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HomeMy WebLinkAboutHouse Demo 2005 Town of Montville Building Department Field Inspection Notice Address: 37 - 39 Pequot Rd. Job Description: Demo House Permit Numbers:B2005-0050 Footing Not Approved: Approved: Comments: 1. Deck Piers Not Approved: Approved: j Comments: 1. 1 Backfill Not Approved: Approved: Comments: 1. Anchor Bolts Not Approved: Approved: Comments: 1. Concrete Slab Not Approved: Approved: Comments: 1. Rough Plumbing Not Approved: Approved: I Comments: 1. Rough HVAC Not Approved: Comments: I. Approved: Rough Electric Not Approved: Approved: Comments: I. Pool Bonding Not Approved: Approved: Comments: 1. Electrical Trench Not Approved: Approved: Comments: 1. Electrical Service Not Approved: Approved: Comments: 1. Gas Line Not Approved: Approved: Comments: 1. Masonry Fireplace Not Approved: Approved: Throat& Chimney Comments: 1. FireBlocking& Not Approved: Approved: Draftstopping Comments: 1. t` Framing Not Approved: Approved: Comments: 1. Insulation Not Approved: Approved: Comments: 1. Demo Final Not Approved: Approved: 3/4/05 Comments: 1. Comments: 1. Page I of 1 Revised 9/20/04 Sheet Printed:3/4/2005 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 DEMOLITION PERMIT Permit Number: B2005-0050 Date: 31-Jan-05 Map/Lot: 072/039-000 Owner ID: 5428000 Project Location: 37 PEQUOT ROAD Unit: Job Description: Demolish Two Family Dwelling Owner Name: David Waddington Tenant Name: N/A Careof: 66 Cross Road Waterford CT 06385- Telephone: Contractor Name: D.W.Transport&Leasing Telephone: (86)084-8169 DBA: Lic/Reg Type: Cl. A Lic/Reg No: 1134 P. 0. Box 462 Exp Date: 30-Jun-05 Uncasville Ct 06382- Construction Value Permit Fees Construction Information Building Value: $3,000.00 Building Fee: $30.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code Mechanical Value: $0.00 Mechanical Fee: w/2004 Amendment $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $3,000.00 Penalty Fee: $0.00 Permit Code: M1 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fee: $30.00 It shall be the owners repsonsibility to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING,MECHANICAL,ELECTRICAL PERMIT INSPECTIONS ❑ Footing-Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical ❑ Backfill- Footing drains and waterproofing ❑ Elec Trench -with conduit installed ❑ Concrete Slab -Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor framing ❑ Electrical Service CRS No: ❑ Framing p ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking _Draftstopping I SPECTION REQUIRED UPON COMPLETION ❑ Insulation /. VCe "cate of Approval (''''''------- ertificate of Occupancy Building Official's Approval: / y, Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231 Application for Demolition Permit Permit#4.2(541 5 _ Z3 '.--5--4 Job Address 3 7 -39 `)eQjZ `?--0 (Number) (Street) (Unit) Job Description (CD(L) ''.-DMot t-r rod Owner L iu Li) W fi t41&Tp 1J Mailingir Address 33e�c..x57 --g`K), City U rUC,ASU iCLe State e_.-7, Zip Q3n. Tel 76C /Vie / /69Z Contractor -).ki 1141l570t( FWD L41e6- Mailing Address Via.O BGS U 6 Z City U liCMSV( at, �z . Zip 063$Z Tel 466 i IN 8'/ /692 Contractor's License Type&Number ( . 5 il 1 No. 1 1341 Exp. Date 6 / 30 i 0-4:- I SI hereby certify that the proposed work will 441,1i to th :asic Building Code and all other codes as State of Connecticut and the Town of Mon adopted by the Contractor Signaturef ���. �� Date/ / �I / y4ip Owner Signature //r Date / / �/ ,(� Construction Value Fee Demolition $ _-300o 6a Building Department Use Only: Disconnect approvals received Sanitary Sewer ❑ Water Service,7 �r/ Electrical Natural Gas 41 A Telephone IFI,, Cable Television AUG-03-2004 TUE 01 :43 PM CL&P WATERFORD FAX NO. 860 447 5755 P. 01 ,j';'. )b'. 1411/ ?e/i?' ' 7 0? I As the owner of this property, Power Company (CLPj elrics servm ice and meterthe(s)to allow forermanent the demolition of the CT accordance with ail,applicable Connecticut General S light& Statutes. 