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HomeMy WebLinkAbout2016 - Sprinkler Replacement in Bldg 4A Field Inspection Notice Town of Montville Building Department 860-848-6782, Ext. 782 Address: 42 Pink Row (Faria) Job Description: Replace Sprinklers with New Piping in Building 4A Permit Number(s) P2016-0041 Permit Date: April 5,2016 Not Approved INSPECTION Date: Comments Sp ,n: • Final inspection for • • See Fire certificate of approval marshals rr Rev.Date: 1/18/06 Page 1 of 1 If TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860)848-3030 X382 FAX. (860)848-7231 PLUMBING PERMIT Permit Number: P2016-0041 Date: 05-Apr-16 Map/Lot: 074/038-000 Owner ID: 5496000 Project Location: 42 PINK ROW Unit: Job Description: Replace Building 4A Sprinklers with New Piping Owner Nam Thomas G.Faria Corp. Tenant Name N/A Careof: PO Box 983 Uncasville £�_ 06382- Telephone: (860)848-9271 Applicant Name David Walencewicz Telephone: (860)456-0515 DBA: P&J Sprinkler Company Inc. Lic/Reg Type Fl Lic/Reg N 11280 67 Main Street Exp Date: 31-Oct-16 Willimantic CT 06226- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: F-1 Plumbing Value: $9,000.00 Plumbing Fee: $135.00 Code: 2005 State Building Code Mechanical Valu $0.00 Mechanical Fe _ $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type 5B Total Value: $9,000.00 Penalty Fee: $135.00 Permit Code: C5 C of 0 Fee: $0.00 Comment Plan Review Fe $13.50 Fire Marshal Fee of$547.25 Paid State Ed Fee: $2.34 Total Fee Paid: $285.84 It shall be the owners repsonsibilitv 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 11 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 E] Certificate of Approval ' ate of Occupancy Cs J Building Official's Approval: — 1�� Building Department 310 Norwich-New London Tpke. li•el.860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 PERMIT APPLICATION FORM . Permit ec�vl(A`'GCYi� Type of Work Occupancy Classification Construction Type Permit Type ❑New Construction I]A-1 ❑B 0 H-1 0 I-1 0 R-1 0 S- ❑Additio0A_2 i ID Type IA 0 Type If 16 0 Building n titinn 0 B,Medical ❑H-2 0 1-2 0 R-2 0 S-2 0 Type IB 0 Type IV 0 Plumbing ❑A-3 0 E 0 H-3 ❑1-3 0 R-3 0 U 0 Type IIA ❑Type VAMechanical Mange of Use 0 A-4 ®.F-1 0 H-4 01.4 0 R-4 0 Mixed 0 Type IIB [j.,Type VB `Electrical 0 A-5 0 F-2 0 M 0 Type IIIA CRS#: Property Address: � �3 /1/0/7c)(di A 772 P)CF- A K a 0t(1 k ,C U ( umber) JJ (Street) ^ (Unit) Job Description: " Fe )/)e--e *• D Li)e y AA-rn c �,/-t-.c f 5 ,-.)141A /W ,N). V Owner: 7T '-ikj MTIA Tenant: 5A)4--e Address: /C1Nv/'4:. „-Address: City/State/Zip: V/V CAS Vl ttc C / ��S� 1 City/State/Zip:Telephone(Qt.) )_ 3 /-51 Telephone C_____) Applicant: tb LA)�p.. ', 44,t _ 1Z - � C DBA: OI 5 `1 nnk-I'.e./ CA :C c Address: /'1n <Jr/ City: t)////i414^1)7 ( State:/ Zip Code:AOPC Telephone( V -) 9 S'/r Contractors-Complete the Following: License/Registration Type: License/Registration No.:) 1 ?-90 Expiration Date: 1 0 )31)K, I hereby certify that the proposed work will conform to the State Building Code and alt other codes as adopted by the State of Connpoticut 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 Signature: '/: Ifl • - ---• "- gate: OA Construction Value Permit Fees Building Value: • Building Fee: Plumbing Value: w Plumbing Fee: �� Mechanical Value: Mechanical Fee: Electrical Value: p Electrical Fee: Total Value: a// dab Penalty Fee: CofOFee: Plan Review Fee: State Ed Fee: Total Fee: Revised August 23,2007 Town of Montville Building Department File Receipt Date: 04-Aor-16 ReceiptNo: 11221 Received From: P&I_Sorinkler Comoanv.Inc. yob Address: 485 Route 32 Town Fees Collected State of Connecticut Fees Collected Bldg Cash: 50.00 State Cash: $0.00 Bldg Check: $285.84 State Check: $2.34 Bldg Credit: $0.00 State Credit: $0.00 Fire Cash: 50.00 Fire Check: $547.25 Fire Credit: $0.00 Construction Value: $9.000.00 Demolition Value: 10.00 CheckNo: 4784 Received By: Carmen Kneeland S p 0 in 0 0 ct in inr) N O OOD N 0 M r N CO O O CO O COet Ii- r In N N In (+7 CO 49 44 49 EA b4 to 49 CO to to 40 ER tR 49 tf} to 49 to to tf? 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Print Lookup Details Page 1 of 1 t{lat;~.�i 7► State of Connecticut lei14 Lookup Detail View Name and Address Name Address DAVID M WALENCEWICZ 67 MAIN ST WILLIMANTIC,CT 06226-2912 Credential Information Credential Credential Type Effective Date Expiration Date Status FRP.0011280-F1 FIRE PROTECTION UNLIMITED CONTRACTOR 11/01/2015 10/31/2016 ACTIVE Generated on: 4/4/2016 2:41:44 PM t.; https://www.elicense.ct.gov/Lookup/PrintLicenseDetails.aspx?cred=80695&contact=312924 4/4/2016 A� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/30/2016 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 Sandra Touchette NAME: The Roberts Agency, Inc. PHONNo.EXt)E (860)242-7726 (A/C No): (860)242-5505 (AIC31 Tunxis Avenue E-MAIL ADDRESS:touchettes@robertsins.corn P 0 Box 805 INSURER(S)AFFORDING COVERAGE NAIC# Bloomfield CT 06002-0805 INSURERA:Gotham Insurance Company 25569 INSURED INSURER B Acadia Insurance Company 31325 P & J Sprinkler Co. Inc. INSURER C: 67 Main Street INSURER D: Willimantic CT 06226 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:CL156203098 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY _EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100 000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ A CLAIMS-MADE X OCCUR GL2013FSC00646 5/31/2015 5/31/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 X Includes E & 0 Form GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 7 POLICY X PE LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED CAA5101112 5/31/2015 5/31/2016 AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) Underinsured motorist $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED X RETENTIONS 10,000 UM2013FSC00246 5/31/2015 5/31/2016 $ B WORKERS COMPENSATION Excluded: David X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY I IMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE YN NIA & Jodi Walencewicz E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in OFFICER/MEMBER EXCLUDED? WCA5101113 5/31/2015 5/31/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under limits Increased 7/16/15 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION brianc@ fariabeede.corn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Thomas G. Faria Corporation 385 Norwich-New LondonTurnpike Uncasville, CT 06382 AUTHORIZED REPRESENTATIVE () ...a..-1,75,,c__ ›S----- 2- �_ Jennifer Semple/SANDY �/- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS(12S(2ninn ,ni Thn A(rlprl nmmea and Innn nrn rnnicfornd mnrkc of Ar(lprl