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HomeMy WebLinkAbout14x14 Addition 2013 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860)848-3030 X382 FAX. (860)848-7231 BUILDING PERMIT Permit Number:82013-0507 Date: 20-Nov-13 Map/Lot:.02/3m(5a59 Owner ID: 5466000 Project Location: 26 PHEASANT RUN Unit: Job Description: Replace Exisa D�cl�wjth�ddif_1on Owner Nam _Losenh A&Teri L Hochdorfel Tenant Name-NIA Careof: _76 Pheasant Run Oakdale CT 06370- Telephone: (8o0 3629036 Applicant Name David Smith Telephone: (8(0448-3447 DBA:.D nendahle Contracting Services I I C Lic/Reg Type JiIC Lic/Reg N �,21g03 .&Elant Drive Exp Date: 3(1:Nov-13 Waterford CT _06385- ronstr' tion.mo up Permit f ec Car c .uctionJn rnintinn Building Value: $2.4.957.00 Building Fee: $250.0— Use Group: IRC Plumbing Value: S0.00 Plumbing Fee: MOD_ Code: 2005 State Building Code Mechanical Valu SD_SID Mechanical Fe S0.00 Electrical Value: $0.00 Electrical Fee: Construction Type IRC Total Value: $24.951.00 Penalty Fee: $n,0ci_ Permit Code: R3 C of 0 Fee: $25.00 Comment Plan Review Fe 5250 State Ed Fee: $ g0 Total Fee Paid: $306.49 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 frami ❑ 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 ❑ Certificate of •.proval V ' ic. of Occupancy __uildinc Offi lsAooroval; 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.: (513 -nal Type of Work Occupancy Type Permit Type ❑ New Construction Single Family : :uilding ddition ❑Two-Family ■ Plumbing ]Alteration ❑Townhouse ❑Mechanical ❑Accessory Structure ❑ Electrical CRS#: Property Address: 2-L erkEA,SkNc: (r (--0 0('c1G-OOct-C' (Number) (Street) (Unit) Job Description: Ctz(1.ST-r -Lf q=tr A O D t1'c' ,`'� P3' P`'4k"J l ' ' Pok---c-Ea tSC-lam 04c_k_. Owner: --S'c.)s>r Pt-F '- Te&.:,-, t-Stoc_tk0otiFCn Address: 2—C., e (_&4'\ /Lij ,may City: O k-a -ZCX-- 67 ! State: eZip Code: Telephone( .70 ) 1C-7-7 _ 9 pg S. Applicant: 0/4-'%n ,S +^1((l F DBA: 0 "9 616 Lcr2 CO.-' -K3- S&L't 1.- 3u c / Address: (C) 1"n L —v 0&\vim City: k J k - - "- State: ex- Zip Code: Or ✓T 161 Telephone( 34 ' ) 4Lep- 3 It() Contractors - Complete the Following: License Type: (k I L- License No.:(07—l 7(3...:. Expiration Date: /'t / LJ 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 Montvillend further attest that the proposed work is authorized by the owner in fee and that I am authorized to make application for a Penn such work as described above. 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 e 7- .w -• - -- is in chapters 33 t • •- - • •- Residential Code. Owner/Agent Signature: Limmill11111 Date: /)/L 113 Construction Value Permit Fees Building Value: Ici000.0 Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: 4Zrviserd_August 23,2007 Town of Montville Building Department File Receipt Date: 18-Nov-13 ReceiptNo: 9004 Received From: Dependable Contracting Services LLC Job Address: 26 Pheasant Run Town Fees Collected State of Connecticut Fees Collected Bldg Cash: $0.00 State Cash: $0.00 Bldg Check: $306.49 State Check: $6.49 Bldg Credit: $0.00 State Credit: $0.00 Fire Cash: $0.00 Fire Check: $0.00 Fire Credit: $0.00 Construction Value: $24,957.00 Demolition Value: $0.00 CheckNo: 1780 Received By: Carmen Kneeland (16-A ' I iLAN,. kila. Address: 26 Pheeasant Run ITEM QTY $/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA New Construction 196 SF $ 118.03 $ 23,133.88 $ 