1 certity that the buildingbuildingvacant.in Removal of Service for Building Demolition is i -- --•" d.- / --ym i,.9,�ren J3.-•. - �� Si G;4thC�ES:M&1=Fd REMOVAL -� I V L DATE NEEGE4 _____, I S'rt=�AQ04 83'NPIE-Er CTftCS- /� TO Ba-EM4VED • /�/J•` i ZIP co�E 60:7632._ y '376 7--0 _.-? 9 760 rr . Min 68g 4141 KZ cVa.. 6/72-31 0i516.8.: 6"2 61417— 6/.7.34 Id' CGMMENI-5 (9‘ 6786- 2-99' (396- V el4 2- 1 i Al ' PRINT NAM •• •..�r<Epi J . MAIL!NG ADORES �- .� � 1,7 STAT_ I ZIP^01-7Win V?el?z„,TO -Wmare -1 14 TE�Ez.).1Q"r"E F,JMBER OF PROPERTY OWNER A +. 6110 , 8eth A.gabs 4tQTARY Ptf8'iSC liqi' / State of CDnnec,+.cc t *Commission Expires 04130/08 6 • - N terry Public // s Qa = Notarized - CL&P arnerrtal Llse Clay Date service removed: . Please add a b note to CRS indicatinganto whom this sign-ot3-form was returned- File this completed form with this completed servi et redate moval work order. INT NAME OF CLS' PR.SENTATIVIE fVA /0 S e�. r LIRE OF CLIP REP- T ;VE a9 TE cZ� / To Avoid&A/Avg s -lease Complete All Information On This Form U.S. Pastas: Mail To: CLAP Clearing desk Overnight Express: Connecticut Ligk)t. .Powers Co. Mail To: Cl.&P Clearing Desk P.O. Box 2985 Connecticut Light& Power Co. Hartford, CT 013104-2985 ;176 Cu,r„�ertartr]eve. 1lrlethersfie.I.1, CT 0,610S JUL 2 1 2004 • PART IV STATE DEMOLITION CODE Sec.29-401.(Formerly Sec. 19-403b).Regulations.The Commissioner of Public Safety shall adopt such regulations in accordance with the provisions of chapter 54 as may be necessary for the administration of this part,including but not necessarily limited to,working definitions of such terms as "demolition", "building", "structure" and the like. Such regulations shall be designed for,and limited to,the carrying into effect of the intent and purpose of this part for public safety. Sec.29-402.(Formerly Sec. 19-403c).Certificate of registration for demolition business; fees.Definition of registration. Exemptions. (a) No person shall engage in the business of demolition of buildings without a certificate of registration obtained from the Department of Public Safety.An applicant for initial registration shall file an application with the Department of Public Safety,furnish evidence of expertise and fmancial responsibility and pay a fee of three hundred dollars for a class B certificate and seven hundred fifty dollars for a class A certificate.Each certificate shall be valid for twelve months from date of issuance and shall be renewable on application of the registrant upon payment of an annual fee of two hundred dollars for a class B certificate and six hundred dollars for a class A certificate.The department may refuse to issue any such certificate for cause,and may revoke or refuse to renew any such certificate for failure to carry out and conform to the provisions of this part or to any regulations adopted hereunder,or for any violation of title 22a.No person shall be refused a certificate or a renewal thereof, and no certificate shall be revoked,without an opportunity for a hearing conducted by the Department of Public Safety. (b) As used in this part,the term"registration"includes the whole or part of any permit which the Department of Public Safety issues under authority of the general statutes and which (1) Requires persons to place their names on a list maintained by the department before they can engage in the business of demolition of buildings, (2) Does not require a person to demonstrate competence by examination or other means and (3) May be revoked or suspended by the department for cause. (c) The provisions of this section shall not apply to (1) A person who is engaged in the disassembling,transportation and reconstruction of historic buildings for historical purposes or in the demolition of farm buildings or in the renovation,alteration or reconstruction of a single-family residence,or (2) The demolition of a single-family residence or out building by an owner of such structure if it does not exceed a height of thirty feet,provided the owner shall be present on site while such demolition work is in progress,shall be held personally liable for any injury to individuals or damage to public or private property caused by such demolition,and provided further such demolition shall be permitted only with respect to buildings which have clearance from other structures,roads or highways equal to or greater than the height of the structure subject to demolition.The local building official may require additional clearance when deemed necessary for safety. Sec.29-403.