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HomeMy WebLinkAbout1996 - Chimney, Fireplace, Gas Tank and Line TOWN or MONTVILLE 0 0 Building d �6 epartment t /i 848-7166 It) APPROVED BUILDING PERMIT OR TRADES PERMIT For 180 Days Permit No: 13179-H Approval Date: 10/29/96 Expiration Date: 4/29/97 Estimated Cost: 3 ,500 .00 Fees: 22 .00 PRF: C .O: Owner : Charles Wozniak Address: 32 Podurgiel Lane Tel : 848-3828 Job Location: 32 Podurgiel Lane Code: 06 Contractor : Hendel 's Inc . Address: 75 Great Neck Road Tel: 443-5337 Stick Built: x Modular Home: Manufactured Home: Commercial : Addition: Garage: Car Port: Shed: Remodeling: Roofing: Siding: Fireplace: x Chimney: x Windows: Pool : Demolition: Plumbing: Heating: x Electrical : Air Conditioning: Gas: x Patio: Porch: Deck: Retaining Wall : New: x Repair/Replacement: Type of material used/discription: reline chimney to code , install gas fireplace logs and gas line and tanks properly located to meet code Size: Type of Heat: Fireplace: No .of Stories: No . Rooms: Breezeway: No. Baths: Garage: Use: 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 . Applicant 's Signature: __._ ,/ _. _ AA&W/ eIf Date: //7/;20 If signed by Contractor , type of license/registration & No: -5-"7 - 7° 7 ‘.. / Building Official 's Signature: /4(. �/�. _. .u/ Date: `�/�7/T Date of Health Dept . Approval : �y'�/9 --- , i`_i _ ___ Date of Zoning Approval : 4///1- THIS IS TO INFORM YOU THAT UNDER THE CONNECTICUT AMENDMENT OF THE BUILDING CODE, SECTION 119.3 A CERTIFICATE OF OCCUPANCY IS REQUIRED PRIOR TO ANY USE OF THE STRUCTURE . A MINIMUM OF 24 HOUR NOTICE TO THE BUILDING DEPARTMENT IS REQUIRED FOR INSPECTIONS. , / ?"44TOWN OF MONTVILLE Building Department Application for a Permit Owner: 4 4-g 1-E'S 1 wa Z/1//,4/c S/1•1/t-� Addr//ess: Tel : 3 �fr- Job Location: /� a � � C � rLL L,� (4/cif SvfL4 Contractor: //A-'-'44F-1.S. 'T��'44F- S C. Address: P �-f/ cA /,J//rg l ; Stick Built : Modular Home: Manufactured Home: commercial : Addition: — Garage: _ Car Port : Shed: Remodeling: Roofing: Siding: _ Fireplace: Chimney: _ Windows: Pool : _ Demolition: Plumbing: Heating: _ Electrical : Air Conditioning: _ Gas: /7i'J,�.-it.vc" Patio: _ Porch: _ Deck: _ Retaining Wall : New: Repair/Replacement: Type of Material to be used/job description: 7// '74/ yc/o41e /?t /t-c �G s Z ,tq 1 /7C 614/ �f Size: Type of Heat: Fireplace: No.of Stories: No. Rooms : Breezeway: No. Baths : Garage: Use: ( '} LP GAS SERVICE AGREEMENT 35 GREAT NECK ROAD (l(,C UGJ (i �y1 //infcf WATERFORD,CT 06385 t(} / +lv t'L V c 1 t _ic,4 443-5337 TYPE OF 11 SCHEDULE t. CUSTOMER SERVICE j"�u L1"— NUMBER i NUMBER ��, THIS AGREEM,NT, THE TERMS AND/CONDITIONS OF WHICH ARE PRINTED ON REVERSE MADE THIS / DAY OF ©c'fio"� 19 9b ,BY AND BETWEEN THE HENDEL'S PETROLEUM CO.,("COMPANY"),AND NAME �Oti�/IA 14— ClUn-LL S (CUSTOMER) LAST :,,,, (RnT� IDDLE NAME 00 U 111.- ,J(AS1/$) k. 3S- 8/+ gkair _z INSTALLATION ADDRESS K BOX OR STREET TOWN STATE ZIP CODE PHONE 0. -.. y MAILING ADDRESS Q BOX OR STREET TOWN STATE ZIP CODE PHONE W g.,*" 0. PERMANENT ADDRESS BOX OR STREET TOWN STATE ZIP CODE PHONE PROPERTY OWNER'S NAME LAST FIRST MIDDLE NAME PROPERTY OWNER'S MAIUNG ADDRESS BOX OR STREET TOWN STATE ZIP CODE PHONE CUSTOMER . EMPLOYED BY �'�-t-,is tO I ADDRESS NOTICE: SEE REVERSE SIDE REGARDING YOUR RIGHTS NOTICE TO CUSTOMER:(1)DO NOT SIGN THIS CREDIT AGREEMENT TO DISPUTE BILLING ERRORS. BEFORE YOU READ IT OR IF IT CONTAINS ANY BLANK SPACE.