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HomeMy WebLinkAbout100 Gal. LP Tank, Line and Fireplace 2006 Field Inspection Notice Town of Montville Building Department January 3, 2007 Address: 22 Pheasant Run Job Description: Gas tank, gas line and vent free fireplace log Permit Number(s): M2006-0255 Permit Date: 28-Dec-06 INSPECTION Not Approved Approval Date: Deficiencies Special Date Conditions Gas appliance 1/02/07 DJ • Gas line • pressure test 1/02/07 DJ • • Certificate of • approval 1/02/07 DJ Rev.Date: 1/18/06 Pape 1 or 1 F • 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: M2006-0225 Date: 28-Dec-06 Map/Lot: 028/005-060 Owner ID: 5464000 Project Location: 22 PHEASANT RUN Unit: Job Description: gas tank,gas lines and vent free fireplace logs Owner Name: Robert E and Patricia L Benda Tenant Name: N/A Careof: 22 Pheasant Run Oakdale CT 06370- Telephone: Contractor Name: Mark Martin Telephone: (860)859-9070 DBA: Advanced Gas Lie./Reg Type: GI Lic/Reg No: 386875 183 E.Haddam Rd. Exp Date: 31-Aug-07 Salem Ct 06420- _., 6420- _ __.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 Value: $525.00 Mechanical Fee: $8.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: IRC Total Value: $525.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.08 Total Fee Paid: $8.08 It shall be the owners repsonsibility to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING, MECHANICAL,ELECTRICAL PERMIT INSPECTIONS ❑ Footing-Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical ❑ Backfill-Footing drains and waterproofing ❑ Elec Trench-with conduit installed ❑ Concrete Slab-Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor framing ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble 0 Gas Piping and leak test LI Fireblocking_Draftstopping INSPECTION REOUIRED UPON COMPLETION ❑ Insulation Mc C-•' -- ofApprova ■ certif.' to , c ••panty Building Official's Approval: a Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.:L� Type of Work Occupancy Type Permit Type NNew Construction I$"Single Family 0 Building Addition ❑Two-FamilyIV Plumbin 0 Alteration ❑Townhouse g Mechanical 0 Accessory Structure 0 Electrical CRS#: Job Address: o�o�_ V SE r A K kl r v 37 (Number) (Street) (Unit) Job Description: . Sm,( Dl .S �( ✓I f'S 11 c� \M +fie �-s ct acP eQ. GS Owner: (�,0 1-- Vkyt,0 S* ta., ' 'Or)LA Address: a P ( A U�V ,iv City: W lJl")l:� %a°b State: (` Zip Code: 06316 Telephone: qQ v ` D V —� - lAJ7/ Contractor: )(VI nlZA 01 IN1211 M DBA: k4 ► I0 eA) G4 -S Address: t 0,_ t Rik Q 0 1 ' r l 04)va City: ,'f State: CT- 420 �( ,1 Zip Code: v5� Telephone:u1QV gSq-q CT) License Type: License No.: 3%g7S cO 3/ 91_,,,, xpiration Date: 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. 0 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: / fr� Date: ( -- I%-oZf)D(o • Construction Value Permit Fees Building Value: • Building Fee: Plumbing Value: Ca S- ( -� Plumbing Fee: Mechanical Value: • Mechanical Fee: Electrical Value: Electrical Fee: Total Value: ,6- , 6-"k- Penalty Fee: C of O Fee: Plan Review Fee: State Ed Fee: Total Fee: g,Q *visa December31,2005 vimmomii • Town of Montville Building Department File Receipt Date: 27-Dec-06 Receipt No: 1965 Received From: Advanced Gas Job Address: 22 Pheasant Run Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $8.08 Check: $0.08 Check No: 10536 Short/Over: $0.00 Construction Value: $525.00 Demolition Value: $0.00 Received By Sandra Pandora ADVANCE.GAS 183 E.HADDAM ROAD SALEM,CT 08420 SALES & SERVICE Telephone 880-859-0070 Fax 880-889-3827 MU) n O-c 1an-i-U t BUILDING DEPARTMENT RE: BUILDING PERMIT APPLICATIONS • PROPERTY ADDRESS: a Ph Pn Salth eun_ niqK 68, cr 063-20 OWNER: &(t- (Ath3 Pr C-1 I- (DA DESCRIPTION OF JOB: 1s1 bG- L-L Pro ry „w QS x,40 k, las it C nd Ve �,+ • c6 a.s 1/4-4-tr tae L S STARTING DATE: la fag Deo(P LICENSED CONTRACTOR: MARK MARTIN HTG.386875 ((,, LICENSED CONTRACTOR'S AGENT: Q.ki , 7-, A PLEASE ALLOW MY EMPLOYEE TO PULL OR DELIVER THIS PERMIT. Sincerely, STATE OF CONNECTICUT ...� DEPARTMENT OF COQ'SUMER PROTECTION HEATING,PIPING&COOLING LIMITED CONTRACTOR G1 MARTIN MARK A MARTIN PRESIDENT 67 FORSYTH RD SALEM,CT 06420 LIC./REG NO. EFFECTIVE EXPIRES 386875 ,;,09{01/2006,,,x, 0 /31/2007 SIGNED '' • • - _... ADVANCED GAS SALES AND SERVICE 183 EAST HADDAM ROAD SALEM, CT 06422 860-859-9070 FAX # 860-889-3627 . . .. • '.. ---- --•• - ..ix......