(Formerly Sec.19-403d).Appeal from decision of department.Any person aggrieved by a decision of the Department of Public Safety refusing to grant or renew or revoking any such certificate of registration may appeal therefrom in accordance with the provisions of section 4-183. Such appeal shall be privileged in assignment for trial. Sec.29-404.(Formerly Sec.19-403e).Local building official to administer State Demolition Code.The local building official shall administer sections 29-406 to 29-413,inclusive.Each such official shall have experience in building demolition,construction or structural engineering, shall be generally informed on demolition practices and requirements and on the equipment necessary for the safety of persons engaged in demolition and the public and shall have a thorough knowledge of statutes and regulations of the department concerning demolition. Such official shall pass upon any question relative to the manner of demolition or materials or equipment to be used in the demolition of buildings or structures. Sec.29-405.(Formerly Sec. 19-4030.Appeal from decision of local building official.Any person aggrieved by any order or decision of a building official may,within ten days of such order or decision,appeal therefrom to the superior court for the judicial district wherein such person resides,and such appeal shall be a privileged matter to be heard by the court as soon after the return day as is practicable. Sec.29-406.(Formerly Sec.19-403g).Permit for demolition of particular structure.Exemption.Waiting period. (a) No person shall demolish any building,structure or part thereof without obtaining a permit for the particular demolition undertaking from the building official of the town,city or borough wherein such building or part thereof is located.No person shall be eligible to receive a permit under this section unless he furnishes to the building official written evidence Sec.29-411.(Formerly Sec. 19-4031).Restrictions on demolition procedures.No person shall use demolition procedures which involve hazard or risk to the general public or unnecessary danger to the workmen,and no person shall use demolition procedures not in accord with good practice. Sec.29-412.(Formerly Sec. 19-403m).Accumulated materials.No person shall demolish any structure or building without making suitable provision for the disposal of all accumulated materials.No person shall overload any part of the protective structures erected during the demolition operations by storage,materials or debris to an extent beyond the live load capacity.No person shall,during demolition operations,allow materials to accumulate which would,by their nature,upon removal,cause an excessive amount of dust,dirt or debris in the air,without suitably wetting down such accumulations with water,dehydrated lime or some similar agent. Sec.29-413.(Formerly Sec.19-403n).Basements and cellars.No person shall allow any basement,cellar,hole or the like to remain uncovered or opened as a result of the demolition of any building,structure or part thereof.Each person who,in a demolition operation,uncovers or opens such a basement,cellar,hole or the like shall fill the same to grade and remove all excess materials, rubbish and debris from the premises.If a new building,structure or part thereof is to be erected on the site of such demolished premises,the building official may waive any of the provisions of this section. Sec.29-414.