(2)YOU AR ENTITLED TO A COMPLETELY FILLED IN COPY OF THIS SERVICE AGREEMENT.KEEP IT TO THE HENDEL'S PETROLEUM CO.("COMPANY") PLEASE PROTECT YOUR LEGAL RIGHTS. I SIGN GAS/, iCE AGREE'ENT� /C --`� /J -7) HERE ,CIJSTOMER! {ir��'(�f-�S� J�� BYCEPTED (/�,{,Q /�7 4- ��C r�O /t '/DISTRICT MANAGER SOCIAL SECURITY NO. DRIVER'S UCENSE NO. INSTALLED EQUIPMENT-INMAL WHETHER COMPANY/CUSTOMER OWNED /4C. INSTALLATION FEE OF $ PAID BY PROPERTY OWNER TENANT ❑ co. cus. ITEM MFG SERIAL YR. NAT BD DOT Le OWN OWN NO. RLT. NO. DATE SECURITY DEPOSIT OF $N/ PAID BY PROPERTY OWNER. TENANT 0 CONTAINER DATE P'R/T�MISED DATE SCHEDULED SIZE Ib/Gal /U ( 0 . `J 7 CONTAINER /!( APPLIANCES SOURCE SIZE lb/Gal DATE INSTALLED TYPE MAKE MODEL CO OTHER - SIZE CONTAINER lb/Gal 5tf O CJ(42 a0 METER MODEL# Y Y 64,5` wGS WrP REGULATOR MODEL L^nCr) { # READING �f 1 C �� + (�-4 V C REGULATOR DEALER MODEL# INDEX S'/,r, -c) N I I I I I I I I I 144I I MAP OF AREA I I I 1 1 II STRUCTIONS: / 1�J'O CA//ate W E T T 7 -r-r-T-T-T-T-7- 5 I I �'I I I I 11111 ry-rA�Z -7;0„I I -r-r -1--I 1--I--r-r-r-r-r-t-7-7-1- I 1 I 1 1 1 1 1 I 1 1 II III I --I-1-I-I-I-I-I-I-1- --I--r-1-1 r-I-i-I- ----------------------- I etuv c7roi (-ins[: /RC2. oLC-5 /O6'/19/ --I--t-i--t--+-+-1-1-1-111111111 1 1 1 I 1 I 1 I I I 1 1 I I I ILI _I I II II I I I III I I 1 I 1 ��uvt Av1G k/!V 0 L7/ / 5 __L_LI -1I- �I 4-- --J1L L L L 1 1 4 4 -I I I 1 I I I I AlG . - -� _-1-J- 1I- L L L 1 1 1 1__IL-I -I I I 1 I 1 I II I I I I I I I I 1 .J __L_L_L_1_1_1_1_J_J_ __I__L_L_L_L_L_1_1_1_J_ I/ 1 I I I I I I I I I I I I I I L L L L 1 1 1 J I I I L L L 1 1 I J SUBMITTED BY �L ' '.a I I I I I I I I I I I 1 I I EMPLOYEE OR AUTHORIZ tESENTATIVE I 1 I I I i I I I I I I I I I I I I i I 1 1 1 I I I I I I 1 x 1 I I I I I I CONTINUED ON BACK OF REVO CARD 1 I r T I 1 I I 1 1 -( 1 1 1 1 1 1 1 1 1 SYSTEM TESTS --i i I i -� I r-E-T. � I I OPERATING PRESSURE-FULL LOAD WC --r-r-r-r" TaaiT' f-'Y'T1 --1--r-r-r-r-T-T-1-7-- I 1 1 1 I I 1 I II I I I I I I REGULATOR LOCK UP WC --r-r-r-r-r-'T--1-1-1- r-r-r-r-t-r-T-Y-1-- r 111111111 III I I I I - �,,,--I--1--r-t-t-t--1--1--I- -r-1--1--r-r-t-t-t-t-1-- UNE LEAK TEST-START WC _. I I I I I I I I I I I I I - I I I 1 --r-I- I -I- I -+I -+II-+I-1I-1I-1I- --I-I -1-I -I-1 -II--i--tI -+11 -+I-t--tI-- AFTER 10 MINUTES WC SIGNATURE OF CUSTOMER DATE 1 1-I F-HI -+-I -}1 I I I 1 I-}-{-{-11- I I--1--1F--I-I -1-I -{--}I -11 -+I--1I-11-- 1st STAGE LEAK TEST-START PSI 4- - 'I- 1- 4- 4- -I- 4 4 4 4 I- I- I- I- I- 4- 1 4 4 4 111111111111111 IIIII AFTER 10 MINUTES PSI SIGNATURE OF INSTALLATION MAN _ L L L 1 1 4 1 J J I L L L L 1 1 -41 -I1 1 i I 1 I I I I I I 1 I I I I 1 . ,. I 1 I I -I 1 1 1 1 1 1 DIY I I 1 I I . 1 ,o ..TIME ARRIVE :_ LEAVE ,.. Gc ,. ,„ . t/e) rrfi • ,..„. ,,,,:_,:„ , ,,,,,,_„:„__4---_,,'„,ii,„°,,,igki,'- "= ---`-„;1' F ! g �.., w 4`,„„," 0. a , •. fir' 1:7',.:,#1:::''[.., �'Yb �'� " £ > € k r Y 'AA "." v r, p of • iii r tel[ r . ; x • • .4„,...,, ''''',""411, ' - ,10111re, -*---,i.,, ` .----.. ..-7. -"-' '- - -- - — - ' ,,.. _ _ ..- IZ ,F ' » z �. � t w' .' y