HomeMy WebLinkAboutSFR Gas Lines Town of Montville
Building Department .P'
Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231
Building / Trades Permit
Permit Number M2001-41 Permit Date 3/28/01 Permit Type Mechanical Permit Code R5
Job Street# 63 Job Location PHEASANT RUN Map/Lot 028/005-045
Job Description Gas Piping
Owner Contractor
Tien Tran
Suburban Propane
Address 63 Pheasant Run Address 262 Gallivan Lane
City Oakdale State Ct. City Uncasville State Ct.
Zip 06370 Telephone 848-2281 Zip 06382 Telephone 848-5510
Lic/Reg Number 390521
Lic/Reg Type G1 Exp Date: 8/31/01
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 $408.00 Mechanical Fee $10.00
Electrical Value $0.00 Electrical Fee $0.00
Other Value $0.00 Other Fee $0.00
Total Values $408.00 C/O Fee $0.00
Comments: Plan Review Fee $0.00
State Ed Fee $0.06
Total Fees $10.06 1
Building Official's Signatu / Date I, /07? / C
It is the owners resp 1 li to schedule the following required inspections(minimum 24 hours notice required):
❑ Footings -prior to pouring concrete
❑ 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 +I' Final Inspection
O Rough HVAC Certificate of Occupancy -PRIOR to use or occupancy
,,s, Town of Montville 4 Permit #flip(-Il
Building Department
3i 0 Norwich-New London Tpke.
Tel. 848-7166 Uncasville, CT 06382 Fax. 8,18-7231
Application for Building or Trades Permit
Building Permit Trades Permit
❑ New Construction ❑Accessory Structure <Ptu.ii6i
cat
[11 Addition Demolition 0 ng ❑9Kechati
E�ectricaC 9feating
❑Alteration ❑Otfier
Air Conditioning
Gas q'ipinj
Job Location (4)- --) `�' ect r p(
Job Description/Materials t` {CLC.S.. IOC T. ACk(\ ) (Cn It rlc 42
ro nq ca,m _ aro .Jt.._ , cc oupf f ca Lcca t
Owner 1 (fin ican Mailing Address (._ 3 1 C
City Inge n-u 1 l lc State C ( , Zip ao 3Tel O / 8-98/ d / t.-
Contractor &A k rL ri P1 y 1AMailing Address C l)ans /(f� � � � �
city
fC,O� 1 o State 0. Zip £3 U Tel e_c&I eeN,55,6
Contractor's License/Registration Type&Number �kteA iptp ni / Ca;)i . Date g` / �/ / Ci
New Home Construction Contractors: HCl 653
Have you entered into a contract with a cons:.mer for the proposed new home?2, Yes ❑ No
I hereby certify that the proposed work will conform to the Basic Building Codz 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.
Owner/Agent Signat e AI _ J lb. 0 t Date /t- c /
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical
Electrical $ e$ '�' ` 7
$
Other $-
$
Certificate of Occupancy
Plan Review Fee $
State Education $
Total $ , D6
$ s , . $ zo , z, -_,
Town of Montville Building Department Receipt
Date d3 /n/d /0 / No. 0D506
.., G7
5Q
From:•
,�L..0..-.../ :60" die
• Job Address: f i�
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Amount $
/a - Op
Check Check #
/ (Circle one)
Received by \d. /, i
° Permit /1
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SUBURBAN PROPANE
P.O.BOX 385
262 GALLIVAN LANE
UNCASVILLE,CT 06382
860-848-5510 PHONE
860-848-5517 FAX
DATE: 3- C _C
JOB NAME:T@.n Tian
n
JOB ADDRESS: Lo, 0�> {-t- 12n
STARTING DATE:
TO: CITY\TOWN OF: (Tt -ui Ile
CONTRACTOR'S ADEN' . ( I j e
PLEASE BE ADVISED THAT THE ABOVE REFERENCED AGENT HAVE BEEN
AUTHORIZED TO OBTAIN A PERMIT FROM YOUR BUILDING DEPARTMENT FOR THE
SPECIFIED PROJECT IN THE NAME OF THE CONTRACTOR.
NAME: LEO R.MARTIN JR.
LICENCE#390521 TYPE: G-1
SIGNED: A. #e -
STATE OF CONNECTICUT.,
I)I/',1N7i1Jl:NT or('ON.S(JMLt l'Kl)7/x7/ON
HEATING,PIPING&COOLING LIMITED CONTRACTOR
LEO R MARTIN JR
91 SCOTLAND RD
BALTIC, CT 06330 Type:G1
LIC./REG.NO. I EFFECTIVEEXPIRES
3905 09/27/2000 I 08/31/2001
SIGNED:4 ' 14.--2.-Zr 4__,-----
03/01/01 15:33 FAX 973 515 5996 SUBURBAN PROPANE IA001/(J01
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PRODUCER �1 ;.-{t�E...;,,,. ,:,.'•>i.-- ..