(Formerly Sec.19-403o).Penalty.Any person who violates any provision of this part shall be fined not more than five hundred dollars or imprisoned not more than one year or both. Sec.29-415.(Formerly Sec. 19-403p).Public service company exceptions.The provisions of this part shall not apply to the structures,such as distribution and transmission poles,towers and fixtures,steam plant,gas plant,gas tank or holder,water tank or electric substation,of any public service company as defined in section 16-1 whose operations are under the jurisdiction of the Department of Public Utility Control. 7A ' 7B 7C (' State of Connecticut N Workers' Compensation Commission DIRECTIONS DIRECTIONS for FILING FORMS 7A,7B and 7C S�Strc Building Permit Requirements for Workers' Compensation Section 31-286b of the Workers'Compensation Act requires anyone who requests a building permit to first submit"proof of workers'compensation coverage for all of the employees who are engaged to perform services on the site of the construction project for which the permit was issued." The only exceptions to this law are the sole proprietor or property owner who will not be acting as general contractor or principal employer. What to give to the Building Official to obtain a Building Permit: 1. The General Contractor or Principal Employer must provide a written certificate of workers' compensation insurance for all of the employees on their project.This certificate may not be for liability, disability or any other type of insurance. 2. The Sole Proprietor or Property Owner who will not act as a general contractor or principal employer is not required to have workers'compensation coverage. In order to obtain the building permit, a FORM 7A should be completed and given to the building official. 3. The Sole Proprietor or Property Owner who will act as a general contractor or a principal employer must provide a written certificate of workers'compensation insurance for all of the employees on their project and must file a FORM 7B with the building official—OR he will sign a sworn notarized affidavit on FORM 7B, stating that he will require proof of workers' compensation insurance for all those employed on the job site. 4. The General Contractor or Principal Employer who has properly excluded himself from coverage using the appropriate WCC form (see NOTE below)must file the FORM 7C with the building official.This form certifies that they have properly excluded themselves, and attests that they will require proof of workers' compensation insurance from every employee that works on the designated job site. NOTE: The general contractor or principal employer may exclude himself from workers'compensation coverage by filing one of the following forms with the appropriate Workers' Compensation Commission district office: Form 6B for employees who are Officers of a Corporation or Managers/ Members of an LLC Form 6B-1 for employees who are Members of a Partnership 9` _ Ike O* I 411.1gSTATE OF CONNECTICUT postmark pate: DEPARTMENT OF PUBLIC HEALTH 1 Tar ctat# DEMOLITION / NO'T'IFICATION FORM J Record s This form is to be completed and postmarked or hand delivered to the Connecticut Department of Public Health at least ten(10)days prior to the start of demolition as required by the Regulations of Connecticut State Agencies (RCSA),Section 19a-332a-3. In case of emergency notifications,this form is to be completed and postmarked or hand delivered within one(1)working day following the start of demolition. A copy of the written order requiring demolition prepared by a state or local building official shall accompany each emergency demolition notification.