Loading...
HomeMy WebLinkAboutWater Heater 2013 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: M2013-0160 Date: 25-Sep-13 Map/Lot: 103/009-000 Owner ID: 5570000 Project Location: 52 PODURGIEL LANE Unit: Job Description: Install Indirect Water Heater Owner Nam Annette Barbay Tenant Name N/A Careof: 52 Podurgiel Lane Uncasville CT 06382- Telephone: (860)848-1481 Applicant Name: Allan Wells Telephone: (860)271-2020 DBA: DDLC Energy Lic/Reg Type Si Lic/Reg No 303006 410 Bank Street Exp Date: 31-Aug-14 New London CT 06320- 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 $2,880.00 Mechanical Fee $36.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $2,880.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: 50.00 Comment Plan Review Fe $0.00 State Ed Fee: $0.75 Total Fee Paid: $36.75 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 19 Certificat- of Approval A - f•.te of Occupancy Building Official's Approval: y____41_, " 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.: VA,ao1.3-U1(. Type of Work Occupancy Type Permit Type ❑ New Construction 21 Single Family ❑Building ❑Addition ❑Two-Family ❑ Plumbing g ❑Townhouse Mechanical ❑Accessory Structure ❑Electrical CRS#: Property Address: J_ 121 dL4r"z.0 "-1 i e.1 -- (Number) J (Street) (Unit) Job Description: i 1, ,�,cA,i cc fk J ui VidiX Owner: , A.)E t i iQ FIOCJ Address:1 g- C�� � � � <1 14 I /L City: £\tJ(I'-- 1. i '1�' State: 4-: Zip Code: Telephone(AIC)) - 1'{6 Applicant: `(A Vi\O&S DBA: D 1) LC. C-I) Address: 1416 6A-k= City: N qt..,) State:C2 rZip Code: C;(:-). Telephone(NC ))cal Contractors -Complete the Following: License Type: (j`( License No:3(D300( Expiration Date: F-3 L —1 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. Fd By 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 of the Residential Code. Owner/Agent Signature: 'l`' J,�?k... " Date: Ci` j ""I 3 Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: / 98O C)4' Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: 4Zgvised August 23,2007 Town of Montville Building Department File Receipt Date: 23-Sep-13 ReceiptNo: 8809 Received From: Connecticut Permit Services LLC Job Address: 52 POdurgiel Lane Town Fees Collected State of Connecticut Fees Collected Bldg Cash: $0.00 State Cash: Bldg Check: $0.00$36.75 State Check: Bldg Credit: $0.75 $0.00 State Credit: Fire Cash: $0.00 $0.00 Fire Check: $0.00 Fire Credit: $0.00 Construction Value: $2,880.00 Demolition Value: $0.00 CheckNo: 3559 Received By: Carmen Kneeland C Nionlimiimm Address: 52 Podurgiel Lane ITEM QTY $/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA Basement,Finished SF $ 41.96 $ - Interior Renovations SF $ 36.09 $ $ AMENITIES Kitchen EA $ - _ Full Bathroom EA $ $ - - - Half-Bathroom EA $ -$ $ - GARAGE Detached SF $ 71.53 $ - MECHANICAL Warm-Air n Y/N $ Hot Water n Y/N Electric n Y/N $ - Air Conditioning n Y/N $ - $ - ELECTRICAL SERVICE Upgrade Amps $ Subpanel EA $ 699.00 Gen Set EA $ 3,850.00 $ $ - SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 6,497.70 $ - Masonry w/1 fireplace EA $ 7,096.65 $ - Masonry w/2 fireplaces EA $ 11,095.70 $ - Wood Stove,free standing EA $ 2,692.25 $ - Wood stove insert EA $ 1,859.77 $ - DECKS,PORCHES,SUNROOMS Deck SF $ 44.07 $ - Porch SF $ 149.38 $ - Sunroom SF $ 176.90 $ _ POOLS&HOT TUBS Hot Tub EA $ 8,01625 $ Inground Pool - EA $ 31,550.00 $ - $ Above Ground Round EA $ 6,299.46 $ - $ Above Ground Oval EA $ 7,019.75 $ $ Pool Heater EA $ 8,984.25 $ - $ Inflatable Type Pool Eq $ $ 1,200.00 $ - $ SHEDS w/o electrical SF $ 25.55 $ w/electrical SF $ 26.85 $ $ RENOVATIONS Roofing,Overlay SF $ 3.50 $ - Roofing,Strip&reroof SF $ 4.50 $ - Roof Sheathing SF $ 1.51 $ _ Siding SF $ 6.75 $ Windows EA $ 550.00 $ Skylights EA $ 1,051.10 $ - Doors,Exterior EA $ 601.50 $ - Oil Tank,275 Gallon EA Oil Tank,550 Gallon $ EA $ MISCELLANEOUS CALCULATIONS $ 2,880.00 TOTALS $ $ $ 2,880.00 $ _ PERMIT FEE CALCULATIONS Construction Value Fee Building $ $ - Plumbing y $ $ - Mechanical y $ 2,880.00 $ Electrical 36.00 Y $ - $ - Working before Permit Issuance n $ Certificate of Occupancy Fee $ Plan Review Fee $ State Education Fee $ 0.75 TOTALS $ 2,880.00 $ 36.75 Figures are based on the 2006 RS Means Residential Cost Data * * DDLC ENERGY Your 4-Season Comfort Company DATE: C . ►d 3 `(3 TO: MOVIE VII I SPi ATTN: Town Building Inspector RE: PERMIT AUTHORIZATION LETTER Dear Sirs: In accordance with Public Act 91-95, this letter serves as written authorization and notification that Connecticut Permit Services, Inc. and it's employees and agents have the authority to represent us in the procurement of permits and pertinent documentation on our behalf. This letter or a photocopy thereof may be regarded by any building official as it's authority to recognize Connecticut Permit Services„ Inc. as our authorized Agent to sign on our behalf applications for permits and any other related documents that may be required by you, and we agree that, for all purposes, we and not Connecticut Permit Services, or it's employees and agents shall be deemed to be the signer of any such applications and related documents. Project Type: tA s4- J Location: Ubr y 5_; f aU ur 1z' U -fes GT ( & ) eyr- ' -i&i Authorized Agent Connecticut Permit Services, Inc. . /41(A,,y (k) t is Service Agent Name Very truly t of-wd hnssn 5) -363066 ice :ee Signature Printed Name & License Number Sep. 19. 2013 10: 20AM No. 4598 P. 3/5 t , ,. LDDLC Energy �dd�� 8,50.271-2020 r. ra • f; ;�` 410 Sank Street E I . New London, CT 06320 �� Fax: 860-271-2050 ?