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Home My WebLink AboutGas Line for Stove 2005 4;"0). Town of Montville Q. .• Building Department Date: Field Inspection Notice Permit#: Address: /-7 icAvG/* ' '` Not Comments/Corrections Required—re-inspection required: Inspection Approved Approved ❑ Footing 0 0 ❑ Backfill 0 0 ❑ Concrete Slab 0 0 ❑ Framing 0 0 • ❑ Rough Elec 0 0 O Elec Service 0 0 ❑ Rough HVAC 0 0 O Rough Plumbing ❑ 0 E1 Gas Line ET 0 ❑ Fireplace Throat 0 0 O Chimney 0 0 ❑ Fire/Draftstopping 0 0 ❑ Insulation 0 0 O Final Inspection 0 0 ❑ CofO 0 0 ❑ 0 , Inspector's Signature TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 MECHANICAL PERMIT Permit Number: M2005-0127 Date: 12-Sep-05 Map/Lot: 084/126-000/ Owner ID: 5381000 Project Location: 17 PEACHVALE DRIVE Unit: Job Description: Gas Tnk,gas line for range Owner Name: Edward Sr and Betty Lou Tracz Tenant Name: N/A Careof: 1482 Route 32 Uncasville CT 06382- Telephone: Contractor Name: Osterman Propane Telephone: (860)447-0341 DBA: Lic/Reg Type: G1 Lic/Reg No: 394019 7 Enterprise Lane Exp Date: 31-Aug-05 Oakdale, Ct 06370- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code Mechanical Value: $450.00 Mechanical Fee: $8.00 w/2004 Amendment Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $450.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.07 Total Fee: $8.07 It shall be the owners repsonsibility to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING, MECHANICAL,ELECTRICAL PERMIT INSPECTIONS ❑ Footing -Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical ❑ Backfill -Footing drains and waterproofing ❑ Elec Trench -with conduit installed ❑ Concrete Slab-Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor framing ❑ Electrical Service CRS No: 111 Framing 0 ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble d❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑ Certificate of Approval ". ific. • of Occupancy • Building Official's Approval: Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential LP-Gas Permit Application Form 7t<;.Family 111 Two-EamiCy Townhouse Permit# go7 dpb� /=.2 7 Job Address L. P CI4 � /22 — 1///j G7 (Number) (Street) (Unit) Job Description� � � 1 /7 7 4 / a I . I �- gigN&( Owner 1.-017Mailing Address City State Zip Tel leO /IXU/ Contractor ,, tie.49,142," Mailing Address 7 6l77 ,e/Ser- City 0G& r/ State(( Zip P537 0 Tel a960/ '/q7 5!-/J Contractor's License Type&Number 6/-- 39 lo/ 5' Exp. Date P1 J // 0k 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. Separate applications are required elec ca Owner/•310 ignature „- -- Date /_3--/ 05 Construction Value Fee $ Mechanical 4'50 -. Electrical $ $ Plan Review Fee State Education $ $ y.��' O $ o • 0 7 Total 07 RCNsaSeptem6er9,2004 • Town of Montville Building Department File Receipt Date: 09-Sep-05 Receipt No: 618 Received From: Osterman Propane Job Address: 17 Peachvale Dr. Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $8.07 Check: $0.07 Check No: 1323 Construction Value: $450.00 Demolition Value: $0.00 Received By Sandra Pandora Town of Montville Building Department Customer Receipt Date: 09-Sep-05 Receipt No: 618 Received From: Osterman Propane Job Address: 17 Peachvale Dr. Fees Collected Cash: $0.00 Check: $8.07 Check No: 1323 Received By Sandra Pandora STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION HEATING,PIPING&COOLING LIMITED CONTRACTOR G1 SAMUEL I_SUGAWARA 260 NORWICH NEW LONDON TRICE#1 UNCASVILLE,CT 06382 LIC./REG NO. EFFECTIVE EXPIRES 394019 09/01/2005 08/31/2006 SIGNED 'In ":" --________ co .