�ca Faxed originals are not acceptable. Revisions to the original notification form ma • i�' . /L-.31-0'I Each demolition notification must.be accompanied + by $ fee of twcrsty-#iv. pliers. A check in that amount made payable to "Treasurer, State of Connecticut" must be submitted with notification form. If it is determined that during demolition, asbestos abatement that disturbs more than ten (10) linear or twenty-five (25) square feet of asbestos will occur,then an asbestos abatement notification form shall be filed with the Department of Public Health,in accordance with §19a-332a-3 of the RCSA. This form shall be submitted at least ten days prior to the start of asbestos abatement. An asbestos abatement notification form filed in This situation shall satisfy the filing requirements of the demolition notification. In all cases of demolition,one and only one notification form (either for demolition or for asbestos abatement,as applicable)shall be sufficient to satisfy the DPH regulatory requirements. 1. TYPE OFNOTIFICATIO) A_ NEW Y ) EMERGENCY C. REVISE ITEMS REVISED 2. FACILITY OWNER/OPERATOR. NAME: ,l‘e., scr ,C. ADDRESS: .}7*� k iIf.. +�•;l ,p/.40 CITY: .�-�'rt .Pio iSTATE: Cr, , ZIP: Gf 6.74P2-- PHONE NO.: 6 e'Ref"/642. CONTACT PERSON: L. ' �.. — 3. DEMOLITION CONTRACTOR: NAME: erg e,, 74'GI'x 4241 7`c.P G ADDRESS: 3.? iG+O7r CITY: ,, 'y,¢,y"7rp STATE: ZIP: t '6.l P Z.-- PHONE NO.: (Aria'452R 4'9 Z- CONTACT PERSON: in accordance with Section 61.145 of the L.I.S. Environmental Protection Agency's National Emission Standards for Hazardous Air Pollutants (NESHAPs) regulation, the owner or operator of a facility shall, prior to the commencement of renovation or demolition, inspect the affected portions of the facility for asbestos, including Category I and Category II nonfriable asbestos. 4. PRE DEMOLITIONASBESTO.SSURVEYCONDUCTEDBY:: NAME: j riJs,7,,'i%' �l,-) CA0r / -15 ADDRESS: /2e,ff ,/�r$� ,0,,,1„r/ - CITY: 6'' STATE: �'. ZIP: S.>y0 PHONE NO.: (840" i9. 'j' INSPECTOR DPH LICENSE NO.: exo Zt/r 64 5(44 START DATE: ./.. .. 5(B) COMPLETION DATE: 2 dins! YY Jw crAYYYY Phone:(860)509-7367/Fax(860)509-7378 Telephone Device for the Deaf: (860) 509- 7191 410 Capitol Avenue,MS#51 AIR j� P.O. Box 340308 Harfford, CT 06134-0308 Affirmative Action 1 An Equal Opportunity Employer JUL l2 2004 13:50 FR SNET IROC 2034202300 TO 18608482669 P.01 111177K't'7 Vii!!' r^1.1"Mw r July 12, 2004 To Whom It May Concern: This letter is to inform you that the telephone equipment, cables, wires and attachments have been removed and/or are not attached to the addresses listed below. 39 Pequot Road Uncasville, Ct This job was performed prior to July 12, 2004 in response to a request to demolish the above address by: David Waddington DW Transport Waste Disposal If you have any questions,please feel free to contact me. Sincerely, 2aub General Office Associate SBC; Network Dispatch Center; 84 Deerfield Lane-Room 2C2; Meriden, Connecticut 06450 Phone: (203) 420-2857; Fax: (203)238-0434 feltrIrm-0 SYx}�c` n�'z 6 + T t 8,f15i' � 5W r.� ,.G Q y it ' -,0014114110 4T a i fir' x #.., Con&iltanth, Inc. Cl°�s � 11°' , ' "N� , 117) Groton, Connecticut 06340 #" Y '",'"4 December 17, 2004 t M , .1 L 4i' Mr. David Waddington D.W. Transport 33 Pequot Road Uncasville, Connecticut 06382 Re: TCLP Test Result Report 37—39 Pequot Avenue Montville, Connecticut Dear Mr. Waddington: A TCLP test was conducted on the sample that was taken from the site referenced above by a trained Lead Inspector from Mystic Air Quality Consultants, Inc. on December 10, 2004. The sample was analyzed by EMSL Analytical Inc., an AIHA accredited lab. Anything above EPA's TCLP standard of 5 mg/1 for lead is considered lead waste. The sample taken was tested and found to be below the concentration of 5 mg/1 which indicates this material does not have to be disposed of as lead waste. Thank you for selecting Mystic Air Quality Consultants, Inc. for these services. Sincerely, i hristopher J. Eident CIH, CSP, RS CEO Enclosure 1: Lab report Enclosure 2: Chain of custody Enclosure 3: Inspector's Daily Log t f t. i P Communications (24 hours): Office: (860) 449-8903 FAX: (860) 449-8860 Toll Free: 1 (800) 247-7746 JUL 12 2004 13:50 FR SNET IROC 2034202300 TO 18608482669 P.02 • Aer (13i ' b 'i July 12,2004 To Whom It May Concern: This letter is to inform you that the telephone equipment, cables, wires and attachments have been removed and/or are not attached to the addresses listed below. 