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Home My WebLink About2004 - Re-Roof Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Building Permit Permit Number: B2004-0161 Date: 26-Apr-04 Map/Lot: 074/038-000 Owner ID 117507 Job Location: PINK Rnw Unit Job Description: roof replacement Owner: Contractor: Martin Gottesdiener Centimark Corp. C/O Kostin Ruffkess and Co 12 Grand View Circle 400 Bayonet St Ste 306 Canonsburg Pa. 15315- New London CT 06320 Telephone: (724) 743-7777 Lic/Reg Type/No. 0 Exp Date: Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $12,495.00 Building Fee: $76.00 Use Group: F-1 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1996 BOCA Mechanical Value: $500.00 Mechanical Fee: $10.00 Construction Type: 2C Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: C4 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $12,995.00 CO Fee: Fire Marshal must be called to inspect pect job site when set up for work-848- Plan Review Fee: $0.00 3030-Ext.381 State Ed Fee: $2.08 Total Fees: $113.08 It is the owners responsibility to schedule the following inspections(minimum 48 hours notice required): ❑ Footing-Prior to pouring concrete ❑ Rough HVAC ❑ Backfill -Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab-Prior to pouring concrete ❑ Chimney-One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service CRS#: 0 Ve] Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑Gas piping and test Building Official's Signature: i Town of Montville Building Department Receipt Date -- V No. 03 %3 From: i /y Job Address: 001/ i Amount $_____12,_.2- _.(f)e- Cash Check Check # Q/� ,� Circle one ~C ��G� I Received byr! .-. -6, ..i,-� Permit # / j I I • COMMERCIAL PERMIT FEE Building $ 12,495 $ 76.00 Plumbing Mechanical Electrical $ 500 $ 10.00 Demolition $ _ Other CO Fee $ 25.00 Plan Review State Ed Fee $ 12,995 $ 2.08 Total Fees $ 113.08 voo- 206150 ..�.� eaThomas G. Faris Corporation 120223 CHECK NO 56912 RP# 1712 04/19/04 113 . 08 113 . 08 11 I Check Amt: 11 Town of Montville # Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231 Application for Commercial Building Permit Permi # 4 ', New Construction 0 AdditionIteration D 'Utility Structure O Other Job Address rZ ii)/V A ROk/ (Number) (Street) (Unit) Job Description �vd.1 /eeo/W9C`P.*ee Owner/4?/4/ e e< Mailing Address VO zr?, o,t�P ,,4 '3 ' LCOS it/ A, /[PSS �� !C City &A/ 4p,vc4t, State Cf Zip 06,32o Tel no / Sy 9a7/ Tenant Mailing Address City State Zip Tel / / Contractor t-jaa(//)/2 as/R/3 Mailing Address /a ',mc/ Vett/ C( e City Kz/cz[sh t i2_ State /q Zip /'5-3/5 Tel 71V / 7Y 3 / 777 .7 Contractor's License/Registration Type&Number Exp. Date / / 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. Separate applications are required for electrical,plumbing, mechanical, etc.. Owner/Agent Signature O _Li/x.,_ /4/f e/2 Date / .2z z Construction Value Fee Building $ Plumbing $ /�1`/ � $ �� Mechanical $ $ Electrical $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ D ` Total $ /°., . ',,� (Code data sheet on reverse must be completed) Town of Montville Building Department 848-3030, Ext 382 