521.36 Basement,Finished SF $ 25.96 $ - $ - Basement, Unfinished SF $ 12.40 $ - $ - Crawl Sapce 196 SF $ 9.30 $ 1,822.80 Interior Renovations SF $ 36.09 $ - $ - $ - AMENITIES Kitchen EA $ - $ - $ - Full Bathroom EA $ - $ - Half-Bathroom EA $ - $ - GARAGE Attached SF $ 56.35 $ - $ - Detached SF $ 71.53 $ - $ - Under SF $ 11.03 $ - $ - Carport SF $ 19.89 $ - MECHANICAL Warm-Air y Y/N $ 1,922.76 Hot Water n Y/N $ - Electric n Y/N $ - Air Conditioning n Y/N $ - ELECTRICAL SERVICE Overhead,new Amps $ - Underground,new Amps $ - Subpanel EA $ 599.50 $ - Gen Set EA $ 3,850.00 $ - SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 6,497.70 $ - Masonry w/lfireplace 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 $ - $ - TOTALS $ 24,956.68 $ - $ 1,922.76 $ 521.36 PERMIT FEE CALCULATIONS Construction Value Fee Building $ 24,957.00 $ 250.00 Plumbing y $ _ $ - Mechanical n $ _ $ - Electrical n $ _ $ - Working before Permit Issuance n $ - Certificate of Occupancy Fee $ 25.00 Plan Review Fee $ 25.00 State Education Fee $ 6.49 TOTALS $ 24,957.00 $ 306.49 I __� _ m = : _- ■ -_7-i_-_-_-_-_,... 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IlllllllliIIIH _ ...■ - 111111111111111 .... ■■■■ , 1 ) . .... i' \! .■.. mum , ■.■■ :;-F: 111111111111111 e:1111111111111111' � - JOE 4 TERRI HOCHDORFER GNARLES PARSONS 26 Pheasant Run Rd. RESIDENTIAL DESIGN Oakdale, Ct 060/S51-1615 I SURF INGFENWAYoGMAILCOM DU1G . FP/ PLANS DESIGNED FOR SCALE: 1/4" = I'-o" DEFENDABLE CpNTRACTINCs DATE: 10/13 HOUSE GARAGE gI..<3 it r t,..r k-,.cAo tr..) EXISTING PLAN ELECTRICAL PLAN , ELECTRICAL SYMBOLS \ P ll 'N\ l i 1101 $ SWITCH :11 • 11101 0 RECEPTACLE-OUTLET - 1Y^ GROUND FAULT OUTLET ADDITION' L / WEATHER PR CECTm GES CUTLET 0 RECESSED CAN LIGHT • ,a s'"> CI EXTERIOR SCONCE TED 6b EXTERIOR LIGHT TED E---- 1=3 FAN/LIGHT HOUSE GARAGE Ib li .11111-1" ACCESS AGCE55 DOC*vIF 3'%Y O EGRESS STAIR AND DECK TBDNIF 1f1f"' ,IIIII;I PROPOSED PLAN ADDITION 4 -0>o.>. ,• ..'moo...' o SHEAR WALL•3 EACH CORNER JOE 4 TERRI HOCNDORFER CHARLES PARSONS 26 Pheasant Run Rd. RESIDENTIAL DESIGN Oakdale, Ct E-1> 860/85-1-76-15 SURFINGFENWAY9GMAIL.GOM DUJG * SCALE: v4" - I'-0" PLANS DESIGNED FOR DATE: 0,13 DEPENDABLE CONTRACTING RIGI—IT ELEVATION 2X10 BUILT UP BEAM -TWO 2X10 WITH I/2 PLT- -- OVER 9'-3"OPENING � Ml 6 !I. . _MiEIh6 _ 6'-0"SLIDER OPENING -. IMI -�� I '- - - -. uta%,, mIaff.cmI II _ Y SHEAR WALL- -y � � Ift"PLYWOOD ON VERTICAL i WITH NAIL SCHEDULE 2"O.C. - 1 6'-2" '° sl 'Ii • • Q,°: • o o-.Q o 0 O• ° .•0Doid^0O • • t0 00• • °^.,,,0 0 O 0, — 0 -0.,0 00. -a% O q o°O -0,,,00..O .0 0.0.', 0 ` •.0....o o'O • °aoo • eo deo°"o o° ate.°°•o '. •000.8 • 0O> LEFT ELEVATION ° • °o -9 112"LVL SINAI F VIF RIDGE oo,/_,o i ao • ________--2X10 BUILT UP BEAM °, -TWO 2X10 WITH I/2"PLY- /' OVER S•-3"OPENING c/ --e- E If it t ITHI L -,- \------2X6 INDICATED WITH DOTTED _,-,---:--- LINE TO SHOW FRAMING (0 - n __� ----2•SHEAR WALL O1/2"PLYWOOD ON VERTICAL / 9-3" WITH NAIL SCHEDULE 2.O.C. zl II I_ 1_ 1- X *-'-;-,4`2,:-°"Xo o ° ,.-e° °. �12'Vp,;i q0-',, ° o °Oo pOf .0-, 0°00p . °0 NOTE: •°0° o°• °o o ^0° 0 ° °o o° HEADER LAYOUT FOR ALL•-ENINGS 0.0 Q.�O ° .•0 00 ^a0 C!, d'„ oo oa 2 ° o�.°00 2X10 BUILTUP BEAM s I"THI•KNESS °° PER FOOT OF SPAN.ALL 4.-ENING 0 neo J o^o o °0 ao 2X2 ACCESS DOOR VIF o.. 0 0.