^ ‘,e,„ . NE R GIY CT81-303006 and RI-PM 3386 HOD#0000385 JOB NO. 3Dr- OIL ACCT.NO. J1kI, `1s. ,NT.ACCT.NO, ? '---) Appllaanl - - - Co-Applicant Name f Prnit-e stn ‘ny Add„.- I l70 Acdresa city,Stale,Zip , City,Slate,Zrn Email / Small Phone.S• Work Fhanell s I? onel Phones i Work Phonek Cell Phoned' ' ` Payment Options: Credit Card Issuer 0 American Express 0 Discover 0 Master Card Ci VISA LIPersonal Check or Money Order r ❑Boller Qty _ Medal# CI Oil Tank Qty_Model if 0 Furnace/Air Handler Qty _Model i Q Humidifier Qty_Model d O gond arise rrHeat Pump Qry Model B D Chimney Liner Qty_Model ft _ , (914/ate k+loal a rilrldfreCt Qrx. Model# L G Qeneralor Qty..`Model if O ANC Coq Cty Model# 1 D Maintenance Plan Exp, Scope of work:(attach eddlitchal description and/or dravringa Ifnace eetry) Cneckbox Il additional peg e(s)were used io describe work. Ill xpg, ",,,,_ .1,17-4o a I�¢ /vim. l , r 0.1-1/4— . L ;r !,,,_ f,"',�c,� le 4', /�ct ..�� ---i 14.0 Z /(GS.�Y, /�, Ci ri/ -z: .p. r . .. ._.�'S/-,�, • -- YC c S .ei-}0''v=^ei, %fes� et/5,-- ji.�c''G- /4-0 �7y 7.""),•-•'/- 0 it ''66 r---- • Installation may nc,ude necessary local Iced,Ilcanses and permits relative to thin proposal, , Replacement of the healing unit viii be performed alrerAsbeslas has been removed,st Buyers THIS QUOTE IS VALID FO 1;THIRTY DAYS FROM9/I'/�� nd expense,by a licensed Asbestos removal contractor,and disposed cf in accordance with1.Ins(al:aitcn Total Cost $, C��5 kO —yfr,_ government regvlatlon5.Price does not Include Asbestos remove/. * _(InItlals) 2.Disposal Fee g ` IJSI - Any fimI1911cns of existing ductwork system le the responslbIlhy of the o,vner/ nplais) on 3.Total Inetallsllon Cost $ . 8‹. !e-) Fcr vatuabfe cons:derawon received,Uwe Lite undersigned do rereby obsoNmly end un:an1i1cnaii gedrenieo,oa on Ind ldualta),peyr vont cl ony Indebledneaa Irroxred by vlrluo or any end all(rent - s),Down payment d - extended In accordance{fid,the�Urfn agreement end ell of Ns terms end cotWitione,The underotgned F y � �d 0�� consents le HOP Energy oolaWNrtg a Consumer Credit Repel l on Apollearl end/or co•epp9cant for the our a _ pose of evoidadno Ihr credit narUuneoa of xppircanl end/or uo•applfCenL In connection**ill)an 5.Amount Financed $ opp4calbnoforeda Theemountofac�lproAdedtonwbnsour behalf 'Zs', NOTICE TO BUYER: 1.Do not sign this contract before you reedit orlf II conlalns any ,5,Arnounl of Monthly Payment . $ DC a "'1 P blank space. 2.You re entitled to a completely(fed•In copy of the contract when you sign II.3. Under the law,you have the Iollowfng dip's,among others: (a)to pay o:1 to ad. `7•Number of Monthly Payments $ CJ`.