COMMERCIAL PERMIT SIGN-OFF SHEET 1422 L Rka Property Address Job Description: bLJc gErakEIV8e— The applicant is responsible for the completion of the form, no permit will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030,Ext.339 Approved ❑ Permit#: ❑ Not Applicable Septic System Date Inspected and ❑ Approved ❑ Not Applicable Food Service Establishment Date Approved ❑ Permit#: ❑ Not Applicable Private Well Date WPCA DEPARTMENT 848-3030,Ext 376 Approved ❑ Permit#: p Not Applicable Municipal Sewer Date Building Trap ❑ Outside ❑ Inside Municipal Water Approved ❑ Permit# ❑ Not Applicable DEPARTMENT OF PUBLIC WORKS 848-7473 Approved ❑ Permit#: 0 Not Applicable Director Date POLICE DEPARTMENT 848-7510 Approved ❑ Permit#: 0 Not Applicable Officer in Charge Date PLANNING&ZONING DEPARTMENT 848-3030,Ext 381 In-Compliance ❑ Permit#: ❑ Not Applicable Zoning Date In-Compliance ❑ Permit#: ❑ Not Applicable Inland-Wetlands Date F ARS 'de/ CE 848-3030,Ext 384 fpproved ,��/ i• 1 ,• Permit#: 0 Not Applicable ` ire arshal II:to 3 v-3 PAGE 1 of 2 CENTIMARK SALES AGREEMENT 12 ttaiicivk 6.,tittle, Canonsburg, PA 15117-8533 1-72444i-7777 Job Number: + Reference Number: h itchaser Job Location Name:Thomas G.Faria Name: SAME Address: 385 Norwich New London turnpike Address: City: Uncasville City: State: CT Zip: 06382 State: Zip: Contact: Don Sawyer Phone:' Phone: 860-848-9271 Building(s)/Section(s): Fornt Office Roof Description of Work Per Proposal Dated: April 16,2004 Or as Follows: tiit'3 htIoi/htit1on, hdkinent ferial.anti Wcirrdniy Purchase Price: $12,195.00 Warranty to be issued in the name of: Purchase PO#: 1.Thomas G.Faria Corporation CentiMark Sales Rep:Mark Thomas 2. Office Location: Rocky Hill,CT Warranty Length/Yrs:'20 Years Phone#: 800-990-0706 Payment Terms:'Net 30 Purchaser to initial acknowledgement of Payment Terms: hlithtilitlg Credit InloiinatIiN - itt*Uiiitb Bank Name: Account#: Address: Contact: Phone#: City: Trade References: 1. Trade Reference: Phone:1 Address: City: State: Zip: 2. Trade Reference: Phone: Address: City: State: Zip: 3. Trade Reference: Phone: Address: City: State:: Zip: By my signature below, I certify that I have authority to hind the purchaser and have had the opportunity to review the terms of this Agreement, including those set forth on the reverse. On behalf of the Purchaser, I understand and accept said terms and agre:tp be ..und thereby. I also authorize the release of credit information toCentimJark Corporation / Appr- e. and epted by purchaser Printed Name and Title Date SUBJECT TO THE FOLLOWING TERMS AND CONDITIONS ON REVERSE Marsh U5A Inc 3fZZ/ZUU3 11 :46 PAU1 Z/Z RightFax 0 ,,-. ..,,Le.,..-,,,,-,,,,:::,-,,,,� b v,, � -,.: aa- : ;. «�`4 � '�£ .,: CERTIFICATE NUMBER ° +.�a,f ; :,:;. ,«a :: m,,+n CLE-001138502-01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Mardi USA Inc. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED N THE Six PPG Place,Suite 300 POLICY.THIS CERTFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE Pittsburgh,PA 15222 AFFORDED BY THE POLICES DESCRIBED HEREIN. COMPANIES AFFORDING COVERAGE COMPANY J02350—ALL-03/04 CENTI A CONTINENTAL CASUALTY CO INSURED CCMPANY CENTIMARK CORPORATION B N/A 12 Grandview Circle Cannonsburg,PA 15317 COMPANY C AMERICAN CASUALTY COMPANY OF READING, PA COMPANY D TRANSPORTATION INSURANCE COMPANY y' `r'� _ ,F,. „,.. , ., , »-:„_ .. .,...,...:-. ..,.,.s...