-Ix TO BE LESS THAN 9'6"IN TO AL Oo0,0 °0°000.U °,6000 0•a.o.. °,:...'2o°,, 0• WINDOW SIZE TO MATCH EXI- ING o'er o 0° O 0 .00 ° °q 00 0• 000 0 I-IEADER 4 FRAMING DETAIL DETAIL JOE 4 TERRI HORCHDORFER CHARLES PARSONS 26 PHEASANT RUN RD. RESIDENTIAL DESIGN oAKDALE, CT P+-IONE:860/851-16 f5 SURFINGFENWAY•CIIAIL.COM DWG " SCALDRAWN BY: CHARLIE PLANS DESIGNED FOR : 0/13 S I/4° = t'-o° DEPENDABLE CONTRACTING DATE: 9 V4'LVL RIDGE BEAM r DOUBLE 2X4 POST FROM HEADER TO RIDGE LVL SUPPORT IMO DOUBLE 9 V4°LVL WADER OPENING FOR V2 RCD[)WlOOIU . --2.50•L 0816 NIX-80 NALS lel, •� '�I 2 JACK STIRS AND SIG STUD _l I l l i . J I SWEAR WALL O -o I/2•PLYWOOD ON vReTICAL ° b o '°. • Oso o • •- WRH NAIL SCHEDULE 2.O.C. p 0 ^• p 0 �• 0 0 ° ° 0 •° •Oe ° 0 •O '° 0• -0• 0•• o 0 0 o ce °e0 b 0°d? °e0• .0 b C�u •e0 p o 0•o -p a. p -oo O•0. S o - a 0•°- ° •°• o •° '�•1 • Do o e ^• m o REAR ELEVATION 2X10 BUILT UP BEAM -TWO 2X10 WITH 17 FLY- OVER 9-3'OPENING THRID BOLTS RAFTER — AND HEADER _ _ ___d_�__ 6'-O•SLIDER OPENING X (r) Oo � 6•-2" `O 2'SHEAR WALL I/2'PLYWOOD ON VERTICAL WITH NAIL SCHEDULE 2'O.G. >t{r O ° • - ri.o °°•" a o 0 .o s ° •�d'• °:..°*O- o°•o-'m •.,4A 00°g • oe de00•0- - .a• oG00•�0 b.,„oo0. O' O• 00- -O' 00, v o• O o• do RIGHT ELEVATION GABLE END DETAIL_ JOE 4 TERRI HORCHDORFER C+-4ARLE ' PARSONS 26 PHEASANT RUN R . RESIDENT1j AL DESIGN OAKDALE, CT EI)1111' PHONE:860/851-1615lSURFi FEMliAYK+MAfLGOM DWG " DRAWN BY: CHARLIEPLANS DESIG=NED FOR SCALE: 1/4" = 1'-0" DEPENDABLE CONTRACTING DATE: 10/13 (71::••-• *),,. ,••••$:;:ilt, 4.1.0:1• -1•73%.).1,.. -;•.:.:,•;;;: •-• JE:•.$*.!:20- 1;41,:•,'_,..0::::S.a- 464.,,,AIA'al'A. .;!,:,-,.4e4;01.',?:;',1 .1•FCS-0;i111,"3.0.:Ftl:;,-;;;.F.;;.'fg1::.4•Iter.:4*.•;;A•S'X';'":0;0?:'4% ,,;:rge•Pg .:3--:.,--'11.Ail .: Oki::: `04. •igrAtIl. 44.1:::: 'P;50,4A.t., 41,Awi:• filt4W:..• ,i1P.41: igips.,._,., ,,,,Av4ikiagr.....%., , .4,10.,As--,..:: -4%.• ' -------, ;76-7.. ' It‘e.iii: '..1.,',.. . -5.4.4, 1 •-•:;V:i •••4„,,,,.. 5 ' 4-,.1,.., He. 'OL, W C5 ••••...5 ,,.. . -.....,/ C •c.„ , ....,.5„... -o , . ....d ;z ; , ,•-, , ,...., 4..• i...-ge----. •• V) cl..) , ' • -,,-/-4: el',-„ , I--i c.T; 'CA t-4 I , "..•;--- : 1.C-trii, 1 •- • ---,,,‘,1. 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(P / t f-E A t1 jet(..4."-v Property Address er)h-J i v -r- A Ni a4 pa t C1) Job Description Required Department Permit Issuance Approval Approval 111 Tax Collector /-1/./ ii/S)/3 Signature/date Comments: ELA Planning & Zoning / 1 Si/3 Signature/date Comments: Fire Marshal ■ Signature/date Comments: Health Department Hequired for properties with private septic or well Comments: ❑ WPCA, Administrative N\IRL"&e/v /—°-1Required for properties on sewer gnature/dat Comments: n WPCA, Operations When Required by WPCA Signature/date Comments: _ 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: I 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 23,2011 AO CERTIFICATE OF LIABILITY INSURANCE 6�10�2013Y) 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 House Account Sava Insurance Group Inc. PHONE(A1C,No,Ext): (860)437-7282 (AIC,No):FAX (860)447-5656 750 Broad Street E-MAIL ADDRESS:www-savainsurance.com INSURER(S)AFFORDING COVERAGE NAIC* Waterford CT 06385 INSURER A:National Grange Mutual 14788 INSURED INSURER e National Grange Mutual Dependable Contracting Services LLC & INSURER C: 6 PLANT DR INSURER D INSURER E: WATERFORD CT 06385-1412 INSURER F: COVERAGES CERTIFICATE NUMBER:2013-2014 Master 