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Security System 2011
Field Inspection Notice Town of Montville Building Department 860-848-3030 Ext. 382 Address: 63 Pennsylvania Avenue Job Description: Install Security System Permit Number(s) E2011-0151 Permit Date: August 2,2011 Not Approved Approval INSPECTION Date: Deficiencies Special Date Conditions • Final inspection and • certificate of approval 8/5/11 DJ **:NOTE** After one re-inspection additional inspection fees payable prior to re-inspection,are as follows: Residential inspections(except SFR C/O& SFR Additions C/O)-$10.00 SFR and Additions CIO re-inspections -$10.00 Commercial re-inspections(except Certificate of Occupancy- $25.00 Commercial Certificate of Occupancy- $50.00 Rev.Date: 1/18/06 Page 1 of 1 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860)848-3030 X382 FAX. (860) 848-7231 ELECTRICAL PERMIT Permit Number: E2011-0151 Date: 02-Aug-11 Map/Lot: 092/116-000 Owner ID: 5412000 Project Location: 63 PENNSYLVANIA AVENUE Unit: Job Description: Install Security System Owner Nam Luvina M Busby Tenant Name N/A Careof: 63 Pennsylvania Avenue Oakdale CT 06370- Telephone: Contractor Nam Protective Security Systems Telephone: (413)569-1330 DBA: Lic/Reg Type L5 Lic/Reg No 184467 5 North Westfield Street Exp Date: 30-Sep_11 Feeding Hills MA 01030- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code Mechanical Valu $0.00 Mechanical Fee $0.00 Electrical Value: $49.00 Electrical Fee: $10.00 Construction Type IRC Total Value: $49.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 State Ed Fee: $0.01 Total Fee Paid: $10.01 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 framin ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation © Certificate of Approval J �'�/� ❑ Certificate of Occupancy Building Official's Approval:_-__ a Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.: F C-1) - 051 Type of Work Occupancy Type Permit Type ❑ New Construction ❑ Single Family ❑Building ❑Addition ❑Two-Family ❑ Plumbing ❑Alteration ❑Townhouse ❑Mechanical ❑ Accessory Structure ®"1`lectrical CRS#: Property Address: -? >/-1./1J yik, 0 � C / (Number) (Street) (Unit) Job Description: i-. // c_. Owner: 2y Address: t?+ ✓•R City: State: Zip Code: Telephone( ) Applicant: Pic,it-cf ' DBA: Address:r /1/9t-d-- k L-1' l� T� 1� ,..111`474i'lam City: /evL,✓l`, /7< / /, State//l/� Zip Code:O/ 3 Telephone( '/ 3 )16_ - /.3:3" Contractors - Complete the Following: License Type: License No.:O1 970 / Expiration Date: 5/3 I hereby certify that the proposed work will conform to the State 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. [21-1:;;;checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Code, instead of the electrical requirements in chapters 33 through 42.f the Residential Code. • Owner/Agent Signature: Date: Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: 49-5 Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: . O Total Fee: ( 0 . Cil %visedust 23,2007 Town of Montville Building Department File Receipt Date: 28-Jul-11 Receipt No: 6655 Received From: Protective Security Service Job Address: 63 Pennsylvania Avenue Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check/Card $10.01 Check/Card $0.01 Check No: 11191 Short/Over: $0.00 Construction Value: $50.00 Demolition Value: $0.00 Received By Carmen Kneeland C GAm �/,_ „ /�.aL JU � f.------e-‘1,- ;+�,.y 'yihL%if',:t ��y1r"'r_�"����i',•'. c/4t.�,••,f%,L�"%i{/•;':V.:?k���.1� "��;\L y',�•-' �r --,._.,•,,(11.1.;-,'A'y.,r.. tea ' ,•'.bi:41 .c" :•.1,; �',.:0),;: .