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HomeMy WebLinkAboutDemo House 2006 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 DEMOLITION PERMIT Permit Number: B2006-0004 Date: 07-Feb-06 Map/Lot: 072/038-000 Owner ID: 5430000 Project Location: 41-43 PEQUOT ROAD Unit: Job Description: Demolish house Owner Name: D.W. Holdings LLC Tenant Name: N/A Careof: 33 Pequot Road Uncasville CT 06382- Telephone: Contractor Name: D W Transport&Leasing,Inc. Telephone: (860)848-1692 DBA: Lic/Reg Type: CA Lic/Reg No: 1134 33 Pequot Rd. Exp Date: 30-Jun-06 Uncasville Ct 06382- Construction Value Permit Fees Construction Information Building Value: $500.00 Building Fee: $15.00 Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code Mechanical Value: $0.00 Mechanical Fee: $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: IRC Total Value: $500.00 Penalty Fee: $0.00 Permit Code: M1 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fee Paid: $1,500.00 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 framing ❑ 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• d❑ Certificate of Approval ■ •. 0 •• panty Building Official's Approval: ��..�. • . • Town of Montville Building Department • 310 Nor,vich N': I �ndon Tpke. DEMOLITION LITION APPLICATION FORM Permit No ? -466o5/. Job Address: qt.—elf 1011' (Number) (Street) (Unit) • Owner: ��'�'' //W4.W4. s. Address: a i ��� U�/�-•° City: 64M✓�.1'' %G State: Zip Code: 06'38Z-- Telephone: (91fa .0 ye? -/652 - . • • Contractor: /../" //;4 ,Pj e _,I 74 t-./0.r/'9Z7i S,o City: . IAA.'l/G%v/€ State: Zip Code:0 671 z • • • Telephone: 6%09- J v License Type:X' °License No.: //3 CExpiration Date: /5--7e5".°8 I hereby certify that the proposed work will conform to the Sta. on Code, State Building Code and all other codes as adopted by the State of Connecticut and the Town of Montville and further attest th-,Al- •,i op.sed 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 Signature; 7 •i . k..// . 4, .- . - Date: / 'Z 2 - 0 6 Contractor Signature: i Date: �'` Demolition Value: ]pe, — Demolition Fee: I- It')rris ( 0p.IIr9(l for submit;Si l—_ {� ❑ Demolition contractor registration (•or B)(C.G.S.Sec.29-402) 7%/ o 6 __/..._____ The following are exempt from the registration requirements o Person engaged in the disassembling,transportation and reconstruction of historic buildings for historic purposes • o Demolition of farm buildings • o Renovation,alteration or reconstruction of a single-family residence • o Demolition of a single-family residence or out building by an owner of such structure if it does not exceed a height of 30'-0",provided that the owner will be present on site while such demolition work is in progress and the structure(s)have a clearance from other structures,roads,highways equal to or greater than the height of the structure subject to demolition • ❑ Copy of certificate of insurance specifying demolition purposes and providing(C.G.S.Sec.29-406); .. • • Liability coverage for bodily injury$100,000 minimum per person with.an aggregate of at least$300,000 • Property damage$50,000 per accident with an.aggregate of at least$100,000 ❑ Certificate shall provide that the Town of Montville and its agents shall be saved harmless from any claim or claims arising out of negligence of the applicant or his agents or employees in the course of the demolition operations.(C.G.S.Sec.29-406) ❑ Certificate of notice by all public utilities having service connections within the premises proposed to be demolished,stating that such utilities have severed such connections and service. (C.G.S. Sec.29-406) ❑ Adjoining property owners have been notified by registered or certified mail at such owner's last address according to the records of the assessor. .(C.G.S,Sec.29-406) • ❑ Uncas Health District approval •?devised eDecem6er31,2005 • Town of Montville ' CONSTRUCTION PERMIT APPROVAL /// fl Job Desction The applicant is responsible for obtaining all of the required approvals checked off on this form. No building permit will be issued until all of the required signatures have been obtained. Required • Department Permit Issuance Approval Approval • Tax Collector .