-v,-- Vance the full amount due end obtain a partial refund of any unearned finance charge;(b) to redeem the property it repossessed fon a default:(c)to require.Linear certain condhlons, 8,Total of Payments $ d i) / , a resale of the property If repossessed.YOU,THE BUYER, MAY CANCELThe arnouelyovwill hove paid tvhanyouhave THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF made ell scheduledpayrneote THE THIRD BUSINESS DAY AFTER THE DATE OF THIS Each Payment Due on(date) CO days after billing TRANSACTION. SEE THE ATTACHED NOTICE OF ' Payment Schedule starling on 30 days alter billing CANCELLATION FORM FOR AN EXPLANATION OF THIS p _.a' % RIGHT. You ecknourledge that Seller has delivered ormafled to you en executed copy of g•raa n y airy oSaentage Hate Ihta cool act. ..__c-2$ .--- 10.Kfnance Charge $ t/we hereby accept the terms and cons tons of the proposal as srl for the above and on the The Doris:amount the credit win=tyeu as reverse sluee dl the eh el,all of lyhlch Uwe have read and agree la be bound thereby. 11,Total Sale Price $ 21 $gyp %i s Apollcartt"� yv�, 1,, �� Dale l_ 1 The Iola)phi--a of your purchase on credit. enaudang your done payment CoAFPhcanl �. Q I Dale q '� Print Name Appllcartt4 Ain Gl7l e 1 a J k Date S Aepresentailve A 2: �C• ala_/ /Cs�f� Co-Applicant Dete • Bea° r i I a, 4 L - �,.1, r� - Date ,/3 t wwvr.DCLCEnergy.ccm J C57-9,6.10 ..• : • • j'' ,5 •-.,; • !{ay,^�• tl g'c.I.�:,,.1 B t g g. ® Y' INSURANCE q tea' 'f' DATE(MM/DOVYYYY) • /•• 2 /2012 : •,'••• #: - •;;:.;.••: ; ' . " ` THIS CERTIFICATE•IS iSSUEDi^A 'AMATiERsOFINIRMAT1ON-OgEN•% iiiitONFERNO�RlGHT3,' POPi.TNE�CER71FiCATEHOLOERTN1S°-:CERTiCAE:DOESVOT=:1FFIFhlAT1VLE,L'YaOR NEGATriZEY;%A.MND;'EX:ENDbOfALTER£7HE•COVERAGE•A'FORDED:BY TfiE•POLICIES:'.BELOW�:iiTHiS CERIFICATE OFINSURANCE:DOES.NOT:CONSTi7iNT*i6ONTRACTBETWE$ „THE,:ISSUiNG:•INSURER(S), AUTHORIZED • • :REPRESENTATIVEfOR'PROD7CEA1l)TNECERT FICA1E_HOL:DER••' • • •:1-•-'•:r ' IMPORTANT: If tiie'certificate:holiieYJis:an=ADDITIONAL•INSUREDy:ttie.pblic}i(les),rriilst'iia=eniforsed:.11SUBROGATION.IS:WAiVED,subject to the terms-and•condltioris ot.the_pollcy;:certaln:poiicles•may fequlre.ari<eniloi'semont_':A•etatetnent.on this certificate doos.not'confer rights to the •certlficate•holderdn•lieti of such endorsement(s),,. . . . . PRODUCER . CONTACT • ••:PG Genatt Group LLC • . 'PHO E. '• X 3333•NEW.HYDE.P.ARK RD `:E•MAIL FA • HQ• 11:516-869-8788.' . I tA/c;Na1:1-536-70&18,97 • SUITE 409 ' . • •:A DF-.5 . RF-.5S: . - _.• • . NEW:HYDE`PARK NY 1.1042• • ,INSURER/8)AFFORDINOCOVERAGE . • NAM c . '.*::iNSURERti•:FIt t.MeroGiyin L rance'•Compen - 0657 - ;'.:. INSURED • wsulieRg iraiisFortatlori:lnsurartCe•CO.. • 0494 • Hop Energyy.L•LC ' ' ' •INsuiiFJt c$tarT'indemriltSisSeLiabilityCo •- - • . 