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: B2006-0003 Date: 07-Feb-06 Map/Lot: 078/053000 Owner ID: 5434000
Project Location: 51 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 El Pool Bonding
❑ Anchor Bolts-with sill plate and prior to floor framing El Electrical Service CRS No: 0
❑ Framing ❑ R HVAC
❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test
❑ Fireblocking Draftstopping INSPECTION REOUIRED UPON COMPLETION
❑ Insulation E] Certificate of Approval
Certifi - . c- p.,
Buildina Official's Approval:
s
Town of Montville
44 Buildin'q Department
310 Norwich-New London Tpke.
•
DEMOLITION APPLICATION FORM . • • Permit No. ?,— ,
Job Address: . S. / /�"L>G"/ •
(Number) (Street) (Unit)
•
Owner: .! f / 43 LZ , •
• Address: 7 Af Z/D/ //' Q
City: V/AGOSI,/ -/G• State: Zip Code: O67a
Telephone: • 26-0 - — "—/G7/91, • . .
• Contractor: �I� 2"f)en / L .r'/y
71 /.P o
City:. l / 7J t,' -�J ' /y,�. State: C✓' Zip Code: o�19
Telephone: ��f�''7bJZ License Type:I #.t.0 License No.: //7y Expiration Date: _ Jd�o‘
.1 hereby certify that the proposed work will conform to.the St- ao1 •lition Code,State Building Code and all other codes as adopted by the State of
,Connecticut and the Town of Montville and further attest th,li iposed work is - thorized by the owner in fee and,that I am authorized to.make.
•
• application for a permit for such work es described above.
.Owner Signature: '.P . Date:
• Contractor Signature: Av %`,` Date: /2, )-- 0C
Demolition Value: GG nc"-nni;tl1n Foe' S
62Ck 2//6 _._,2 _
❑ Demolition contractor registration (C!ass A or B)(C.G.S.Sec. 2 -=102)
• 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 structures)have a clearance from other
structures,roads,highways equal to or greater than the height of•the structure.subject to demolition
o Copy 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) '
L I 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)
o •Uncas.Health District approval . .
devised(Decem6er 31,2005 . •
•
Town of Montville
CONSTRUCTION PERMIT APPROVAL
U /f-d
Job Description •
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 Collectori/ 7 Jo 6,.
❑ WPCA, Administrative • 36.10
Sin f_#care/date
Comments:
WPCA, Operations _ice , 3 G'_
S': ature/:d-te
Comments: •
❑ Planning & Zoning
Comments:
Health Department Com. 3o
-04,
Department of Public Works
Comments:
State Dept. of Transportation
Signature/.date. .
Comments:
fS5' Fire Marshal
0 %-i/e'
! ZVie
igne/ date
Comments: •
•
RZevired 7ugwt S,2005
G Alit le\
E Mystic Air Ciality Con&iltanth, Inc.
1204 North Road (Rt. 117) Groton, Connecticut 06340
September 30, 2005
Mr.David Waddington
D.W. Transport
41 Trumbull Street
New Haven, Connecticut 06510
Re: Post Abatement Inspection
Pre-Demolition Review
51 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 51 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,
IAA
Richard Haffey r
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`GAIRgO
Mystic �1�' QualityConsultants
E
c0° T
suL ���s 1204 North Road (Rt. 117)
Groton, CT 06340
Report of Inspection of Asbestos Removal, ( "sinal
Renovation, and Demolition Project [] Interim
Date: Oqj - O-d�S
Site Location: ,vc VA-4-- � -
Building Identification: S/ S?gavcr 4_
Containment Location: — 5,5-4WE, —
[Final Inspection Passed
[] Inspection Indicates More Work to be Done
CHECKLIST:
Residual dust on:
YES NO YES NO
a. Floor V- e. Vertical
b. Horizontal surfaces
surfaces f. 04-
c. Pipes g. Ducts
d. Ventilation
Tih. Register
equipment i. Lights j(::
FIELD NOTES:
U 1 N-Co+,0 C LAZJ NCS 5 — eic O ZC.
1-1NOL__wk N • K-\TGHtyl
L, ( P ') - 1�L,1 '? fe Z'�
Fi c 111,tES - 2---- -P,0011, Sa..'TFt
• Lt..�\--x\tA C\ - Cok &A t.s&4
FINAL AIR SAMPLE RESULTS: to be Analyzed
] PCM Analyzed on Site
Sam # Sam #
S le # mple #
ample #
(0---------
INSPECTOR: //b Mu
Printed 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
-44
CUSTOMER REQUEST SYSTEM(CRS)I.2ACKING NUMBER REMOVAL DATE NEEDED,^
%Z. oU .../141V2
STREET ADDRESS WggRE ELECTRRI SEIZ70 BE PERMANENTLY REMOVED
J / !'0
TOWN1/2n� l �/ STATE ZIP COC���
ACCOUNT NUMBER ,0 S` z//
S ,
METER NUMBER(S)
O c-. _p /�
COMMENTj�a> y- 7 ,�fjLa/�GS
�,d� 21 �J��J P� J? „„4, C)
7
PRINT NAME OF PRO ER NER SIGNATURE OF PROP•; •.