�-�� /f�`��—. . /,1.7/0(e, ✓ WPCA, Administrative4))(24. gignaturel date Comments: ,/ WPCA, Operations l Saturel d e • Comments: Planning &Zoning; Si iiatuiel date Comments: I 7 Health Department /—s ;t Department of Public Works Comments: El State Dept. of Transportation Signature/date . Comments: ( Fire Marshal • . Signature date Comments: • • • 4rtiisee)ugust 5,2005 'l (":c;AIR Mystic Air Qjality Conu1tanth, Inc. 4", 1204 North Road (Rt. 117) Groton, Connecticut 06340 oGsuitt" September 30, 2005 Mr.David Waddington D.W. Transport 41 Trumbull Street New Haven, Connecticut 06510 Re: Post Abatement Inspection Pre-Demolition Review 41-43 Pequot Road Uncasville, Connecticut Dear Mr. Waddington: On September 30, 2005, our asbestos abatement project monitor, Christopher Muller (monitor license#000427), completed a visual inspection at 41-43 Pequot Road Uncasville, Connecticut for fulfillment of criteria for inspection prior to demolition. This site review was for the purpose of determining whether the asbestos-containing materials sited in the asbestos inspection were completely removed in order to allow for demolition to go forward, with regard to asbestos issues. ACM Materials At this time, all of the stipulated asbestos-containing materials are completely removed from the house and property. There is no visible asbestos related dust or debris remaining from these materials in the building, as required by US EPA NESHAPS and the State of Connecticut regulations to allow demolition to proceed. As allowed for by State standards for asbestos abatement, there were no final air tests performed at this site. As such, there can be no entry into this building by any service contractors or other non-asbestos personnel. Should such entry be needed, you will need to contact Mystic Air to return to conduct air tests. Thank you for selecting Mystic Air Quality for these services. Sincerely, Richard Haffey President Communications (24 hours): Office: (860) 449-8903 FAX: (860) 449-8860 Toll Free: 1 (800) 247-7746 website: www.mysticair.com e-mail:magc2@aol.com A.`G AIR gees Mystic Air Con8ultants .A sULit• 1204 North Road (Rt. 117) Groton, CT 06340 Report of Inspection of Asbestos Removal, [`rj/inal Renovation, and Demolition Project [] Interim Date: Site Location: NUICb Ulu- C� Building Identification: 4.11-42, Ucr 0,44 Containment Location: -- s,}N\E- [�Final Inspection Passed [] Inspection Indicates More Work to be Done CHECKLIST: Residual dust on: YES NO YES NO a. Floor e. Vertical - / b. Horizontal su faces Y surfaces f. Nji'�- c. Pipes g. Ducts d. Ventilation h. Register equipment i. Lights FIELD NOTES: C 'r1Nnti�y FINAL AIR SAMPLE RESULTS: M to be Analyzed ] PCM Analyzed on Site Samp # Sam ## S le # mple # ample ## INSPECTOR: 644 / Signature As the owner of this property, I am requesting the permanent removal of the existing CT Light& Power Company (CL&P) electric service and meter(s)to allow for the demolition of the building in accordance with all applicable Connecticut General Statutes. I certify that the building is vacant. Removal of Service for Building Demolition CUSTOMER R QUEST SYSTEM(CRS)TRACKING NUMBER REMOVAL DATE NEEDEpc,c.$0,42 STREET ADDRESSJWHERE ELECTRIC SERVICE IS TO E PERMAN REMOVED cf.- TOWN�,/tel/ y.7 /'') , STAT�/Ef f--GG�� int /I -V..S !!i/.'ti /?- ZIP CODE_ �•a�Cl J Ai`I -d37t?ER8/q&69.8-7,0.-s-182-6 . (S '•~/ 2 �-I' '_ 262 zi?r;dcP METER NU BER S _/_ i(6�Jc . !'- 8frs_S6i7�, 4, -�'SSs/ 24/ -,1` _ � i/ ./S;9113 b sv�%�'s2�1�� ?� -' ot / -�J" S'- 1241 �,r"G©l - PRINT AME OF PROPERTY OWNER, SIGNATURE'OF•"fill?.. l wr•• / /a6hS f Z-� �' 1r 1 // /-„ 2,-o5��, 74oi-,rem MAILIN;; ESS(D� ��C.' TOW N,N�f� /� STATE 6� ZIP CODE J �j TELEPHONE NUMBER O7/g EE/RTY OWNEfj/0 R2467,0 O Beth A. Jabs NOTARY PUBLIC State of Connecticut 1. My Commission Expires 04/3078 �--/ /�1”, Notary Public Date •ot. ized —CL&P Internal Use Only— Date service removed: . Please add a job note to CRS indicating the date and to whom this sign-off form was returned. File this completed form with this completed service removal work order. PRINT NAME OF CLAP REPRESENTATIVE SIGNATURE OF CL&P REPRESENTATIVE DATE To Avoid Delays , Please Complete All Information On This Form and Mail the Original Form to CL&P. FAX copies will not be accepted U.S. Postal: Overnight Express: Mail To: CL&P Clearing Desk Mail To: CL&P Clearing Desk Connecticut Light & Power Co. Connecticut Light & Power Co. P.O. Box 2985 176 Cumberland Ave. Hartford, CT 06104-2985 Wethersfield, CT 06109 CONNECTICUT Department of Public Safety, Division of Fire & Building Safety DEMOLITION CONTRACTORS CERTIFICATE NO: 1134 CLASS :A � DATE ISSUED:2005/07/01 EXPIRES:2006/06/30 Certification as a Demolition Contractor is hereby granted to the person or firm named hereon. Name of Designated Technical Expert : David Waddington SIGNED (DTE) ISSUED TO: D.W. Transport & Leasing, Inc . 