8318 AutomaticffLC. • •• •irisuiIsz - ' . ''e: • • - 0508 4 West:Red.Oak,L'ane r • White•Plains•NY;10604 • • • • '•:;•INsulIEE;E:MagsaChusutta•Workers Compensation • •. - . . INSURER F:' • • . • . . . COVERAGES:: • .CERTIFICATE NUMBER:7.24198480:.,, •., 'REVISION'N(:IMBER: • . THIS. :IS TO•:CERTIFY THAT THE..ROLICIES.OF•INSURANCE.LISTED:BELOW-HAVE.BEEN ISSUED'TO THE 1NSURED•NAMED-ABOVE FOR:THE POLICY PERIOD •. 'INDICATED,•NOTWITHSTANDING:ANY%REQUIREMENT,TERMOR CONDITION;OF`AN`I•CONTRACT"OR-OTHER;DOCUMENT•W(7H RESPECTTO WHICH THIS • • .•CERTIFICATE:MAY:BE,iSSUEDD,,OR',MAY:PERTAIN; THE INSURANCE?AFFORDED,'DY•THE;POUCIES;;DESCRIBED,HEREIN.iS'SUBJECT;TO ALL THE TERMS, • ,.::••:": .::EXCL•U510N5'AND{CONDfT10jdS;OFsSUCNPQt�ICIES'LIMfiSSFIO1M�f•MAYRAVE;SEENREt5l10ED:BYPAID:GLAIMS. INSR •••••- :• •• . ,: --- •••Po(JCY aFF..,•0'POUCY t7(P,• TYPE.OF-INSURANCE;' _ , ,.ss, -. , r:'POLICY NUMBER:••:'.. ••Al .. LIMITS •. _ -::.';`; :":•:'.'•: ,.,...uu. a sins • •' A.%�4:EEIiERAL•LIABIUTY.•'. ' • " ;':';MACGL000001,890801 10/27/201 .::: 0/27f26„:13'';••••;EACH OCCURRENCE, Si 000;000 ''•X;' •COMMERCIAL•°GENERAL:LIABIUTY,°• • . • • - • .PREMISES.(Es cociaiente).,_''•$50,000,. 'CL•MMS=MADE•I :OCCUR...::•-• •• • .'• , - MEb:EXP IAny" P )`• oris ereon S:. • X • SIR:3100:000._ , - . . '• HRS6NAL,BADViN3UR1',.• S11000,000, •' • •• .. .. GENERALA0J3REGATE". : :52,000,000: •• . • GEL AGGREGATE UMiTAPPLIES-PER: • PRODUCTS:COi.1P1OP1AGCI:..$2 000:000„ ' •• POLICY'n PFO .n LOC. ... � • S • 8 AUnOMODI E LIABIIJTr • BUA208344198 • 10/27/2012 0/27/7013• ;i .azldenl ..„• UMIi ' i 000 000 ' X : ANY AUTO BODILY'INJURY.(Perperson): :•S•. . ALL OYVNEti' SCHEDULED •'13ODILYINJURY Perecdden ..S: • AUTOS _'AUTOS I _ HIRED AUTOS. — AUTOS• V�TIEO PRePE dTYOWMAGE :S •:. • _ . . . • • • S • C X UMBRELLA LIAB X OCCUR - - SISCSEL01841412 • • •10/27/2012 • 0/2712013 •-EACH OCCURRENCE • 34,000,000 ; • EXCESS'LIAB - 'CLAIMS-MADE " . AGOREGATE:.• $4:000.000 • DEM'X r ;RETENTION S10,00D _ • .. 0 • . .• D WORiCERS:COMPENSATiON ' :WC2098344a93' 10!7/2012, 0/27/2013•'•:)C'• ^4UCSTItTIIs kli:7f{- • . E AND EMPLOYERS'.•LiABILITY • YIN - .TBA • , • • 10/27/2012 • 0/27/20131- ' TORY LIMITS FR 'ANY.PROPRIETORII'ARTNER/EXECUTIVE EL:EACHACCIDENT: '-:,$i,000,000:. •• •OFFICER/MEMBER•EXCLUDED7 v '.n N/A . • - • }•(Manda(orytn•NH)" • •~. •E.L:.•DISEASE.•FA:EMP.LOYi41;000,000• ' '' • :. II yes:decnbe eunder- • _ :••,S'• ;• DESCRIPTION OFOPERATIONS'belov/ • .• _ .. _ . • . ".•:ELIAstaSE..POLICY.LIMIT '$1,000,000' - •• DESCRJPTION.OF OPERATIONS/LOCATIONS! HI VECLES,,(Atach'ACORO 101,AddUonel Rene,ke$cheduise If mere spool Is required!' . •• CERTIFICATE HOLDER' IS.ADDI'TIONAL'INSURES.AS=RESPECTS'•LIABILIT,Y:COVERAGE:AS,JRECQU;RED, 1BYYWRITTEN-CONTRACT ' `'•' • • '•.•: ;CERTIFICATE HOLDER„ , . : ' : :•: CANCELLATION . .. .: ' - • BHOULD•ANY-OF.I•NE•ABOVE'DESCRIBEb POLICIES BE CANCELLED=BEFORE;:` •:THE.