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HomeMy WebLinkAbout2015 - Weigh Station Footings for Temporary Use Field Inspection Notice Town of Montville Building Department 860-848-3030 Ext. 382 Address: 42 Pink Row Job Description: Install Footings for Weigh Station, Install Weigh Station &Temporary Use of Weigh Station Permit Number(s) B2015-0183, E2015-0139 Permit Date: May 26,2015 Not Approved Approval INSPECTION Comments Special Date "onditions Footings 6/3/15 DJ per • Rebar in footing drawing 6/3/15 DJ schedule Final inspection and 3/29/17 DJ • Weigh station removed and never called for . certificate of approval inspection ReN.Date: 1/18/06 Page 1 of 1 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: B20�5.218 Date: 96-Mov-15 Map/Lot: 074/0,38-flan Owner ID: 5496000 Project Location: 42 PINK ROW Unit: Job Description: _finstqll_EootinasloX Weiah_Stationat,Site.,._1r35tall_We h Staiion—T_er]nc2[ary_Us_e_o_LW__eigh_StQlion Owner Nam Thomas G.Foria Coro. Tenant Name_WA Careof: PC)Box 983 L1ncosvitle CT 06382- Telephone: 18601A4R-9271 Applicant Name _Gporae Baldwin Telephone: (203)164-3917 DBA:_AEC,Jnc. Lic/Reg Type Lic/Reg N 0 41A Commerce irdle Exp Date: Durham CT Cao tract on Yafue Pe if Fie Cor me ni forrnnfinn Building Value: 58.675.00 Building Fee: $13500 Use Group: F-1 Plumbing Value: 50.00 Plumbing Fee: _ SCLOO___ Code: 2005 State.Building Code Mechanical Volu $0.00 Mechanical Fe sa.an Electrical Value: 5500.00 Electrical Fee: 5_50 tL Construction Type 5B Total Value: $9,175.0_0 Penally Fee: MOD__ Permit Code: C2 C of 0 Fee: s0.00 Comment Plan Review Fe S1850_ Fire Marshal Fee of$64.75 Paid State Ed Fee: S2.39 Total Fee Paid: $205.89 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 I] Certificate ► Approval )10 . e of Occupancy _Buildina Official's AoorooL' Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 PERMIT APPLICATION FORM Permit No.: j c3 B�tS T e.of Work Occupancy Classification Construction Type kit rmit Type New Construction ❑A-1 ❑ B ❑H-1 ❑ I-1 ❑ R-1 ❑S-1 ❑T❑ dition ❑A-2 ❑B,Medical ❑H-2 ❑I-2 ❑ R-2 ❑S-2 ❑Type IA ❑Typeype IB ❑Type IV IVB Building Plumbing El Alteration 0 A-3 0 E ❑H-3 0 1-3 12 R-3 Type IIA 0 R-3 0 UMechanical a ❑Change of Use 0 A-4 1 0 H-4Type VA 0 Mechanical 0 A-5 ] -2 0 1-4 0 R-4 0 Mixed 0 Type IIB Type VB 0 Electrical M 0 Type IIIA CRS#: Job Address: e/Z-- /4 k i dW (Number) (Street) (Unit) Job Description: QSTr) //'/ Sys — IA/ei)1 ,S' J- ce - mics/ j( Gv.�<fh j -4 -, j-e °-'--1 C/s—� s - Owner: / ID S A /"A— Tenant: 1/4 A. ,T-h'Cd-- Address: LI/2— A'""' '"w C ^ Address: Y/`F7'�' City/State/Zip: V/le-S((rile_ T- City/State/Zip: Telephone: ('860 j g yg - .72_7/ Telephone: Contractor: 4g/ —TAX-- MP(/' --e--ill7.- XIIC/ (zG) -)L ie. r- DBA: • / 39 /7 Address: if 4 O',Z 1/rc. - CI"4C City: 1A -AA C f - o‘V 1 Z State: Zip Code: Telephone: License Type: License No.: Expiration 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. M /t711014— iFid / s_ • Owner/Agent Signature: i fA,rri -j /I •• Date: •• ' - Construuccttiion.Value.. . • .. • • .Permit fees Building Value: jJ •t9 7 C• 0"0 •• • Building Fee:. ' , ' Plumbing Value: . .. Plumbing Fee: ' Mechanical Value: . • Mechanical Fee: . • • Electrical Value: Electrical Fee: Total Value: Penalty Fee: ' • •C of O Fee: Plan Review Fee: • State Ed Fee: • Total Fee: •r grolterk cDeccm6er31,2005 ' Town of Montville Building Department 310 Norwich-New London Tpke. TA. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 PERMIT APPLICATION FORM Permit No.: Type.of Work Occuaancy Classification ❑New Construction 0 A_1 0 B 0 H-1 1-1 Construction Type Permit TVPe R-1 0 S-1 0 Type IA 0 Type IIIB Building❑Addition ❑A-2 0 B,Medical 0 H-2 0 1-2 0 R_2 0 S-2 0 Type IB 0 Type IV Plumbing0 0❑Alteration o A-3 0 E 0 H-3 0 1-3 0 R-3 0 U 0 Type IIA 0 Type VA 0 Mechan al❑ ati of Use A-40 F-1 0 H-4 0 1-4 0 R-4 ❑Mixed ❑Type IIB 0Type VB 0 Electrical A-5 0 F_2 M 0 Type IIIA CRS#: Job Address: ;4- k 4") (Number) (Street) Job Description: /—i( evei (Unit) c, b. - ‘2.4.5/41-1/ /tip. 4 .y 74\-- t_. C ` °•-•"-a,, C.,i- S / Nt',,_ • Owner: // )ibis £-50-A— lcle� G✓i -e c - / Tenant: Ti.�C Z Address: ,2._ i, JL - civ- City/State/Zip: Gill bks offddress: sft'l f �� Cr—�� City/State/Zip: Telephone: (+�6t )£ 3 tl 9 Z-7/ Telephone: • Contractor: 4L no-Ar: ,44-,_b.__I -ter (Zo3 I.YGY-3817 DBA: r, Address: `//A ',41 in-?rc-_ c r c-i‘ City: .A A ., State: Zip Code: . Z Z Telephone: License Type:• YP License No.: Expiration Date: I hereby cartify that the proposed work will conform to the State Building Code and all other codes as adopted by the State of Connect) 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. cut and the Town A ,12 z Owner/Agent Signature: ( A' Jt. F =� > Date: P /� • • . • • ' Coifstruction.Value•. . Building Value: • ' . .Perm Fees ' ' • . •• Plumbing Value: . • Building Fee:, Mechanical Vaiue: . • Plumbing Fee: . Electrical Value: Mechanical Fee: • Total Value: Electrical Fee: Penalty Fee: •C of O Fee: Plan Review Fee: State Ed Fee: Total Fee: • r • • 1Wiieck fDecem6tr31,2005 . Town of Montville Building Department File Receipt Date: 21-May-15 ReceiptNo: 10365 Received From: AEC Inc. Job Address: 42 Pink Row Town Fees Collected State of Connecticut Fees Collected Bldg Cash: $0.00 State Cash: $0.00 Bldg Check: $205.89 State Check: $2.39 Bldg Credit: $0.00 State Credit: Fire Cash: $0.00 $0.00 Fire Check: $64.75 Fire Credit: $0.00 Construction Value: $9,175.00 Demolition Value: $0.00 CheckNo: 1023 Received By: Carmen Kneeland 14 rY\ 0 0 (Lr) °i 'd• 6 I O I I c' N tt I I I . I 1 I I I I • • (.0 • r N (` N 1f3 Eft E9 El) if)- Ef3 EF) EA E43 Ef3 40 ER ER *ft VI (1) E9 VI Eft to- -(4 Z 0 to O nin y N N (0 (f) V LL LCL F_. r cc 0) c Q as co J a) u) U Cc > it m g ill .— m ._I - c II Q .2 a) ii c.) ii t N Z I— rro N 0 a) >. 0 - 1)Cc 0 Fr Y 6' N 'a W . 3 O m a v a •7) .2 m m d ns > f-c 5 0E 69 v7 Ef3 m Q co ca c a E Ci 43 C 7:1CC 0) a w a v) 2 Y LL W C , L a' III - 0 0 c u _ALL 0 0 E cc cc 0 0 3 3 a c0a) 0 0 £ a 0).2 >Tri a) ssen o a E a) m e c , a) N ,c20) L LL � � � � a� ¢ w 0 0 c a) •5 c a) 0 0 al ca •5 O mLT2w0 [Tc7i m it I— c >> >. c c cic cic c c c c c 173 1a) t a) 0 > cc m c 2 m — 2 ca a m it a Commercial Recording Division Page 1 of 1 Business Inquiry A HOME 'i HELP Business Details Business Name: AEC, INC. Citizenship/State Inc: Domestic/CT Business ID: 1159305 Last Report Filed Year: NONE Business Address: 41A COMMERCE