33 Pequot Rd Uncasv' lle, T 06382 AUTHORIZED BC -�C... SP-981-C 01 J6 16:56 FAX CPM INSURANCE SERV INC [)001 At ,o„ CERTIFICATE OF LIABILITY INSURANCE OAID AM DATE(MM/DOt(rn) DWZ'RA-1 01/27/06 PRODUC, . . This CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CPM Insurance Services, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 90 Hinman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cheshire CT 06410 Phone: 2 03-272-3521 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA Lincoln General Ins Co D. -W. Transport & Leasing, Inc INSURER B: American Alternative CT Scrap LLC; DW Holdings LLC; Wadd Power LLC INSURER C; Great American Ins Co 33 Pequot Road INSURER 0: Essex Ins Co Uncasville CT 06382 INSURERS: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. [NSF(AUL)L ' POUCYEFFEC'TVE POL CYEXPIRATI W LTRJINSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ L.,000,000 D X X COMMERCIAL GENERAL LIABILITY CGL 082135 04/15/05 04/15/06 PREMISES(Eaoccuronce) $50,^000 CLAIMS MADE xIi OCCUR MED EXP(Any cne person) $Excluded .PERSONAL RADV INJURY 51,000,000 , GENERAL AGGREGATE $2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ 1,000,000 POLICY }[ PRO. — -' - JECT LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1000,000 A X ANY AUTO LWI 100365-02 04/15/05 04/15/06 (Ea actiden1) r ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTos BODILY INJURY X NON-OWNED AUTOS (Per acdaenq X MCS-90 PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 5 10,000,000 B X1 OCCUR CLAIMS MADE 60A2UB000080200 04/15/05 04/15/06 AGGREGATE 310,000,000 DEDUCTIBLE RETENTION 310,000 '3 WC STATU- O1 H- WORKERS COMPENSATION AND (TORY LIMITS ER EMPLOYERS'LIABILITY -- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,de�cribc under --•. - .-- SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S OTHER C Contr Equip I ci341o5e (1,000 DED) 04/15/05 05/15/06 Contr Eq 721,000 C i Cargo MAC1341058 (1,000 DED) 04/15/05 05/15/06 Cargo 15,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Town of Montville is named as additional insued, held harmless CERTIFICATE HOLDER CANCELLATION TOWNM-8 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of Montville IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 310 Norwich-New London Tnpk Uncasville CT 06382 REPRESENTATNES- AUTH ED REPRESENTATI a_ ACORD 25(2001/08) C ©ACORD CORPORATION 1988 01/27/2006 16:56 FAX CPM INSURANCE SERV INC Z002 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) Jan. 27. 2006 4: 15PM No. 3673 P. 2 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 01/27//DDI6Y) PRODUCER 01/27/2006 TYLER COMPANIES Serial# 100664 ONLYTHIS CANDIFICATE IS CONFERSISSUED AS A NO RIGHTS UPONROF THEN CERTIFICATE CATE 330 ROBERTS STREET HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR E HARTFORD,CT 08108 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED OEM AMERICA/DW TRANSPORT&LEASING INC INSURER A: THE PHOENIX INSURANCE CO 330 ROBERTS STREET INSURER B: - EAST HARTFORD, CT 06108 INSURER C: INSURER B: I INSURER E; COVERAGES 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR ADoL TYPE or INSURANCE POLICY EFFECTIVE LTR,NSRDPOLICY NUMBER DATE(AIM/DO POLICY(MXP(RATION GENERAL LIABIUTY M'1 DATE MMIDD LIMITS EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurenco) S !CLAIMS MADE E1 OCCUR MED EXP (Any one person)_ $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER, -1POLICY n JE n LOC PRODUCTS-COMP/OP AGG 5 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ -- (Ea acadenf) - ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) _ (P&aCcdetIAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ 7 ANY AUTO OTHER THAN EA ACC 5 AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABIUTY EACH OCCURRENCE 5 OCCUR Ejj CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKER'S COMPENSATION AND THR-UB-100D6752-05 02/28/05 02/28/06 X 7 1°N- $ A EMPLOYERS'LIABILITY TORY �MI ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? K describe untlel SPEEL DISEASE•EA EMPLOYEE $ 1,000,000 _ CIAL PROVISIONS below OTHER - - EL DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF MONTVILLE DAT T REOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN • ICE 0THECERTIFICATEHOLDERNAMEDTOTHELEFT,BUTFAILURETODOSOSHALL 310 NORWICH- NEW LONDON TURNPIKE UNCASVILLE, CT 06382 MPDS=NC)OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REP- -ENTATIVES. RUTH.•IZED REPRESENTATIVE OF TYLER COMPANIES I ACORD 25(2001/08) V ©ACORD CORPORATION 1988