HomeMy WebLinkAboutGas Lines 2001 Town of Montville
Building Department
Phone: 848-7166 310 Norwich New L2ndon Tpke Fax: 848-7231
Building /Trades Permit
Permit Number M2001-153 Permit Date 10/12/01 Permit Type Mechanical Permit Code R5
Job Street# 44 Job Location PHEASANT RUN Map/Lot 028/005-055
Job Description Gas Piping
Owner Contractor
D'Amato Bros. Hendel's Inc.
Address 183 Quarry Road Address 35 Great Neck Road
City Milford State Ct. City Waterford State Ct.
Zip 06460 Telephone 203-877-3276 Zip 06385 Telephone 443-5337
Lic/Reg Number 308397
Lic/Reg Type G1 Exp Date: 8/31/02
Use Group R4 Code 1995 CABO Type Construction 5B
Building Value $0.00 Building Fee $0.00
Plumbing Value $0.00 Plumbing Fee $0.00
Mechanical Value $100.00 Mechanical Fee $10.00
Electrical Value $0.00 Electrical Fee $0.00
Other Value $0.00 Other Fee $0.00
Total Values $100.00 C/O Fee $0.00
Comments: Plan Review Fee $0.00
State Ed Fee $0.02
yFees $10.02
Building Official's Signature ,_ _ Date,/e)//J /Q�
It is the owners responsib'i v to schedule the following required i ections (minimum 24 hours notice required):
[Footings -prior to pouring concrete
E Backfill -footing drains and waterproofing ❑ Fireplace Throat
❑Concrete Slab, prior to pouring ❑ Fireplace Final
❑ Rough Framing ❑ Chimney -one flue above thimble
❑ Rough Electrical ❑ Firestopping/draftstopping
❑Electrical Service ❑ Insulation
[Rough Plumbing and leak test ❑ Pool bonding
® Gas piping -pressure test and installation ❑ Final Inspection
❑ Rough HVAC ❑ Certificate of Occupancy -PRIOR to use or occupanc
Town of Montville Bui'ding Department Receipt
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c Date , 10 9 le, / No. 01165
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Job Address:
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Amount $ /4 -1=2-4 - ic as Check Check #
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Received by
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_411.„... ,,,':-,ef-, lib, le.„,,....:-.........:. _ Permit
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Town of M9ntville Permit #A5,200/-7-573
Building Department
310 Norwich-New London Tpke.
Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231
Application for Building or Trades Permit
Building Permit Trades Permit
0 New Construction ❑Accesso
'y Structure 0Plum6ing ❑9Kec(nnicaC
❑Action 0 Demot tion L}ElectricaC
g
0 Alteration ❑Other
Air Conditioning
n
ditioning
Gas Piping
Job Location ll 9 Phe.a,5-el,pyt- r-(,iL,
Job Description/Materials CIA A) cCA-S //çv 6co a L
C6A)N.c. cA -j0 Prv-c, Z00
Owner � 'Ids, Mailing Address _ rf I)�, 0
Air
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City State ( Zip eV-, / e7) Telc. l / 77i• - -'767--_,
Contractor / °J e.L Mailing Address 33— 42-ct T W e CI( Rb
City •- c `1 f)- 0r- State Zip 0 (2 Y) Tel (// 3 i33 7
Contractor's License/Registration Type&Number G I 3v ''3 9 7 Exp. Date -/ (3 l / O Z
New Home Construction Contractors:
Have you entered into a contract with a consumer for the proposed new home? 0 Yes 0 No
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 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.