=EXP.IRA710Tt';DATEtTHEREOF,:NO ICE•WILL- BE DELIVERED' IN %,. ' ACCORDANCEWITH T13E FOLICY'PROVISIONS. • • : %{�U,7}iOR. '.REPRESE!•jjj►T)VE•. • • . . . .. .. .. ,.... • -• :=©:1988-2010•ACORD CORPORATION.-All rights'reserved. •:::%ACORD'•26(2010105) • • The:ACORD•name_arid:logo•are.registered;marks�of'ACORD•• , Aug. 30. 2013 8: 15AM No. 4339 P. 1 .'i.L.02 Rev 09/03 3830:13 STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION 165 Capitol Avenue • - Hartford Connecticut 06106 Attached is your license. Such license shall be shown to any properly interested person on request. No such license shall be transferred to or used by any other person to whom the license was issued. liar questions,please contact the Occupational&ProfessionaI Trades Division at(860)713-6735 or email dcp.occupational ofessionalecc,gov. Visit our web site to download applications and verify licensure at www.c.tgpvJdcp. S'11A'1'E OF CONNECTICUJ' UEI'iLI flII;11'T CII"CONSUMER PROTECTION • FIEATING,PIPING&CQ Q..LiNg•j7NLIMf1TECi CONTRACTOR ' RICHARD M JOHNSON JR }. i 243 TIMBER TRI, �,,� J {` 1 Iuc�>�.M oxrYs�t�' R ..�43. t• PABi ltYl`ps EAST HARTFORD, CT 06118-3583 i EAST IL Cj I 1 •'6113-3583 1 LIC.I REG NO, •. :',EF,FEdrIVEa:: : •,• •, EXPIRES l-x'1'G.0303006- if I.09�01/Z0 3 ' f...•.. 08/31/2014 rr/,_P1 •••sy SIGNED ��- { :,.,.p_ .:ry •�.1k.r ,�.^c�•� .Fi`css6•I• :Y,�,`1�...d. .`V,;:; ��,�.re.0+;, •{�..'1�.n��:r,:`..•�l/.::f,.`I';r '•V.. b�•1�.•' •'•I •ary:•V'• ',•Y, :\V. ',{i_. •�{.•- 'yr.. •c,:"�•4`•'ir 5.. .:Sr7....1:. f•yah• ., ;: :•?Fi�.f V-.:_d','•% .{•` '••..a. •ri.�r,r•.t •. ..ki.'s •s. f ,r. .ta�'. .{. .,f h .,,�,r gas .o-. •5%;i� q xl•. ,'�".�. .SS :':a 1 „Q•d. _rf• �.: .i 'b' 3:•, w..,�:.5•c°"':•;•.�. . :•�5•;`'.a :r�•h` `:; moi:::_' •:.: ;•rt_ :•£••: •.n�. ,.r�:�.•,,.:�5;1'ct`•`:'�..t. fir:•. .,;,. ,�...:K�i?•£,,•.h., .N...n:!'te ..s,,{{"��'::•:.1°{':..ti;. ,F.r.,�..•.�1.a... .a ,...•�a ,,�1 ..f `..I'�• , :'�f°•:r::< :�,.. •:'>t.•:...s,•� .s�R`r�;,. :.�r�Y. :§,. ..l...?_ .:,.t,• .:Z;,:,iY• :t;, .�i F,,v. Y :.,5*, � ,.R�•:AMl�s�i a;: s.'�'+t;,.. •. %2i#i::. •:a:x:E:>: "•�:» ..�%, ( `T..:: •••r•':<:•>'r. :r.8•�. • �4 r k,.a `1 :... .2 ✓.• aSh i'��?.v.+Y�•.`�y„�r�,.3`?`•.F.�':�\�i,F,>t:.:R � _ y y, y j'%�r:r j� t::PS+^� yy, �:�•� �r,4,TY� .::If�: ,frr S, p y . __w•1-, b•�e� ll..s^ ��f�4. .i':Pr ro':1:, '.•p7f^:; • 2/ :, i�!�'r Nii i;•i.• •:1i ixf �'r.G,. g.,:,. ,y;�. _'tS:/�X11` /�'�'�',�” '�',+�'_ �'..- -�- -'� --" STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION �`:3 y Be it known that -:� A .'�� RICHARD M JOHNSON JR . • s ,. , 243: I �. R R : .4. EAST O"�` R. I�. 6118-3583 tfIt ..f.i:j 't``.> .t.,... , )\ 1111"b:::1 ' t:,..;::::,, , ,:-.1;6! 1F �, r � j..,�i h' has been certified by the;0epai .A r gond Fier Protection as a licensedtow . '•-ik , , ter. , ; .�' HEATYNO PIPZN 1�.. ; (.