37 Pequot Road Uncasville, Ct This job was performed prior to July 12, 2004 in response to a request to demolish the above address by: David Waddington DW Transport Waste Disposal If you have any questions, please feel free to contact me. Sincerely, o Laub General Office Associate SBC; Network Dispatch Center,-84 Deerfield Lane-Room 2C2; Meriden, Connecticut 06450 Phone: (203) 420-2857,- Fax: (203) 238-0434 ** TOTAL PAGE.02 ** JAN-03-2005 NON 02:59 PM CL&P WATERFORD JUL-21-2004 WED 01 :00 PM CL&P FAX NO. 860 447 5755 P. 02 FAX NO. 877 285 4498 P. 01 As the owner of this property, I am requesting Ps the y tCLt. Ic m equ and g the permanent removal of the existing CT Light S eccordence with all appilcabie Connecticut General statute I ce ttfdemolition thbuilding the lis vaca . Removal of Service for Building Demolition ,a vacant. oscrofr6CT BYSe.(CR9)TA,C,( GNUMQCR . RG►AovA�DA7f7 Nacpr- ~6TRE4TA..-•:3 wry / TOW • ,.t' s• e IIMIIIIIIIImmu ZAOa6,76L to.'Ar(I , �.. ' rte IR 4.4;;;;;;;,,3yy 767-0 .)7 (-> 762.42 j Mcrere M1UM`JCA«1 oif/ �'8'�2,' yz ofl 3'8 ocF e.'6'.7 4t i 6 . i COMMirr7, LJO6- Zyy . . ��-�d ��( ..fy ! 1 MAILING gOORL.y 37 `, 'Or �� T III T Kr'NON6 NUM6�OF PROPERTY ` Tit comic)6-.7 "�i � _ 04 ' - 6r / - 8 -- e , --,7—^ " N Beth A, Jabs 0TARY PUBLIC �� State of Connecticut _ . .. .�4_4_ W/ 7 DIY commission Expires 04/3 .....- :;Niotiny Public / a/i)8 0 6os No Azad ►-� CLAP Internal Use Only— Date Service removed: / " ` ~ _ and to whom this sign-off form Was rete ed. File this completed form with this completed Please add a job note to CRS Indicating the date work order,preiI P service removal i �TEOFCLipREia + HTAT.V[ "n OF TE Te_itiAmajudarg Please Complete All Information On 7hls Form U.S. Postal: U.SMail To: CL&P Clearing Desk Overnight Express: Connecticut Light &Power Co. .. Mail To:spq CLdita Clearing Desk onnect HaP.urttordXCT oetoa-28952985 :w- T 1C,:4..��_,7s Curnlberland A've.ower Co. Wethersfield, CT 06109 JUL 2 1 2004 41/4c, AIR E � ,- Mystic Air Qality Con&jltimnLg, lert o°hsuL,t P`` 1204 North Road (Rt. 117) Groton, Connecticut 06340 December 6,2004 Mr.David Waddington D.W. Transport and Leasing, Inc. P.O.Box 462 Uncasville,Connecticut 06133 Re: Post Abatement Inspection Pre-Demolition Review 37-39 Pequot Road Uncasville,Connecticut Dear Mr. Waddington: On December 6,2004 our asbestos abatement project monitor, Stewart Oakes,completed a visual inspection at 37=39 Pequot Road Uncasville,Connecticut for fulfillment of criteria for inspection prior to demolition. This site review was for the purpose of determining whether the asbestos-containing materials stipulated in the earlier survey performed by Mystic Air Quality Consultants were completely removed in order to allow for demolition to go forward,with regard to asbestos issues: ACM Materials At this time,all of the stipulated materials identified by the inspection documents are completely removed from the building and property. There is no visible asbestos related dust or debris remaining from these materials in the building,as required by US EPA NESHAPS and the State of Connecticut regulations to allow demolition to proceed. As allowed for by State standards for asbestos abatement,there were no final air tests performed at this site because there is no need for this building to be reoccupied. Thank you for selecting Mystic Air Quality for these services. Richard Haffey President Communications (24 hours): Office: (860) 449-8903 FAX: (860) 449-8860 Toll Free: 1 (800) 247-7746 ••• ...a,,••a•, ni:..rag}neuroneServices,Inc, FaxiD:CPM Insurance Sewic To:Pete Olsen Date: 12/21/04 04:19 PM Page:2 c ACCRA CERTIFICATE OF LIABILITY INSURANCE o , , DATE; OMIYY} PRODUCER DWTRAPID 1 0 9/2 009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cilli Insurance Sarvia�s, Inc AND CONFERS NO RIGHTS UPON THE CERTIFICATE 90 Hinman Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Cheshire CT 06410 