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HomeMy WebLinkAboutStructure Move 2003 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Demolition Permit Permit Number: B2003-0606 Date: 21-Oct-03 Map/Lot: 072/036-000 Owner ID 116016 Job Location: PEOUOT Rnen Unit Job Description: Remove garage Porches-move structure to 59 Hammel Owner: Contractor: David Waddington D.W.Transport P. 0. Box 462 66 Cross Road Uncasville Ct. 06382- Waterford CT 06385 Telephone: (860)848-1692 Lic/Reg Type/No. Class-A 1134 Exp Date: 30-Jun-04 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $5,000.00 Building Fee: $35.00 Use Group: R4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABG Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 56 Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: M1 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $5,000.00 CO Fee: $25.00 Plan Review Fee: $0.00 State Ed Fee: $0.80 Total Fees: $60.80 It is the owners responsibility to schedule the followin4 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 El Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: Town of Montville Permit # Building Department 310 Norwich-New London Tpke. Tel. 848-7166, Ext 81 Uncasville, CT 06382 Fax. 848-7231 ;/ ' Application for Demolition Permit Job Location /mgr/"'a/ ��LZ��- Job Description/Materia24!A ,Ad 71 17v-,,O/ ge/ s '/-tYPI,A � ,4h.6 4 Lv/;,-1 x �� CI. �y� �.�, r SVA-! 1,P2Owner //d�% /,lh Mailing Address O Ch.6.4esol City / ' c%/ State 617. Zip O6I6P5- Tel / g/ Contractor� t< 224/16;1004.4, Mailing Address gQ� 96-2- City 6ZCity f//va, iL, State C--141 Zip C;67e92, Tel /64/ J Contractor's License/Registration Type&Number AL 1/1 y - 42,J 1 Exp. Date /Jo / 09 I hereby certify that the proposed work will conform �, : B sic Building Code and all other codes as adopted by the State of Connecticut and the Town of Montvill--0 ,� Contractor Signature d7 `� ��� Date /0 / � / Owner Signature ` , ` Date/ 5 / -7 / ar Construction Value Fee Demolition $ r Q D"O -. $ State Education Fee $ Total $ $ Town of Montville Building Department Receipt Date /v / c,?/ / 03 No. U3277 From: 99 0/ ZUA00//0‘.73 Job Address: 96 46 is V i A Amount $ 6c) Cash 41M Check # 3 (Circle one) Received by _ - Permit #62003 -6.0G COMMERCIAL PERMIT FEE Building $ _ $ Plumbing $ $ Mechanical $ _ $ Electrical $ _ $ Demolition $ 5,000 $ 35.00 Other $ - $ CO Fee $ 25.00 Plan Review $ - State Ed Fee $ 5,000 $ 0.80 Total Fees $ 60.80 Town of Montville Building Department 848-7166, Ext 81 Application Requirements For Demolition The requirements for demolition shall conform to the State Demolition Code (C.G.S. section 29-401) and BOCA Section 3310 & Section 110.0. ❑ Certificate of Insurance specifying demolition purposes ❑ Liability coverage for bodily injury of at least $100,000/person with an aggregate of at least $300,000 ❑ Property damage of at least $50,000/accident with an aggregate of at least $100,000 ❑ Certificate shall provide that the town or city and its agents shall be saved harmless from any claim or claims arising out of the negligence of the applicant or his agents or employees in the course of the demolition operation. n Certificate of notice executed by all public utilities having service connections stating that such utilities have severed such connections and service (Electrical, Sewer, Water, Gas) n Certificate of registration from the State of Connecticut (Class A or Class B) Exception: ❑ Historic structure disassembling, relocation ❑ Farm Buildings n Renovations, alterations of single-family residence n Owner engaged in the demolition of a single-family residence or outbuilding ❑ Permit to be signed by the owner and demolition contractor ❑ Adjoining property owners shall be notified by registered or certified mail (min. 1 week prior to work being performed 3310.1) ❑ Fence to be erected during the operation, min. 8 ft high; fence may be waived at the discretion of the Building Official in writing Required Inspections: Minimum 24-hr. notice required Final After debris has been removed and property re-graded Town of Montville Building Department (860) 848-7166, Ext 81 DEMOLITION PERMIT SIGN-OFF SHEET HEALTH DISTRICT 0 The septic system has been disconnected, inspected, and approved. This structure is not served by a septic system. S Gt/'-d 1 Suture u � ,e���1 Date Agency lEr The well has been disconnected, inspected,and approved. 