CIRCLE, DURHAM, CT, 06422 Business Type: Stock Mailing Address: NONE Business Status: Active Date Inc/Registration: Nov 06, 2014 Principals Details Name/Title Business Address Residence Address ANTHONY RICHARDI 41A COMMERCE CIRCLE, 21 PROMONTORY DRIVE, WALLINGFORD, CT, PRESIDENT DURHAM, CT, 06422 06492 ANTHONY RICHARDI 41A COMMERCE CIRCLE, 21 PROMONTORY DRIVE, WALLINGFORD, CT, DIRECTOR DURHAM, CT, 06422 06492 Agent Summary Agent Name ANTHONY RICHARDI Agent Business 41A COMMERCE CIRCLE, DURHAM, CT, 06422 Address Agent Residence 21 PROMONTORY DRIVE, WALLINGFORD, CT, 06492 Address Back View Filing History View Name History View Shares http://www.concord-sots.ct.goy/CONCORD/PublicInquiry?eid=9744&businesslD=1159305 5/12/2015 CORO ACERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/3/2015 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 Mary Tomaselli The Falcigno Group, LLC IAONNFxtt' (203)901-1093 (AG .N9): (203)234-7386 P.O. Box 271853 ADDIRESS:mtomaselli@falcigno.com INSURER(S)AFFORDING COVERAGE NAIC# West Hartford CT 06127-1853 INSURERANautilus Insurance Company INSURED INSURER B:Great Divide Insurance Co. AEC Environmental, LLC INsuRERc:Great American Insurance Co Earth Technology II, LLC INSURER D: Post Office Box 338 INSURERS: North Haven CT 06973 INSURER F: COVERAGES CERTIFICATE NUMBER:2015-16 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 A CLAIMS-MADE OCCUR ECP0154518813 2/1/2015 2/2/2016 MED EXP(Any one person) $ 5,000 X POLLUTION LIABILITY PERSONAL&ADV INJURY $ 1,000,000 X PROFESSIONAL LIABILITY GENERAL AGGREGATE _ $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 1 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BAP154518913 2/1/2015 2/1/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-O ED PROPERTY DAMAGE X MCS-90 (Per accident) $ Uninsured motorist combined $ 40,000 X UMBRELLA LIAR _ OCCUR EACH OCCURRENCE _ $ 4,000,000 A EXCESSLIAB CLAIMS-MADE FFX154518713 2/1/2015 2/1/2016 AGGREGATE $ 4,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY Y/N X TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E EACH ACCIDENT $ 1,000,000 B (Mandatory in NH) WCA154519013 2/1/2015 2/1/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C MOTOR TRUCK CARGO MAC755900509 2/1/2015 2/1/2016 LIMIT $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 *****SAMPLE***** ACCORDANCE WITH THE POLICY PROVISIONS. *****CERTIFICATE***** AUTHORIZED REPRESENTATIVE Mary Tomaselli/TOMAMA —V- ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSD25 r,mnrn i nt Tho Arr1Rll Hamm anri Innn arc ranicicrmri mar4c of Arrtpn pikS DEPARTMENT OF ADMINISTRATIVE SERVICES STATE OF CONNECTICUT DIVISION OF CONSTRUCTION SERVICES OFFICE OF THE STATE FIRE MARSHAL DEMOLITION CONTRACTOR LICENSE LICENSE NO:2042 CLASS:A This License is being issued pursuant to Connecticut General Statute 29-402 to: AEC Inc 41A Commerce Circle Durham CT 06422 Designated Technical Expert: George P. Baldwin Issued by: CA74 /1( Commissioner Date Issued: 2015/05/01 Expires: 2016/03/31 165 Capitol Avenue, Room 258 Hartford, CT 06106 Phone: (860) 713-5580 Fax: (860) 713-7424 www.ct.gov/dcs An Affirmative Action/Equal Opportunity Employer 0 Cfl Z M Z LO z C7 5 ... cV . z_ — � co r z M z M ; O