�.: -G r I� Y {ED CO • ?'.,,:•r `Qui... ,, ,vg 1,--- t:,,$ `, License :.:=U 303006-S1 R 7...1,.•� `� Effective; 09/01/2013 --.•,...- P.-'S cA, - 08/31/2014 :.:: Expiration.:. K • r . — c s{ ,Conimissionc _ _— win*.M.Rub a`will, "�'' '• II• 01/04/2013 11:15 FAX �/ uutiuul . ■ YCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/25/2012 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 CONTACT NAME: PG Genatt Group LLC PHONE FAX 3333 NEW HYDE PARK RD INC.No.Exn:516-869-8788 (A/C,No):1-516-706-1897 SUITE 409 ADDRESS: NEW HYDE PARK NY 11042 INSURER(S)AFFORDING COVERAGE NAIC0 INSURER A first Mercury insurance Comm 10657 INSURED INSURER a:Transportation Insurance Co, 20494 Hop Energy LLC INSURER C:Starr Indemnity&Liability Co 38318 DDLC Energy INSURER D:Valley Forge 20508 4 West Red Oak Lane White Plains NY 10604 INSURER S:Massachusutts Workers Compensation INSURER F: COVERAGES CERTIFICATE NUMBER:1166695423 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY MACGL000001890601 10/27/2012 10/27/2013 EACH OCCURRENCE $1,000,000 AGE 'O RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 CLAIMS-MADE [X I OCCUR MED EXP(Any one person) _ $ X SIR$100,000 PERSONAL 8 ADV INJURY $1,000,000 I GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 7 POLICY PRO- PRO-JECT LOC $ B AUTOMOBILE LIABILITY BUA298344188 10/27/2012 10/27/2013 COMBINED SINGLE LIMIT ' (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( _ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS $ {per accident) $ C X UMBRELLA LIAR X OCCUR SISCSEL01941412 10/27/2012 10/27/2013 EACH OCCURRENCE $4,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE _ $4,000,000 DED X RETENTION$10,000 5 D WORKERS COMPENSATION WC2098344093 10/27/2012 10/27/2013 X WC STATU- x OTH- E AND EMPLOYERS'LIABILITY Y/N TBA 10/27/2012 10/27/2013 TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NI-I) E. If yes,describe under L.DISEASE•EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 TOWN OF MONTVILLE ACCORDANCE WITH THE POLICY PROVISIONS. 301 NOR-NL TPKE Uncasville CT 06382 AUTHORIZED REPRESENTATNE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) 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. 5._A e I Property Address Job Description Required Department Permit Issuance Approval Approval Tax Collector apc &L r � \a`�� Signature/date Comments: Planning g & Zonin -� � � 3T7/(, Signature/date Comments: Fire Marshal (211(— l9 Signa to > Q Comments: I ✓. , F/kk [ Health Department Required for properties with private septic or well Comments: LJ WPCA, Administrative Required for properties on sewer Signature/date Comments: I WPCA, Operations When Required by WPCA Signature/date Comments: Fl 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 Revised May 2.3,2011