thOwner/Agent Signature ) i Date /0 / 7 / CI
Construction Value Fee
Building $ $
Plumbing $
Mechanical $ ,/('6, U $
Electrical $ $ /2)
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $ n
Total $ /moi $ /C9,,e7
04/23-01 15:12 FAX 860 447 3119 -
LEVINE, WEBSTER INS 0002/003
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--- DATE(MM100/'!Y)
Client 11763 1r U
K� CERTIFICATE OF LlAB1L(TY INSURANCE,MCE 04/23/01
AS A MATTER OF
ON
THIS CERTIFICATE IS t OgIGHTS UPON THE ICERTIFFICAITE
PRODUCER ONLY AND CONFERS N
Levine / Webster Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
914 Hartford Turnpike ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Waterford, CT 06385 INSURERS AFFORDING COVERAGE ---
850 447 1735 —_— --'INSURER A.o...a Republic In3urance _—____
INsuaeo -,NSURER B:Commerce __——--- —
Hendel' s Inc . INsuaERc: ---
P.O. Box 201 - — — _ — — — ----
35 Great Neck Road INSURER0:__—_— --
Waterford, CT 06385 .,INSURER E:
COVERAGES BEEN
AHENY POUCREQUIREMENT,
T, TERM OR CONDITION DIITION OF AN CONTRACT OR OTHER ISSUED TO THE DOCUMENT SPECT TOE POLICY WHICH�CERTIFICATE MAY BE ISSUED OR
ANY PERT IN. E. S AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCWSIONS AND CONDITIONS OF SUCH
MAY PERTAIN. THE INSURANCECLAIMS --—
POUCES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID T`Ic7 EFFECTNE POUcv - n0 LIMITS
— --� POLICY NUMBER D.1 L.,,m,W 0 I L,,I..IJI_
ILTR TYPE OF INSURANCE 1 EACH OCCURRENCE Sl OOO OOO
GENERAL IHML25896 04/11/0104/11/02 -----i—`—'
A FIRE DAMAGE(Any one rre�s3 0 0�0 0 0
I�COMMERGVS GENERALLIABILITY - 1 MED EXP(My one Person).Its5,000 -
+ CLAIMS MAO
OCCUR; IiERSONAL i ADV INJURY X31,O O O,O O O
_—_1 i 1 GENERAL AGGREGATE '$2,000,000
~ • I PRODUCTS-COMPtOP AGGI S 1,0 0 0 f O 0 O
i GENE AGGREGATE LIMIT APPLES PER: '
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A1 POLICY I !JECT LOC 1 1 ,1 COM81NE0 SINGLE LIMIT 1 s
UTOMOBILE UIBI(RY (Ea acclaent)
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�ANY AUTO 'BODILY INJURY i ALL OWNED AUTOS I BODILrson)
SCHEDULED AUTOS �, 1 —
I BODILY INJURY 3
1 HIRE D AUTOS (per accident) �—
NON-OWNED AUTOS I PROPERTY DAMAGE
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1 ^ter I AUTO ONLY-EA ACCIDENTI$
GARAGE LIABILITY 1 I OTHER THAN EA ACC s —
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ANY AUTO I AUTO ONL Y. AGS 1S
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1 DEDUCTIBLE S
(RETENTION s 04/11/01 04/11/02 X 7nwr11urrsiOT _—-$ 1 WORIteRSCOMPENGATIONAND IWC7206709 1 E.L.EACH ACCIDENT 5500, 000
EMPLOYERS'LIABIUTY
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I I E.L.DISEASE-EAEMPLOYEE$500,000
I' II E.L.DISEASE-POLICY LIMIT s5OOJ 000
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1 DINER �1
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DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICL EIEXCLUSIONSADDED BY EN 0ORSEMENTISPECIALPROVISIONS
Evidence of insurance
CERTIFICATE HOLDER
ADDMONALINSURED.INSUREFILETTEFt CANCELLATION
GHIDUW ANY OFTHEABOVE DEGcwAED POLICES BE CANCELLED BEFORE TFE EXPCIATToN
DATE THEHEOF,THE ISSUING INSURER WI LL ENDEAVOR TO MAILED—DAYSWRaTEN
NODCETOTHE CERTIFICATE HOLDERNAMEDTOTHE LEFT.BUTFAILURE ToDOSost-TALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURERRS AGENTS OR
REPRESENT�ATTiVEG.
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