z C+) M z O O > O Z 4 J !e m J L G6S ,.,., � z UhI! O 3 W C � 0 0 `?w wE < co zvW p x r aEc> a z �,< a Et A ^' z F U) 7% - = m z D U) o H m W / E. I `, STATE OF CONNECTICUT HOISTING CERTIFICATE George Baldwin 316 Hubbard Rd. Higganum, CT 06441 DOB : 03/28/1943 LICENSE # : 1272 EXP. DATE: 03/28/2017 Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL Applicant is responsible for obtaining all of the required approvals. No •ermit will be issued until all the re.uired si•natures are obtained. Li 2 „1/4:4 Property Address V2-‘1.44-d- (--(-k-Ntr Job Description Required Department Permit Issuance Approval Approval y�,� Tax Collector -�c,�2� / l!C 1-uc„ - /5"-- /5 i n toe/date Comments: C Ccri.i 'ic SiS Planning &Zoning Ott-, Signatu e/date t Comments: ® Fire Marshal //•� j Signature/date Comments: ❑ Health Department Required for properties with private septic or well Comments: WPCA, Administrative V V `� ( `5 Required for properties on sewer ignature/date Comments: ❑ 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: ❑ State Dept. of Transportation Required for Structures over 100,000 sq.ft or with more than 200 parking s.aces-Official co• of STC Certificate of O.eration re•uired-.er CGS 14-311 Signature/date Building Department Review Complete Signature!date 2.eviser<,ay23 2011 Commercial Recording Division Page 1 of 1 Business Inquiry HOME 0 HELP Business Details Business Name: AEC, INC. Citizenship/State Inc: Domestic/CT Business ID: 1159305 Last Report Filed Year: NONE Business Address: 41A COMMERCE CIRCLE, DURHAM, CT, 06422 Business Type: Stock Mailing Address: NONE Business Status: Active Date Inc/Registration: Nov 06, 2014 Principals Details Name/Title Business Address Residence Address ANTHONY RICHARDI 41A COMMERCE CIRCLE, 21 PROMONTORY DRIVE, WALLINGFORD, CT, PRESIDENT DURHAM, CT, 06422 06492 ANTHONY RICHARDI 41A COMMERCE CIRCLE, 21 PROMONTORY DRIVE, WALLINGFORD, CT, DIRECTOR DURHAM, CT, 06422 06492 Agent Summary Agent Name ANTHONY RICHARDI Agent Business 41A COMMERCE CIRCLE, DURHAM, CT, 06422 Address Agent Residence 21 PROMONTORY DRIVE, WALLINGFORD, CT, 06492 Address Back View Filing History I I View Name History IView Shares I http://www.concord sots.ct.gov/CONCORD/PublicInquiry?eid=9744&businesslD=1159305 5/12/2015 ACCPREP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/3/2015 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 Mary Tomaselli The Falcigno Group, LLC PHONE IAlC No F>nr. (203)901-1093 FAX No1:(203)234-7386 P.O. Box 271853 E-MAIL mtomaslli ADDRESS: e@falci gr10.COm INSURER(S)AFFORDING COVERAGE NAIC# West Hartford CT 06127-1853 INSURERA:Nautilus Insurance Company INSURED INSURER B Great Divide Insurance Co. AEC Environmental, LLC INSURERC:Great American Insurance Co Earth Technology II, LLC INSURER D: Post Office Box 338 INSURERE: North Haven CT 06473 INSURERF: COVERAGES CERTIFICATE NUMBER:2015-16 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 LTR TYPE OF INSURANCE INSR MID POLICY NUMBER (MM/DD/YYYYL(MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 A CLAIMS-MADE OCCUR ECP0154518813 2/1/2015 2/2/2016 MED EXP(Any one person) _ $ 5,000 X POLLUTION LIABILITY PERSONAL F.ADV INJURY $ 1,000,000 X PROFESSIONAL LIABILITY