•'.','44.1:- ''"A"rt.:.0rok;.i;?,i. . 0 ?-, 'N .• ..-........--...........-.......——-....-..---..- '''"-,-;:....tr..''..'4,.•L''.-'-'---' - ' .-- ----- - - ' t 't.• - ' t •".•• 1•• ••••-••• ',V.:6,',1".....Ny...,,V.,..f..:m..''.1,77:6•74.x...:Ntr,:;;;:xf,v, - tf-•7."•••'71•'•7."".7 `fr..7.'•;,••'17.:.7.:67.7.•..NY.a..y...;.-r,P%;:.;,..•`• :4"*:•:.:,..:-":1:1Xx.:..,•.: .:Ip....:.:;4., ..;40......1,,. 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',i ' HEATING,PIPING&c•pol,agq LZAREKED CONTRACTOR 1 60 Ittig,,,12tPt: 841,EM,•mi;06420--i\ ',• *K-- "5.. •,,,, - .),1- .,-• .-.. LIC./REG NQ :.-....- .............::;;;*.kg,ffECIIV . ,-...,.....,--7 EXPIRES 386875 e-•-• ' --h 4,-iM10-1/-2046-cw.',N,-4)8131/2 0 07 1 .-...',141-tiii•-•-.--(61''''''' .- ..--...S:4iir•• SIGNED . ... From:Sue Ross At:Tracy-Driscoll FaxID:Tracy-Driscoll Ins To:Gene'and Brenda Date: 10/16x1006 08:53 AM Page:2 of 3 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID SR DATE(MM/DD/YYYY) PRODUCER ADVANO2 10/16/06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Tracy-Driscoll HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 126 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bristol CT 06010 Phone: 860-589-3434 Fax:860-589-6406 INSURERS AFFORDING COVERAGE INSURED NAIC# INSURER A: St. Paul Trawler■ Insurance 10647 Advanced Gas Sales & Service INSURER B. Guard Insurance Group LLC INSURER c Landmark American Ins Co 183 East Haddam Road Salem CT 06420 INSURERD: 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. INN AUL)L LTR NSRC TYPE OF INSURANCE POLICY NUMBER PDATE(MM/DD/W)E YDATE(MM/DDIYY( LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY 6605655C366 10/01/06 10/01/07 PR MISES(Eaoc uence) $ 100000 CLAIMS MADE X OCCUR MED EXP(Any one person) $5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 _ GEN'L AGGREGATE LIMIT APPLIES PER: —I POLICY ECT LOC PRODUCTS-COMP/OP AGG $2000000 AUTOMOBILE LIABILITY . Emp Ben• 1000000 A X ANY AUTO BA77200035 10/01/06 10/01/07 COMBINED SINGLE LIMIT $ 1000000 CO accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per person) $ NON-OWNED AUTOS BODILY INJURY (Per accident) $ A X MCS-90 BA77200035 10/01/06 10/01/07 PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY , AUTO ONLY-EA ACCIDENT $ ANY AUTO _ - OTHER THAN EA ACC $ AUTO ONLY: EXCESS/UMBRELLA LIABILITY - AGG $ EACH OCCURRENCE $ 1,000,000 C X OCCUR I I CLAIMS MADE X51082552 10/13/06 10/01/07 AGGREGATE $ 1,000,000 $ DEDUCTIBLE X I RETENTION $10,000 $ WORKERS COMPENSATION AND $ EMPLOYERS'LIABILITY WC LIAIU- I IDtH- B ANY PROPRIETOR/PARTNER/EXECUTIVE WC1082552 (TORY LIMITS ER OFFICER/MEMBER EXCLUDED? 10/01/06 10/01/07 E.L.EACH ACCIDENT $500000 es.describe under E.L.DISEASE-EA EMPLOYEE SPECIAL PROVISIONS below $500000 OTHER E.L.DISEASE-POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: Proof of Insurance w/regards to the named insured — CERTIFICATE HOLDER CANCELLATION ADVANO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 O DAYS WRITTEN Advanced Gas Sales & Service Stacy Martin NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 183 East Haddam Road Salem CT 06420 REPRESENTATIVES. AUTH. IZED REPRESENTATIVE ACORD 25(2001/08) 4 , • I (9J_1 ©ACORD CORPORATION 1988 Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL as Pf ii-Ar LJkt - nP1-1f141...E cX c 37L) Property Address 1s7 LL, 1.0 r ', + Lem Pr `-(`a- - as L+.nas a d 1/ort TIT.cin5S Job gescription The applicant is responsible for obtaining all of the required approvals checked off on this form. No building permit will be issued until all of the required signatures have been obtained. Required Approval Department Permit Issuance Approval (e„ 2 Tax Collector v /V s c,saw 1c j 7l o Comments: ❑4- WPCA, Administrative � a` )-j 1 Comments: 1 ❑ WPCA, Operations Signature/date Comments: ❑ Planning &Zoning ;3rd/ date Comments: ❑ Health Department Signature/date Comments: ❑ Department of Public Works Signature/date Comments: • ❑ State Dept. of Transportation •Signature/date Comments: Fire Marshal • 62/a7 g y/ ch �j0 m Signatur ! rete �b Comments: � L � l 14ta'se1August 5,2005