},�..t :*;n 5• by 4 ./,, r,•' "V'''''.."-::t. ,` it \ ; \'' 'gra \ k{ ; ti+aU ,,y k,,,,,,,,/' � �.� -1'400.- ti c f, 4 4 ,t� it sr • P..\ �yy roti.,., (y, F '‘,4„.,- ,4 .,- '' cu. ` Z _� ,.0 v r�` t. 0 rV, . ' rt Z ttl....17-157,1 t `/ � v a Z z . -' W rc.... + . ,4„..s.......::::::___-_,,,/, al 1 co F .0 - U O :: a - ; H H o W CL) (...i U W O ' O W c 0 b ,-= U .0 © E� a U W W 1 . -- . si �� i. ' 5 � -- 4 �v3� � y iyp , " . '*" :k#Nti nd " 11-. -- s.`we•,;. I�`. ,• . ,,+ti"i• S' . 5• L • . -•dy ' ` :.....m.,.. �'• _ , ""—fi •••,4� �,\ :-4 _/�.._.-2,4,.:::-__‘...,,-.4..„:"Z-2,4.: ‘,„.._ �,'�' - , _-__6/, /,, r` _ '4R D CERTIFICATE OF LIABILITY INSURANCE "T"'"'"""" Dio" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTMrs. Morey Hoffman PHONE Beecher Carlson Insurance Services, LLC 6MAILI�,E (Am,Nu) (877)865-0003 obo Security America RRG ADDRESS: PRODUCER 8390 E. Crescent Parkway, Ste. 200 CUSTOMERINN Greenwood Village CO 80111 INSURERS)AFFORDING COVERAGE MAIC INSURED INSURER A-Security America RRG 11267 INSURER B Protective Security Services, Inc. INSURER C: 5 N. Westfield Street INSURER 0: INSURER E: Feeding Hills MA 01030 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: This IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. BY EXP L RR TYPE OF INSURANCE p(5 WVD POLICY NUS (e ) el POLICY EFF YD Y) LIARS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL UABII.RY PREMISES ocam6nce) $ 100,000 A CLAIMS-MADE X OCCUR 005291011 7/27/2010 7/27/2011 MSW( ma ) S 10,000 X E & 0 PERSONAL&AU/INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEML AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,000 1 policy J n LOc AUTOMOBRE LIABILITY COMBINED SINGLE UNIT S (Ea accidm) ANY AUTO BODILY INJURY(Per person) S ALL OWNED AUTOS BODILY INJURY(Per accident) S SCHEDULED AUTOS PROPERTY DAMAGE S HIRED AUTOS (Per ) _ NON OWNED AUTOS S S UMBRELLA UAB _ OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY UNITS ER ANY PROPRIETOR/PARTNERIEXECUT1VE EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? NIA Mandalay M NH) EL DISEASE-EA EMPLOYEE S n resa8 a under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UNIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Cheryl Jones/MOREYE ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL Applicant is responsible for obtaining all of the required approvals. No permit will be issued until all the required signatures are obtained. (n3 f e n ris - — Property Address ❑��, ( SeC s}-c.+41) Job DescriptionI Required Department Permit Issuance Approval A. 'royal Tax Collector ��-� ��-� 7A2.. eP I i i Signature/date / Comments: in Planning &Zoning �' �`� 7 2E// I 1 ,^ Comments: Signature/date /v !V1 (/ .� iL 111 Fire Marsh r ' i ( t, Signature!date Comments: Health Department Required for properties with private septic or well Comments: m-4 WPCA, Administrative { 7r �1 L 1 Required for properties on sewer Signature/date Comments: ❑ WPCA, Operations When Required by WPCA Signature/date Comments: �l Department of Public Works Required when project includes driveway work or certain drainage requirements Signature/date Comments: Montville Police Department Required for all permits EXCEPT one and two family residential Signature/date Comments: ❑ State Dept. of Transportation Required for Structures over 100,000 sq.ft.or with more than 200 parking spaces-Official copy of STC Certificate of Operation required—per CGS 14-311 Signature/date Building Department Review Complete Signature/date &vised May 23,2011