MARSH USA NC. THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION UNI Y AND I;UNEMRS
I
44 ROAD
no NIONT,UPON DHE CEA IIFICAI'F HOLDER UTHPR THAN IWISP 5ROVIIJUI)IN THE
P.O. BOX 1965 POLICY.THIS CERTIFI^.ATE DOER NOT AMEND,FXTFNO OR AI IFR TRE CnVFRAnF
MORRISTOWN,NJ 07982.1966 AFFURDF•D BY THE POLICIES DF$r.RIAED HEREIN.
COMPANIES AFI NUINU 1.:UVERAGE
50800 CORP-04-01 CAMPANY
A PACIFIC EMPLOYERS INS.CO.
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SUBURBAN PROPANE, L.P, Pnrvr
1 SUBURBAN PLAZA R N/A
P.O.BOX 206 __.___...._-----
WHIPPANY,NJ 07981 caNY - ...
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TENS 19 TO CERTIFY THAT POLICIES OF INSURANCE D(s6CRIBED HEREIN IIAVH KEN IBSueo TO THE E SURED I lE �1'trt:!••4'(I,+b„
NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CFRTIFICA F rOn THE POLICY
RE ISS(1E oP IvKY
PERTAIN,THE INSURANCE ArroRDrb BY THE POUCIE5 DESCRICeu HEREIN is suBJECT 10 ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF PI CH POLICIES.LIMITS SI TOWN
MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE PDUCY EFFFCTIVF POI ICV prnIRA71ON
QTR POLICY DUMBER DATE(MN/DD/YT) DATE(MM/D DIYY) I IMIII
A OGNEFALL1ABIUTT HD4G1 19888g54 U3/01/01 03101/02 �' . .. --- —
S X COMMERCIAL GENERAL LRIUTY
UL (ANEW AGGREGATE 2,UOD,100
rROuIX:IS•GUMMI'ACM $ 1,000,111O
?'µ} , 1 CLAIMS MADE �j OCCUR PERSONAL d AUV INJURY S 1,000,000
OwNER'S&CONTRACTORS PROT rl1r:11 C4;4URRCIICE $ I',L/00,000
X AGC;REGAIELIMIT PER PIPS IIAMARO?Any nA,.r-,,) 4 S11,RM1
POLICY
A AUTO MO RILE LIABILITY MELT Ulf(MIy[Inn Arms) $ 5,0UU
) A HO 768589) '03/01/01 03/01/02 —
X ANY nano COMBINED SIWH F LIMIT 5 1,000,0OU
X ALL OWNED AUTOS - -
BOUILTINJURY
X SCHEDULED AUTOS (Per pr,rc7n) $
X HIRED AUTOS -- ----- ----
BODILY INJURY a
X NUM-OWNED AUTOS (pa PPnIrI'.,1)
—• •
PROPFR TY DMMARE $
GARAGE LIABILITY _ ---- ---.-
GARAGE
AUTO ONLY EAACCIDENT G
ANY AUTO OTHER THAN au I H OM v- t 1, ,,.,1 ,`t ri
___�___,.EACH ACCIDENT $•-_---
EXCESS LIABILITY
----_. AGUREGn1E $-
BAGI I(OGT%UnnfNCE $ -
UMBRELLA FORM -
A0011r0AIC $
OTHER THAN UMBRELLA FORM
$
A WORKERS 6OMRENSAt10N AgD- WLR C4 2983767 it -- - e
EMPLOYERS'LIABILITY 03/01/01 03/01/U2 TdTU 1111E ,:'!;`. ,,...,••
SCF G4 29832.57 X wive LIMIIS 1 I ER.„4.-.:7,:-.C::)::,-,.; !;1; a
03/01/01 03/U1/07 UI.FA('H ACCIDFNI $ 1,000,000
' THE PROPRIETOR/ WCL PO
- - -
PART1'IER$,EXECUTNE - EL LNSEASE LICY LIMI1 $ i3OOU,000
OFFICERS ARE: F CL
ELDISEn9Eent.a1EMPLOTEE S 1,000,000
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/SP ECLAL ITEMS(LIMITS MAY BE 8UBJECT TO DEDUCTIBLES OR RETENTIONS) _"_-- ”----- -'----"�
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TNF INSURER AEI-DADS C('VFRKrE Wl I FNIKAJV,I In MAII in nn WOITIFN NnRrp re) r F
FOR INFORMATION PURPOSES ONLY
GER-II-ICATE INH DER NAMFU IIFR'IN.PUT rAr IIRF In MAI/ .I I^.11 N,111,1F'I,AI I 11407.1,.Nn r,E111:A7M'N n
LIAOLUIY or ANY KIND I,VllFI IIIF kF.'IoFrl ArrnnrlrlM CA`r..R',li In soFNIR H'PFr PP7FNIA IVR
MARSH USA INC. -- —•
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