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 (MMIDDIYYYY) (MM/DDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGEIO REN1ED — COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE n OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ _ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ — PRO- -I POLICYEl T 1'LOC --t$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X •SCHEDULED B1T2106J 5/20/2013 5/20/2014 BODILYINJURY(Per $ AUTOS AUTOS1 _ XX NON-OWNED PROPERTY DAMAGE — HIRED AUTOS _ AUTOS {Peraccident) _ $ Underinsured motorist $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE _ t EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED _ RETENTION$ $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITYY/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) WCT3687H 2/19/2013 2/14/2014 EL.DISEASE-EAEMPLOYEE $ 100,000 Ees,describe under E L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 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 ACCORDANCE WITH THE POLICY PROVISIONS. FOR INSURANCE PURPOSES AUTHORIZED REPRESENTATIVE Claire Thayer/CLAIRE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD __---.IN DEPEN-1 OP ID:MS AWRL` CERTIFICATE OF LIABILITY INSURANCE DATE 06/20/DD/YYYY) 06120!2013 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). PRODUCERCONTACT Waterford dba Redden Phone:860-447-3111 NAME: Mallory Walker Brown 8 Brown of CT Fax:860444-1205 rat.o,Ext):860-665-8417 I(a/c,No): 203-639-0031 PO Box 277 a DRESS:mwalker@bbhartford.com Waterford,CT 06385 Brown&Brown of CT Inc. INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Main Street America Assurance INSURED Dependable Contracting ServLLC INSURER B: Dependable Skylights, LLC INSURER C: David Smith &Ken Bird 6 Plant Drive INSURER D: Waterford,CT 06385 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 LTRINSR wvn- POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPT4222K 10/15/2012 10/15/2013 DAMAGE 70 RENTED 500,000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEM_AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMP/OP AGG $ 2,000,000 PODCY JE& LOC •-$- - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL SA�OEDULED BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE _ $ _ EXCESS LWB CLAIMS-MADE AGGREGATE $ DED RETENTION 5 — $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 Byes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Informational purposes only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Dependable Contracting THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Services,LLC 6 Plant Dr AUTHORIZED REPRESENTATIVE Waterford,CT 06385 l�cCk K/// — 1 !� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD f tVV STATE OF CONNECTICUT DEPARTMENT OF CONSTRUCTION SERVICES 0 � Office of the State Building Inspector November 14, 2013 Mr. David Smith 6 Plant Drive Waterford, CT 06385 RE: M-1042-13 26 Pheasant Run Oakdale, CT 06370 Dear Mr. Smith: I have reviewed the referenced request for modification of Section R301.2.1.1, of the 2003 International Residential Code portion of the 2005 State Building Code, which states in part that construction in regions where the basic wind speeds equal or exceed 110 mph shall be designed in accordance with the provisions of this section. It is my decision to approve this modification, as requested, and allow an addition to an existing single family dwelling