1�GU 6 / by c - C-• &To %G,t?jyQp .dl c-4t✓P-ti
MAILINCygrDDR2'O�
TOWN/1
�G-v��li_ / CJ STATE _ ZIP C0O4E
TELEPHONE NUMBER OF PROPERTY OFO :3 L/
Beth A.Jabs
NOTARY PUBLIC
State of Connecticut
/
My Commission Expires 04/30,V8 G/
Notary Public Date o arized
—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 CL&P 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 ` 1
N0: 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 B c tfC 4,. SP-981-C
01 J6 16:56 FAX CPM INSURANCE SERV INC [ ]001
At ,o CERTIFICATE OF LIABILITY INSURANCE OP ID AM DATE(MMlDCrfYYY)
DWTRA-1 01/27/06
PRODUCT. . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CFM 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 NAIC#
INSURED INSURER A: Lincoln General Ins Co
D. -W. Transport & Leasing, Inc INSURER B: Amerin caAlternative
CT Scrap LLC; DW Holdings LLC;
Wadd Power LLC INSURER C: Great American Ins Co
33 Pequot Road INSURER D; Essex Ins Co
Uncasv>_lle CT 06382 --
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 W)TH 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 SI•IOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
!NSF(IAUU L ' CY-EFFECT( PIRNTR5FF
LTR INSRB TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY DATE(MM/DD/YY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE S 000,000
UANWGL I O REN[EU
D X X COMMERCIAL GENERAL LIABILITY CGL 082135 04/15/05 04/15/06 PREMISES(Eaoocuonca) 350,000
CLAIMS MADE I X J OCCUR MED EXP(Any one person) $Excluded
.PERSONAL&ADV INJURY 31 000,000
, GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS•COMP/OP AGG $ 1,000,000
POLICY X JECT I. LOS
AUTOMOBILE LIABILITY
A X ANY AUTO COMBINED1J INGLE LIMIT $1,000,000
LWI 100365-02 04/15/05 04/15/06
ALL OWNED AUTOS
BODILY INJURY
SCHEDULED AUTOS (Par person)
X HIRED AUTOS
BODILY INJURY
X NON-OWNED AUTOS (Per accident)
X MCS-90 PROPERTY DAMAGE 6
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY: AGG S
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE 310,000,000
$ Xi OCCUR CLAIMS MADE 60A2UB00006Q200 04/15/05 04/15/06 AGGREGATE 310,000,000
S _
DEDUCTIBLE S
X RETENTION 310,000 3
WORKERS COMPENSATION AND I
TWC S tAi U- OTH-
ER
ER
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL,EACH ACCIDENT 3
OFFICER/MEMBER EXCLUDED?
E.L.DISEASE-EA EMPLOYEE $
II yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 3
OTHER
C Contr Equip IM,c13410513 (1,000 DED) 04/15/05 05/15/06 Contr Eq 721,000
C Cargo Ms 1 41o5e (1.000 DOD) 04/15/05 05/15/06 Cargo 15,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I 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 06302 REPRESENTATIVES.
AUTH— ED REPRESENTATI
ACORD 25(2001/08) p ACORD CORPORATION 1988
01/27/2006 16:56 FAX CPM INSURANCE SERV INC t )002
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(MM/DDIYY)
PRODUCER 01/27/2008
TYLER COMPANIES Serial# 100664 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
330 ROBERTS STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
E HARTFORD,CT 06108 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURED INSURERS AFFORDING COVERAGE NAIC#
OEM AMERICA/DW TRANSPORT&LEASING INC INSURER A: THE PHOENIX INSURANCE CO
330 ROBERTS STREET INSURER B:
EAST HARTFORD, CT 06108
INSURER C:
INSURER D:
I
COVERAGES INSURER E;
THE POUC1ES 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.
LTR NSR
D TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE POLICY "P- T IN
GENERAL LIABILITY DATE MMfDDL/ -1 WOO LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS MADE ❑OCCUR
PREMISES
DAMAGE
RENTED ccrenco) S
MED EXP (Any one Penson) $
—,— PERSONAL&ADV INJURY $
GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY n JE n LOC PRODUCTS-COMP/OP AGG $
AUTOMOBILE LIABILITY
ANY AUTO (OMBINED?accident)
LIMIT $
ALL OWNED AUTOS
SCHEDULED AUTOS BODILY INJURY
(Per person)
HIRED AUTOS $
NON-OWNED AUTOS BODILY INJURY
(Pwaceident) S
PROPERTY accident GE $
GARAGE LIABILITY
ANY AUTO AUTO ONLY-EA ACCIDENT $
OTHER THAN EA ACC $
EXCESS/UMBRELLA LIABILITY AUTO ONLY: AGG $
JOCCUR 0 CLAIMS MADE EACH OCCURRENCE $
AGGREGATE •g$
$
DEDUCTIBLE $
RETENTION $ $
WORKER'S COMPENSATION AND THR-UB-100D6752-05 W�S 7t�� _ $
A EMPLOYERS'LIABILITY 02/28/05 02/2$/06 X TORY �MI1F OTH-
ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? EL EACH ACCIDENT $ 1,000,000
h describe under EL DISEASE•EA EMPLOYEE $ 1,000,000
___SPECIAL PROVISIONS below
OTHER EL DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLE9/EXCLUSIONS 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• ICE 0 THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SD SHALL
310 NORWICH-NEW LONDON TURNPIKE
UNCASVILLE, CT 06382 MPDS-NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,!TS AGENTS OR
REP- -ENTATIVES.
EtA
ED REPRESENTATIVE OF TYLER COMPANIES
ACORD 25(2001/08) _
ACORD CORPORATION 1988