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone:203-272-3521 INSURED Phan 1 INSURERS AFFORDING COVERAGE NAIC# mURERA Lincoln General Ins Co INSLERERe American Alternative D33. W.ctTTransport i Leasing, Inc +ter Great American Ins Co 1 Uncascalle CT 06382 INSURER SURER D: i COVERAGES INSURER E ITHE POLICIES OF INSURANCE LE5/EU BELOW HAVE BEEN ISSUED TO TME!ANY RELICIE OF I TERM OR CONDITION OF ANY CONTRACT INSURED NAMED A80VE FOR THE HTHIS POLICY PERIOD INDICATED NOTWITWTANDING MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN WITH RESPECT ALL TH IET.EEXCLUSIONS CERTIFICATE CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS TYPE OF! LITt _ MlERAL LIABILITY INSURANCE POUCY NUMBERle � DATE ,-.'V+'• UNITS X �wGENERAL LIA81LITr Lt1pp3s5 EACH OCCURRENCE _ $1,000 04/15/04 04/15/05 PREMISES(Es xcErcrcq)� $ -----2---- 000 50,000 ©m CLAIMS MADE OCCUR MED Exp(Arty PPrsan) $ 5,000 ____ n. PERSONAL a ADV NARY $1,000,000 S PER: sell.AGGREGATE LIMIT APPLIES GENERAL AGGREGATE S 2,000,000 111 POLICY ©- .LOC F'RaDucTs-COMP/OP AGG $ 1,000,000 Auromo LE LIABILITY A ©ANY AUTO LWX 100366 (E"ccEDSINGLE'_LIt.NT al ALL OWNED AUTOS 04/15/04 04/15/05 Eeeccraenl} $1,000,000 -SCHEDLLED AUTOS {130Dper INJURY ©HIRED AUTOS {Pei Berson} $ ElNON OYVNED AUTOS BODEL Y INJURY lMCS-90 iPeraccdi+rRi $ • PerPROPERTY DAMAGE $ �►T /l!�� (Par acacion”III IIAUTO ONLY-EA ACCNDENr $ OTHER THAN EA ACC $ EXCESS/UMBRELLA UABLITY ALTO ONLY AGG $ BQ OCCUR ii CLANM5 MADE CO7 5 910 EACH OCCURRENCE a 5,000,000 04/15/09 04/15/05 E � �� $5,000,000 111 DEDUCTIBLE $ • ©REIENT70N7 $10,000 $ WORKERS COMPENSATION AND (�y��IIIIIIIIIII$ EMPLOYERS'UANLITY ANY PRPAR'rNER+EXECUTIVE TORY Ltl,MTS j R EXCLUDED? E L.EACH ACCIDENT OFFICERIMEh ISPEC'pa.FrzOV IStCNeS Chow E L DISEASE-EA EMPLOYEE $ O - E L.DISEASE-POLICY LIMIT $ C Contr i• MAC1341058 CRIPTION O OPERAI LOCATIONS I VEHICLES I EXCLUSIONS ADDED r-„ --,.. I.7-9-71 O04/15/04 T1PRQ 04/15/05 6• i1y►ent RC Valuatic Includes Demolition coverage and hold harmless. vaawNs CERTIFICATE HOLDER CANCELLATION EASTL-1 SHOULD ANY of THE ABOVE DESCRIBED POLICIES ae CANCBLL5O aer'c Re TME EXPIRATION DATE meteor.THE ISSUING ICER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,OUT FAILURE TO DO SO SHALL IMPOSE,NO OBLIGATION OR UABLTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. A ORIZED REPRESENTATIVE CORD 25{2401/48} Jim Bradanini 0 ACORD CORPORATION 1985 CONNECTICUT Department of Public Safety, Divisisn of Fire & Building Safety DEMOLITION CONTRACTORS CERTIFICATE ,,�',,;,. '`- NO:1134 CLASS:A DATE ISSUED:2004/07/01 EXPIRES:2005/06/30 ) Certification as a Demolition Contractor is hereby granted to the person or firm named hereon. Name of Designated Technical Expert: David Waddington SIGNED (DTE) ISSUED TO: D.W. Transport & Leasing, Inc. 33 Pequot Rd Uncasv' l e, CT 06382 AUTHORIZED BY: �. . easAZ? SP-981-C ( /-of-.;js 1 II 1 --'4-1-7 --tire- --)4) _ .es-jit;,_ /2.-___L ,„, g'<-,,k IIK, ,,,,e Ag .74 ,,, ,,,,,, /,A,,, ii � 72 - 74 ��yv' /�, /..A/ is „ _ ,r/, ' . _ -- -- ,..e-. 24 II 114 II 0, °5 aY �'��Qn , O,� /04 IIS ��.47. 7),,V " Town of Montville Building Department Receipt Date � No. 04607 From: / � Job Address: • Ar- , ,e„ Amount g Cash heck Check #4Z one) Received b ' P ., Pet I UO PRI 16:24 FAX 8604436031 ECCTV 0 001 Castern onnee cu P.O.Box 6001, 61 Myrock Avenue CabeTelevlsAon, Waterford, CT 06385-6001 Inc. :".•• ; Your Home Entertainment Center! (860) 2 44' -8525 • (860) 928-3866 • (860) 564-1967 FAX: (860) 443-6031 January 28, 2005 A.TTN_ Sandy This letter is to verify that our cable lines were removed from 37-39 Peq not this was done on July 12, 2004. q Road, Please call me at 442-8525 if I may be of any further assistance: Sincerely, Ann TOWN OF MONTVILLE WATER POLLUTION CONTROL AUTHORITY 310 NORWICH-NEW LONDON TPKE UNCASVILLE, CT 06382 Phone—860-848-7094 x311 or 312 Fax—860-8484354 January 31, 2005 To Whom It May Concern: Property located at 37-39 Pequot Rd has been disconnected from the sewerper inspection of Gary Blackstone. p coon 41 / r ,