to be exempt from the above code section. This decision is based on the fact that such addition is tied to the existing structure that is compliant with a previous code that did not require high wind design. If you have any questions, please contact me at (860) 685-8310. Very truly yours, Daniel Tierney Deputy State Building Inspector DT:jlc c: Vernon Vesey II, Montville Building Official 1111 Country Club Road,Middletown,CT 06457 Phone: (860)685-8310/Fax: (860)685-8365 www.ct.gov/dcs An Equal Opportunity Employer 01,3) STATE OF CONNECTICUT DEPARTMENT OF CONSTRUCTION SERVICES OFFICE OF THE STATE BUILDING INSPECTOR FILE# 1111 COUNTRY CLUB ROAD MIDDLETOWN, CT 06457 TELEPHONE: (860) 685-8310 FAX: (860) 685-8365 fif/Q 1 / REQUEST FOR MODIFICATION I° OF THE STATE BUILDING CODE FOR OFFICE USE ONLY 1. Nameand Location of Building: F ( C-wt c t�OD (, ftIf4-3�lti-c' ✓�-�->r i c' - A'f-i c� CT o Cfl J"7 7 Number et City State ip 2. Building Owner: ��1_` 3. Applicant's Name: ( L i,c S t Telephone: 3-4,0 if y ?' Applicant's Address: Co QLt r-1- vi- Numbe Street City State Zip (Include Firm Name if Applicable): �lfCL,1 O/''Li LA 0 L,v�'M- C_IZl t— < c yl ✓i( (...LJ Name of Person to Contact: Telephone: (For information if required) 4. A. Date of Application for Building Permit: 11 ( k B. Applicable Code (Title and Date): 5. Use Group: C? A. Was there a change of occupancy: ❑ Yes Na B. If yes from to 6. Building Construction Classification: t ° 7. Square Foot Area of Building (Total): (.7 to L f. Largest Square Foot Area per Floor: g �- 8. Number of Stories: 9. Check Applicable Designation: ❑ New Building ❑ Existing [,Addition ❑ Other(Explain) 10. Fire Protection at subject premises (Check appropriate headings) Er Smoke Detection ❑ Heat Detection ❑ Extinguishers ❑ Sprinklers ❑ Standpipes ❑ Other (identify): [MODAPP_NET] DPS-0844-C(rev.7/1/11) 1 of 2 REQUEST FOR MODIFICATION OF THE STATE BUILDING CODE (Cont.) 11. Describe alarm system(s) at premises: 12. Building Code Section that modification is requested from: (2- c ` t2 t\ , 13. Modification Sought: It e-_-(__ 1 cZ fJ t. t. ( (. �t-+- �-c-i 14. Reason Modification is Sought: pg-r- /V ,AA ,( c-16\4--,c,_.,,,\--G s-- ZC-) -, 15.AFFIDAVIT: I certify that,to the best of my knowledge and belief,the foregoing statements are true and made in good faith. C Applicant's Signature Date Signed /( /` (c f 16. Important Requirement Failure to provide the following information will delay modification process. The Building Official must comment below on the modification request as per Connecticut General Statute 29-254 (b). *Note: Must be signed by Chief Building Official, Acting Building Official or Provisional Building Official. 0 Support Request Do Not Support Request The decision on this request is left to the Office of the State Building Inspector. fi/ ❑please contact the undersigned. Building Official's written comments, if desired. 1/4//j3 uilding Official (Printed) Town ,.Z4z,4ie i :uilding Offic a ' ignattte Date Signed g6o - gy 8 -303 b 2/33c g/1/14 - c/P/1-7 Building Official's Telephone Number Best Time to Contact The Office of the State Building Inspector cannot accept this form electronically. Please mail a paper copy of the signed form, with the local Building Official's written comments and signature, to the Office of the State Building Inspector. [MODAPP_NET] DPS-0244-C(rev.7/1/11) 2 of 2