• L• '"g'"'''' °12. CENSE `216992838 COMMERCIAL DRIVER LI i. Doe.09-21-1978 eLEN.I.212g ' / En : f Ga a Restr.B ed.09-11-2004. �i:YEyes.BR� . 5 63 suGx AAI- ,-Li:U4 L:U TM FAC/M: F.,a !'.,:-(IA_Le Ihell_dr,,, Ti: ixh1)44-,U".95 7ACtE: . -=F Client#:2427758 OSTERGAS ACORD,. CERTIFICATE OF LIABILITY INSURANCE l DATE(WM/CD'YYYY) PRODUCER 10(21/04 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I Gaudette Insurance Agency,Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE One Plumrrwrs Corner HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Whrtinsville,MA 01588-2100 ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. 508 234-6333 1 INSURED INSURERS AFFORDING COVERAGE NAIC# E.Osterman Gas Service,Inc. INSURER A Liberty Mutual Insurance Company AIG003 INSURER 6: American Home Assurance One Memorial Square Whitinsville. MA 01588 INSURER c INSURER D I INSURER E r COVERAGES ',E POLICIES C'-INSURANCE L'STED BELOW-IAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER CD INDiCATEO.NOTWITHSTANDING ANY RECIJ,REMENT TERM OR CONDITION 0:ANY CONTRACT OR OTHER DOCUMENT WITS RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED DR MAY PERTAIN.THE INSURANCE A:FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEF(✓S.EXCLUSIONS AND CONDITIONS OF SUCH PO'_10ES.AGGREGATE LIM'TS SHOWN MAY-AVE BEEN REDUCED BY PAID CLAMS INSR ADM., LTR NSRCi TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION GATE(MMIDD/YY'. PATE($WdVD/YY) UMITS A GENERALUABILRY BINDER290468 10/01/04 10/01/05 EACH OCCURRENCE $1,000.000 1 X COMMERCIAL GENERA_L NEIL Tr DAMAGE rO REN I ED PRFM!SES(Eorj^E-re ce, 550.000 ' !CLAIMS MACE J X J OCCUR MED EXP(An;one persor, S 6_ PERSONAL&ADV N,.UR" Si 000.000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS•COMP/OP AGG $2,000,000 •PCL CY I ,PER° fl LOC A AAuTOMOeILE LUBILrrY BINDER285108 10/01/04 10/011/05 r ANY AUTO "OMBINEC SWGLE LIMIT (Fa ac[;1:1enIJ $1,000,000 ' AL OWNED AUTOS SCHEDII FD AUTOS BODILY NUR" $ '�— I (Per persur I X ,H RED A•JTOS -- �' BODILY INJURYS.JURY X :NON-CINIED AUTOS (Per accident X • Drive Other Car rT PROPERTY DAMAGE (Per accident $ GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ -- — ANN AUTO ^ i ! OTHER TLUW EA ACC$ 1 • AUTO ONLY AGC $ B EXCEES,UMBRELLALIABLITY BINDER285109 10/01/04 10/01/05 EACHOCCURRFNCE $10,000,000 X CCCL P r^CLAMS MACE AGGREGATE S10000,000 S —;DEDUCTIBLE $ X RETENTON $10000 $ A WORKERS COMPENSATION AND BINDER285107 1,10/01/04 10/01/05IYCSTAM,- I0TH. EMPLOYERS'LIABILITY TCRYLMITS ER AN',PROPS ETOWPARTNER/EXECUTM1IE EL EACH ACC:DENT $1,000,000 OFF!:ER/MEMBER EXCLUDED? '1 ies:esc 1,73 vr�er F I DISEASE-FA FMPLCYFF $1,000,000 STHPROv 5 OHS 7eI '+_ E L DISEASE-PDL CMIT $1,000_000 '---1 OTHER i : DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUNG INSURER WILL ENDEAVOR TO MAL :RA_ DAYS WRrTTEN NOTICE TO THE CERTFICATE HOLDER NAMED TO THE LEFT.BUT FALURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVEI ACORD 25(2001,'08)1 o1 2 #S50539/M50402 � "' �� wL"' MDB @ ACORD CORPORATION 1988 Town of Montville ' Building Department 848-3030, Ext 382 RESIDENTIAL LP-GAS PERMIT CONSTRUCTION PERMIT APPROVAL 781C Z J /7 /PE4-C1->t t d LL �/i�/C�9-S V) 1 e- / /Property Address Job Description The applicant is responsible for obtaining all of the required approvals checked off on this form. No building permit will be issued until all of the required signatures have been obtained. Required Department Approval Permit Issuance Approval Tax Collector ,� /(, 9/,4 p S c dol El WPCA • ' '�` LIWA&. 9-/do Si nature date ❑ Planning&Zoning Signature!date ❑ Health Department Signature/ date ❑ Fire Marshal Signature/ date Comments/Conditions: c vseiSeptem6er9,2004