0 This structure is not served by a well. 4,,,.,icv-L,Q._:. ,o^,, ,3 gnature Date Agency MUNICIPAL SEWER/WATER The municipal sewer line has been disconnected, inspected, and approved. 0 This structure is not served by a municipal sewer system. - S,),‘C))%---...........___, 40C--7— Q), k,L) LA Signature Date Agency ❑ The municipal water line has been disconnected, inspected, and approved. X] This structure is not served by a municipal water system. - 'ktV.:%)-. — e.. C) CT— C.) LA>C.A Signature Date Agency ELEC ' CAL (Letter from utility company required) The electrical service has been disconnect inspected,� p ed, and approved. P This structure is not served by the electric utility. Iii 649 kir° Signature Date Agency NATURAL GAS (Letter from utility company required) ❑ The gas service has been disconnected, inspected, and approved. ❑ This structure is not s ed by natural gas. t7 . Si‘i2re Date Agency (C.-`) li OCT-20-2003 MON 03:20 PM CL&P WATERFORD FAX NO. 860 447 5755 P. 01 `,— R .CEWE } a M24i4 NV. evririectiveti Lig 4i h.Powta CO. P.0 Box?ARS �. iJUL, 24T-43 Hartford, CT. 06104-2985 li. i CL:iit�l't7v� RE:Removal of Service for Boildine Demolition e i.-; As the owner of this property's am requesting The permanent removal of the existing CT'Light&Power Company (CL&P1 PJP.[Aric SBYuiac4>3!?d.!tlette,r(S,1.tty 011.a40/.fnr the.ttAmaJituic+of the itv.lading,is.acccv wee Imo"an aJilicabJ Connecticut General Statutes. I certify that the building is vacant Customer Request System (CRS)tracking number (-#b lae r3B- 9,-.00,-..-). i I Lt/ drirsss 14rt'P7es** csarvice.iF to fix;+ ntlsremnvied. P IlL1/1r,Cis. v R t e___ c_7; 0 t-.5 fir-.X.,-, mull,State and-zip costo C oz 5-,z 05-1e,) 460 a?S`6_, - Meter number(s) CSS ,w9,) Mc t.cr number(s) % j Comments:: ®`l Y � /�ZC�v"` J GruLe Tier'r Print name of property owner: bG .J'•--tl 14 j ,i\---- �/ rH / T -4-t,...._, Signature of property ouvncr: ✓ 1 -�fJfJ Mailing Address: I'. C'- 6, -1___•1(4,,4-4, L Tok State Zip Code: �-t^^c--6.�,v'C>l ,. Cr( d(.3 ,f _ F.- . . ..Pi•: i,ne Number or property owner; `t. iti }'t - /s.S J-, _ 1....-fir Beth A.Jabs j I NIOTA RI'PUBLIC Notary Pt1b; ,c ••• - _ _ - I. �+eCtiCdi I I _ ' ars P v Commission fires D 417ai itL UNA`Inler�tri use only . _. , y l r?3wie service removed - -� I e 5 6 Please add a job note to CRS indicating the 1 signed-off-form was returned. bile this completed form with the c L dere and to whom this �¢tp eted service rfmoval work order. v.srst nearre of CLt�.2 4tepst;scrAs►ti'vt',__Vnkr 1 '`, C C Signature of CL&.l'Representative: .e___ '_• .�-dh.a y Telephone Number: 3j 7• . E� 4 Date: 8-�,-�To Avoid Delays Please Complete All information On The Form CONNECTICUT Department of Public Safety, tit' 0 Division of Fire & Building Safety . DEMOLITION CONTRACTORS CERTIFICATE NO: 1134 CLASS :A DATE ISSUED:2003/07/01 EXPIRES:2004/06/30 Certification as a Demolition ontractor is hereby granted to the person or firm nam- . Name of Designated Techn'�'' eon. SIGNED (DTE) /��, Expert : David Waddington ISSUED TO: D.W. Transpo4Pr& Leasing, Inc. 33 Pequot Rd Uncasvoe, 0 3 2 AUTHORIZED BY: SP-981-C ACORD CERTIFICATE OF LIABILITY INSURANCE OP IDAM I DATE(MMIDO/YY) PRODUCER DWTRA-1 04/10/03 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: 203-272-3521 INSURERS AFFORDING COVERAGE INSURED INSURER A: Lincoln General Ins Co INSURERS: Diamond State Ins Co D. W. Transport & Leasing, Inc INSURER C. 33 Pequot Road Uncasville CT 06382 INSURER O. J 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 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. MISR LTR TYPE OF INSURANCE POUCY POLICY NUMBER DATEiMMADD/YY)EFFECTIVE DATEI WDD/YY)N LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A 111 coMMERCIALGENERALUABILHY LWI 100365 04/15/03 04/15/04 FIRE DAMAGE(ARY PIN R.) f ■ CLAIMS MADE I X I OCC 50,000 © MED EXP(Any one pawn) s 5,000 ■ PERSONALaADVINJIRY s 1,000,000 GENERAL AGGREGATE f 2,000,000 DENS AGGREGATE LIMIT APPLIES PER: POLICY X PRO PRODUCTS-COMP/OP AGG ECT LOC s 1,000,000 AUTOMOBILE LIABILITY A X MA'AM LWI 100366 COMBINED SINGLE LIMIT f 1,000,000 04/15/03 04/15/04 (EA cc°°"> ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per