GENERAL AGGREGATE _ $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 -X POLICY PRO- .ECT LOC $ 1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Eaaccidenq $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BAP154518913 2/1/2015 2/1/2016 BODILYINJURY(Peraccident) $ AUTOS AUTOS X HIRED AUTOS X NOTN-OWNED PROPERTY DAMAGE — X MCS-90 (Per accident) - $ Uninsured motorist combined _$ 40,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS UAB CLAIMS-MADE FFX154518713 2/1/2015 2/1/2016 AGGREGATE 5 4,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- 0TH- - AND EMPLOYERS'LIABILITY Y/N X TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A B (Mandatory In NH) WCA154519013 2/1/2015 2/1/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000 000 If yes,describe under , DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C MOTOR TRUCK CARGO MAC755900509 2/1/2015 2/1/2016 LIMIT $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS I 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 *****SAMPLE***** ACCORDANCE WITH THE POLICY PROVISIONS. *****CERTIFICATE***** AUTHORIZED REPRESENTATIVE Mary Tomaselli/TOMAMAcLM-S_T ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSO25r9mnnsim Tho A(CIPll name anti Inns arc,renicterc,ri marlrc of ArrlRrl j!1 hyry��i. DD1S EPARTMENT OF ADMINISTRATIVE SERVICES . STATE OF CONNECTICUT DIVISION OF CONSTRUCTION SERVICES OFFICE OF THE STATE FIRE MARSHAL DEMOLITION CONTRACTOR LICENSE LICENSE NO:2042 CLASS:A This License is being issued pursuant to Connecticut General Statute 29-402 to: AEC Inc 41A Commerce Circle Durham CT 06422 Designated Technical Expert: George P. Baldwin Issued by: j.e.,44 ._ C � ' Commissioner Date Issued: 2015/05/01 Expires : 2016/03/31 165 Capitol Avenue, Room 258 Hartford, CT 06106 Phone:(860) 713-5580 Fax: (860) 713-7424 www.ct.gov/dcs An Affirmative Action/Equal Opportunity Employer I • U C O 00 z (h 5 • N —� J i O . c1xC) = " Q z M c, O M OO > o Ce .:., n en J i 4 <0) F J ? lll o .. U ° i- <CW <LAI U) W Zv:W p r y0 W, z Di—Q CIO (_ T CO M z F U) o Q z m < w A cC D O 1 110 STATE OF CONNECTICUT HOISTING CERTIFICATE George Baldwin 316 Hubbard Rd. Higganum, CT 06441 DOB : 03/28/1943 LICENSE # : 1272 EXP. DATE: 03/28/2017 Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL Applicant is responsible for obtaining all of the required approvals. No •ermit will be issued until all the re a uired si•natures are obtained. Z ,fit RC11^-) Property Address •� -4:4 ��"( Job Description .% Required Department Permit Issuance Approval Approval ® Tax Collector ,P1(.2_x�- z> ���� S �I ,Signature/date Comments: Planning &ZoningCepee,--t6-1 S/1" Al-- Signature/date t Comments: ® Fire Marshal //w` /i�'j /( Signature/date Comments: ❑ Health Department Required for properties with private septic or well Comments: WPCA, Administrative Required for properties on sewer Signature/date Comments: ❑ 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: ❑ State Dept. of Transportation Required for Structures over 100,000 sq.ft or with more than 200 parking s.aces-Official co. of STC Certificate of O.eration re•uired—.er CGS 14-311 Signature/date Building Department Review Complete Signature/date Revised May 23,2011