� ...-, ss ,.� .mss iiF�w s 3 �� THIS IS TO CERTIFY THAT PCL ICES OF INSJRANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSJRED NAMED HEREIN FOR THE POLICY PERIOD INDICATED NOrWTHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VNTH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSJRANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS CONDITIONS AND EXCIUSONS OF SUCH POLICES AGGREGATE LIMITS SNOW MAY HAVE BEEN REDUCED BY PAD CLAMS CO POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS LTR DATE(ITUM MONY) DATE(MM/DDNY) A GENERAL LIABILITY GL251940534 05/01/03 05/01/04 X COMMERCIAL GENERAL LIABILITY GENERA-AGGREGATE $ 2,000,000 PRODUCTS-CCMP/OP AGG $ 4,000,000 _. CLAMS MADE IX l OCCUR PERSONALSADVINJURY $ 1,000,000 O/MNER'S3CONTRACttR2'SPROT EAO'IOCCURRENCE $ 1,000,000 •ER PROJECT AGGREGAT: FIRE DAMAGE(My metre) $ 100,000 MED EXP(Any mepereal) $ 25,000 A AUTOMOBILE LIABILITY BUA251940548 05/01/03 05/01/04 COMBINED SNGLE LIMIT $ 1,000,000 X ANY AUTO ALL CANED AUTOS BODILY INJJRY $ ----------- SCHEDULED AUTOS (Per perean) HIRED AUTOS ---__---- BODILY!WAY $ NON-OWNED AUTOS (Per eccltlent) ---------__-- PROPERTY DAMAGE $ GARAYAE LIABILITY AUTO ONLY-EA ACCIDENT $ ■ANY AUTO OTHER THAN/WTOONLY: '>n . 1111 EACH ACCIDENT $ EXCESS LIABILITY AGGREGATE $ — - -- EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM ^$ C WORKERS COMPENSATION AND 1AC251940503 AOS I we srgru- dTH :.? x , „ EMPLOYERSLIABILITV ( 05/01/03 05/01/04 s, e, ns�y..a�;wiat�ss�:g,000 _ T{XRYLIMITS ER =WWW..a;/0mva.,4,R444iHW D Vi.C251940498(NJ,OR,WI) 05/01/03 05,101/04 EL EACH ACCIDENT $ 1,000,000 C THE PROPRIETOR/ INC. M251940517(CA) 05/01/03 05/01/04 PARTNERSEXECJTIVE EL DI�A9EFO_IG1'LIMIT $ 1,000,000 CFFICERSARE• EXCL ELDISEAS=.EACH EMPLOYEE $ 1,000,000 OTHER DESORPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS OTHER WORKERS'COMPENSATION-FOR INFORMATION PURPOSES ONLY-AZ State Fund#187763-2;OH Self Insured#20005105;WA Risk #804.219-00 4,WV Risk#79002151-101;ND Acct#122447;NY State Fund#1320208-4 RE: Job#2600031125,Thomas G. Feria Corporation,385 NorwidVNeN London Turnpike,Uncasvilie,CT 06382 � .' I .'77.7.' a s`? `ycAxw W'''.*Ya oxsi« t� .�s rn Aa,UMa ,;:: � � :- . .�,«ate ,r�t �:as: •` W ,*.x B-IOU)ANY OF TI-E POLICIES DESCRIBED VFREIN BE CANCELLED BEFORE TIE EXPIRATION DATE TVEREOF, THE INSURER AFFORDING COVERAGE WIL FIE)FAVCR TO MAIL. 30 DAYS WRITTEN NOTICE TO TIE Thomas G.Faria Corporation CERTIFICATE HOLDER NAMED HEREIN BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO ORLIORTON OR 385 Norwich/New London Turnpike Uncasville,CT 06382 LIAM ITY OF ANY RIM LEON TI-F INSAFR AFFORDING COVERAGE.ITS AIDENIS OR REPRE SE NIATIVE S OR T1-E I SRRIFR OF TH S CERTIFICATE MARSH USA NO. av R Scott Holden . '' ''''. ••, :ate .. .434" r4; ud ,>» ra = L�..-..-..-<-...F 9/2� , �# DA8 szRysaa„u u u� ,.,.na# 3, ; uax�aw ','”" O . ..--