Person) $ X HIRED AUTOS X NON-OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE IP-.cadenq GARAGE UABIUTY ANY AUTO AUTO ONLY-EA ACCIDENT f OTHER THAN EA ACC f AUTO ONLY: AGG 5 EXCESS LIABILITY EACH OCCURRENCE s 10,000,000 B X OCCUR I CLAIMS MADE CU75910 04/15/03 04/15/04 AGGREGATE s 10,000,000 DEDUCTIBLE f X I RETENTION s 10,000 WORKERS COMPENSATION AND ORSYU TYLMITs I IRRT OTR.ER EMPLOYFRS'LIABILTTY E.L.EACH ACCIDENT f E.L.DISEASE-EA EMPLOYEE f OTHER E.L.DISEASE-POLICY LIMITf DESCRIPTION OF OPERATIONS&LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER I N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SAMPL-1 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jim Bradanini ACORD 25-S(7/97) ©ACORD CORPORAWN 1988 ACORD INSURANCE BINDER OP ID AN1 DATE 09 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT,SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM/16/03 PRODUCER PHONE (A/C,No,Ext): 203-272-3521 COMPANY BINDER# 10871 Quaker Special Risk CPM Insurance Services, Inc EFFECTIVE TIMEEXPIRATION DATE DATE TIME 90 Hinman Street Cheshire CT 06410 AM 12:01 AM 09/17/03 PM 11/17/03 NOON Jim Bradanini CODE: THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY SUB CODE: PER EXPIRING POLICY#: 02 CPLD 02 2 7 AGENCY CUSTOMER ID: DWTRA-1 DESCRIPTION OF OPERATIONSNEHICLES/PROPERTY(Including Location) INSURED Contractor's Pollution Liability D. W. Transport & Leasing Inc P.O. Box 462 Uncasville CT 06382 I COVERAGES TYPE OF INSURANCE LIMITS COVERAGE/FORMS DEDUCTIBLE COINS% AMOUNT PROPERTY CAUSES OF LOSS BASIC BROAD SPEC GENERAL LIABILITY EACH OCCURRENCE $5,000,000 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE OCCUR _ X Pollution Liabilty MED EXP(My one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $5,000,000 RETRO DATE FOR CLAIMS MADE: PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS _ BODILY INJURY(Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS MEDICAL PAYMENTS $ PERSONAL INJURY PROT $ UNINSURED MOTORIST $ AUTO PHYSICAL DAMAGE DEDUCTIBLE $ ALL VEHICLES SCHEDULED VEHICLES ACTUALCASH VALUE COLLISION: OTHER THAN COL: - STATED AMOUNT OTHER $ GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ EXCESS LIABILITY AGGREGATE $ UMBRELLA FORM EACH OCCURRENCE $ — OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: AGGREGATE $ SELF-INSURED RETENTION $ WORKER'S COMPENSATION I WC STATUTORY LIMITS AND E.L.EACH ACCIDENT $ EMPLOYER'S LIABILITY E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ SPECIAL CONDIITIONS! COFEES $ VERTI3ES TAXES $ NAME&ADDRESS ESTIMATED TOTAL PREMIUM $ MORTGAGEE ADDITIONAL INSURED LOSS PAYEE LOAN# AUTHORIZED REPRESENTATIVE Jim Bradanini ACORD 75-S(1/98) NOTE:IMPORTANT STATE INFORMATION ON REVERSE SIDE ©ACORD CORPORATION 1993 ACORDM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YY) 04/03/2003 PRODUCER Serial# B2260 THIS CERTIFICATE IS ISSUED AS A MATTER-OF INFORMATION TYLER UNDERWRITING SERVICES, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 330 ROBERTS STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. EAST HARTFORD, CT 06108 INSURERS AFFORDING COVERAGE INSURED O.E.M.OF CONNECTICUT,INC../D.W.TRANSPORT& INSURER A: THE PHOENIX INSURANCE COMPANY LEASING, INC. INSURER B: 330 ROBERTS STREET INSURER C: EAST HARTFORD, CT 06108 INSURER D: 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 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. INSTZ LTR j TYPE OF INSURANCE POLICY NUMBER PEW; POLICY(EXPIRATIOW ( /'n') DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(My one fire) $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: _ POLICY JECT LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS _ NON-OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO _ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE _ RETENTION $ A I WORKEMP ERS COM E NSPENSA ON AND TRH-UB-100D6752-03 02/28/03 02/28/04 X I TORY LIMITS I ER ITY E.L EACH ACCIDENT $ 1,000,000 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 OTHER E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCL USIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION 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 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. 1 Al ORIZED REPRESENTATIVE / ACORD 25-S(7/97) a) Let�j i �l �( �, ACORD CORPORATION 1988