HomeMy WebLinkAboutRepaired Fire Damaged Electrical 2002 • 1 Town of Montville il
Building Department
Date / /7/ a a2 Field Inspection Notice Permit #f q? ( 't�
Job Location 6 9 Aboi /valt/1�'
pproved Type of Inspection /0,5 ala / O/c(
i Not Approved - Please call for re-inspection when the following corrections have been completed:
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Building Official
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New Landon Turnpike
Uncasville,CT 06382
860-848-3030, Ex.t 82
Building Permit
Permit Number: B2002-136 Permit Date: 08-Apr-02 Permit Code R4
Job Location: 64 PENNSYLVANIA AVENUE UNIT: - MAP/LOT: 092/182-000
Job Description: repair fire damage/remodel
Owner Contractor
RALPH E+ NANCY E JACKSON United Cleaning&Restoration
16 Main Street
64 PENNSYLVIA AVE Unit: - Durham,Ct.06422
OAKDALE CT 06370 Telephone: 860-349-2448
Lic/Reg Type: HIC
Use Group R4
Lic/Reg Number: 560951
Code 1995 CABO
Exp Date: 11/30/02
Construction Type 5B
Construction Values Permit Fees
Building Value: $31,000.00 Building Fee: $184.00
Plumbing Value: $0.00 Plumbing Fee: $0.00
Mechanical Value: $0.00 Mechanical Fee: $0.00
Electrical Value: $4,000.00 Electrical Fee: $22.00
Other Value: $0.00 Other Fee: $0.00
Total Value: $35,000.00 C/O Fee: $10.00
Comments: Plan Review Fee: $18.40
State Ed Fee: $5.60
Total Fees: $240.00
jt is the owners responsibility to schedule the following reauired inspections(minimum 48 hours notice requested):
❑ Footing-Prior to pouring concrete ❑ Rough HVAC
❑ Backfill-Footing drains and waterproofing ❑ Fireplace Throat
❑ Concrete Slab-Prior to pouring ❑ Fireplace Final
O Rough Framing ❑ Chimney-One flue above thimble
O Rough Electrical 0 Firestopping/draftstopping
❑ Electrical Service 0 In '.lation
❑ Rough Plumbing and Leak Test I Final • .-
0 Gas Piping and Pressure Test 0 ertificate ." •. upJ• -Prior to use or occupancy
Building Official's Signature:
T
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Town of Montville
Building Department Permit #/91,2650 cR — /36
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231
One & Two Family Building Permit Application Form
❑ New Construction ❑Action []Alteration []Accessory Structure
12 Other 'j ir& P-Z r—
Job Location 6 '7 Neh/l S cilk)Qr Ck. A Ve, . t lavi : /10 CA
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Job Description/Materials r CA.lc.,,t,( yd.C- j f 0' .� 40-4 (2).1.6;/16.1
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Owner nar IL Pa Ii)1 �G(.1CCo f.. Mailing Address 6 ii PerNY1 S Ai6-1,Gi 74V e,.
City h,` (ffti C State C 4— Zip Tel 0 / / a IV P
Contractor UI'11 C ban I n y I- Mailing Address /�p ma t n S�.
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City DM r-1G�, State l— Zip 0614,,x, Tel X60 / 3 7 F/ Ov 7 c'
Contractor's License/Registration Type&Number 510D -/ 57 Exp. Date / / / 301 ;001
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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.
TJDA Owner/Agent SignatureDate ( / 65-/ 0:4
Construction Value Fee
3%,
Building $ (�d d $ /.5' y ,-----
Plumbing $ $
Mechanical $
Electrical $ ��r�6 dam- $ o?
Other $ $
Certificate of Occupancy $
Plan Review Fee
State Education $$ ' VG)
Total $ 9 0 X $ 0, 96 ,O0
Town of Montville Building Department Receipt
Date / , '"- /____O_,2 No. 16 1
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Amount $--__3t7VA 0-0 Cash Check Check # /�
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Received by i�,`, 4,4„, __ika2edp4f;t„....-- Permit #ieala --f 3115
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ent By: United Cleaning & Restoration ; 860 349 2580; Apr-5-02 2:05PM; Page 1.1
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ACORD CERTIFICATE OF LIABkLJ I i II\ ,URANCE DATE(MM/DD/YY)
TM
03/27/2002
PRODUCER (203)453-2701 FAX
(203)458-7009 III • - • ' •- " . ••
N.E.P. Inc. dba The Stone Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
5 Boston Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
0. Box 309
uilford, CT 06437 INSURERS AFFORDING COVERAGE
INSURED United Cleaning & Restoration, LLC INSURER A: Peerless Ins/Liberty
United Holdings, LLC INSURER B.
16 Main Street INSURERC
Unit 205 INSURER D:
Durham, CT 06422 INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TNSR
FUMY thF EL JIVE YULILY EAFIRA IIUN
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS
GENERAL LIABILITY CBP 9446606 08/17/2001 08/17/2002 EACH OCCURRENCE $ 1,000,000 .
X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 300,000
CLAIMS MADE X OCCUR MED EXP(Any one person) $ 10,000
A X Employe Benefits L PERSONAL 8 ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE PLIIMMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000
7 POLICY JECT LOC
AUTOMOBILE LIABILITY BA 9446706 08/17/2001 08/17/2002 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $ 1,000,000
ALL OWNED AUTOS
BODILY INJURY $
A SCHEDULED AUTOS (Per person)
A HIRED AUTOS
BODILY INJURY $
X NON-OWNED AUTOS (Per accident)
. PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY CU 9446806 08/17/2001 08/17/2002 EACH OCCURRENCE $ 1,000,000
OCCUR CLAIMS MADE AGGREGATE $ 1,000,000
A SIR s
10,000
DEDUCTIBLE , S
RETENTION $ $
WORKERS COMPENSATION AND WC 9443606 08/17/2001 08/17/2002 X TWil.b1HIll- VIM-
ORY LIMITS ER
EMPLOYERS'LIABILITY
A E.L.EACH ACCIDENT $ 100,000
E.L.DISEASE-EA EMPLOYEE$ 100,000
E.L.DISEASE-POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Contractors specializing in insuranace claims clean up & restoration after fire, smoke & water damage
for residential & commercial jobs.
CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE C...,,..:CATE HOLDER NAMED TO THE LEFT,
Nancy & Ralph Jackson BUT FA. "RE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
64 Pennsylvania Avenue OF ANY KIND UPON THE COMPAN ITS AGENTS OR.REPRESEN T)VES.
Oakdale, CT 06370 AUTHORIZED REPRESENTATIVE /
Mary-Anne Cole CIS ./ r�/
ACORD 25-S(7/97) c ACORD CORPORAT ION 1988