• i U t 4.4 v c((k , C`e Job Description/Materials (wA I-dat i`tA„5 tn.£,W arP,W I` ,4-e, ravt45 G Owner Tn44.44-- 1 . � i S �: t. Mailing Address j�o � q� --VGtl� D/'. City( . ,CLS 1(e `k State C.4, Zip 06 d b - rel d' c) / ?l-Jr/ 0e -7 Contractor*Cite elLV Mailing Address 3(o TtiLa- . ,es City re) State 64v Zip 0 6?go Tel y6O /91417 ?4, Contractor's License/Registration Type&Number 61 /110 663 Exp.Date d /1/ / 63 I hereby certify that the proposed work will conform to the Basic Building Code and all other codes as adopted by the State of Connecticut and the Town of Montville and further attest that the proposed work is authorized by the owner in fee and that I am authorized to make application for a permit for such work as described above. Owner/Agent Signature4944Date 7 /�y/ &3 Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ ,c— $ /e7 Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ © off Total $ 'eic' $ /a 07- Town of Montville Building Department Receipt eipt • Date 7 / La_ / 413 No. ; 2 : From: Job Address: / 6 Pe4..cL vLs Dr-. Amount $ /D , 01 Check 411:110Check # (Cirdc one) Received by '' `�'� Permit # O _c ar PICER 4/4 s 36 Thames Street, Groton, CT 06340 (860) 445-2436 • 800-448-2028 Fax (860) 445-2313 Date: a)103 City/Town/Borough: Mev; tie Address: Ao P LA 4e 1) r , U"-c,oLs c Let C6 0(.37D-- This letter authorizes Robert Mitchell to obtain a permit, on my behalf, for: Property Owner: 2064- JA Y s Address: ((o 'Pe ;viae 1)r, r LQ4A„c4A Nfo(/le £, --a 6 38")- J � (3 -e,Ld Harold E. Everett- LP Gas Technician Division of Spicer Plus, Inc. • CT Lic. # 00308503 • RI Lic. # 00006311 " �vw JdFI L( U.) 1L•JU r. J1 I AcoRD. CERTIFICATE OF LIABILITY INSURANCk PIC" JG OAT! 01/27/03 I MOD z THIS CERTIFICATE*ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE George J. Smith S Son Ins, HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR :47 Broad Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. :Silford CT 06460 Phone:203-878-4641 Sax:203-876-9886 INSURERS AFFORDING COVERAGE fNsuRED __.. _— NsuRERA: Natl Council onComp Spicer Plus, Inc. ETAL rIwRER s �VE D Toad Chas ler ' SURER C: PO Box 903 36 Thames St NSURERD; Groton CT 06340 •, .__-- JAN 2 ry 2-093I NSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BrsGN 15$UEO TO THG tN$IJRm NAMED ABOVE FOR DE POLICY PERIOD WDICATEO.NOTI5RTN5TA l DING GLFI TIbFENT ANY REGUt EN cN.TERM OR CONOMOM OP ANY CONTRACT OR OTHER DOCUMENT WIT-1 RESPECT TO w►11CH THIS cEATiFiGTE,MAY DE ISSUED FORD,CONNECTICUT NWY PRRTAIN,THE INSURANCE AR7ORDED SY me POLICIES DESCPo9EO HFSISIN IS SLBJECT TO ALL THE TERMS,EXCLUSIONS AND CONO,TION$OF Iycl4 POLICIES AGGREGATE lIMITs 5sowN MAY NAVE BEEN REOUCED BY PAD CLAWSTaw . TYPE CFURANCE --I IWPCUCYMUIIBER ntererecnve(POI iR's`VSTi' G[M OAT!(V16TX VYI I DATE(VIN DCVYY) I LIMITS �—,[Ru LlAat fTY I EACH OCCURRENCE S ' COMMIORCIAL GENERAL UAEILITY ; FEU DAMAGE(Ary one lie) S I CLAANS MADS 71 OCCUR MEC EXP L_H PERSONAL d ADV INJURY .i 4 LIGENERAL AGGREGATE $ Ml AGGREGATE LIMIT APPLIES PER S i I DROOL CTS-CGhIP/OP AGO I f 7 pou( 7 q ; I LOC AUTON OSILE UAStLITY 1 • ANY AUTO COMBWEL'SINGLEuMR S Ike Aocemn) I ALL OWNED A;./Fos "! 7 SCHEDULED AUTOS 6001y INR+RY j IPv+.P•rsa') 7 HIRED AUTOS j I NON-OWNED AUTG9 BODILY INJURY S (Pet eexielq I>PROPERTY DAMAGE f oro T BARAGa UAIfUTY I AUTO ONLY-EAACCIDEM ANY AUTO ..__._ I EA ACCs �Q ONLY: AGO 5 I IXCESS LIABILITY I OCCUR CLAIM.S.MADE I AGAGGREGATE Ce S 1 I 1 DEDuCTtilE I ' ~ RETENTION S I I 5 'WO/WAS COMAF'ENSA ON ANO fW^STATU- [ OTFF d►LOYlR,a UABLRY ` i X'TORY lIM1T5 i ER A TO BE ASSIGNED 12/31/02 12/31/03 j El_EACH ACCIDENT s 100000 [IL OfSEASE-EA EMPLOYEE s 100000 i.L CISEASE-POLICY U5 3500000 OTHER memo-nom OF OPERATIONSLOCAT70M3/VCacLE5JEXCLUSI0VS ADDED BY ENOORSEYENTBAEGAL PRONA,Si0NS CERTIFICATE HOLDER I N I AOORIOMALMURED; y L CANCELLATION iILTOEt s110ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC$LED BEFORE NE EKPtRAT10N Guilford Town Hall DATE TMFRioc,THE S MI UG NSURER WILL ENDEAVOR TO UAL 1Q_DAYS EVRISTEN Fax 203-453-8034 Building Department NOTICE TO na cERTEncATG 1404.15551 NAMED TO TME LIFT,BUT FAILURE TO 003AL 0 SML pumas Boston Street e5 No o641(3ATTON OR we<rry OF AYY IMO UPON THE fNSVRER OG} FT$• IZ7.OR Guilford CT 06430 R!PRE3ENTATtVEZ. ALTAORIEED RSPRESSNTARY1 1 George J. Smith & Son Ins. Artnwn lc.0 Mier" A encooA e`ns'PA.ATIAN 14AR