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HomeMy WebLinkAboutDemo House 2007 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: D2007-0022 Date: 14-Nov-07 Map/Lot: 078/054-00B Owner ID: 5438000 Project Location: 53 PEQUOT ROAD Unit: Job Description: Demolition of Dwelling Owner Name: D.W.Holdings LLC Tenant Name: N/A Careof: 33 Pequot Rd Uncasville CT 06382- Telephone: (860)848-1692 Contractor Name: D.W.Transport and Leasiing Inc. Telephone: (860)848-1692 DBA: Same Lic/Reg Type: A 33 Pequot Rd. Lic/Reg No: 1134 Uncasville,CT 06382 Exp Date: 30-Jun-08 Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 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: $7,500.00 Penalty Fee: $0.00 Permit Code: Ml C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fee Paid: $75.00 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 REFIRED UPON COMPLETION ❑ Insulation :7 6-rtifi • e of Approval ❑ ;• 'ficake of Occupancy Building Official's Approval: CT Town of Montville Building Department - F 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 DEMOLITION APPLICATION FORM Permit No.: '266?— GOZ I Job Address: E 3 Pecs uc r RD (Number) (Street) (Unit) Job Description: 2 r'- OLt'3 t-f D,...... C LC,,V Cr- Owner: D. \A/, I-{©LD f NG S L L C Address: t3 3 Pecit saT Rv - U City: NCA5 V CLLt State: E . Zip Code:T 61037)/Z. '� Telephone: 8 kp 0- e cT e ( tocit Contractor: DALT1 4NS PO IZT AN D Le.45 t kic, ( NE C DBA: S2 P14f� Address: 3 3 PeQ U o"t R City: U MC r4,5+�rILyL State: C."T. Zip Code: OHO 3 8/E _ Telephone:84 8 1 7 2 Licen - ype: LA License No.: 1 t 3 8 Expiration Date: �— 3 Q �Q Q I hereby certify that the proposed work wit info to Fe State Connecticut and the Town of Montville . � �tnolition Code, State Building Code and all other codes as adopted by the State of application - : t that t e .roposed work is authorized by the owner in fee and that I am authorized to make for a permit for such work .. .- .,�.-d ... e. Owner d /!'All Signature: /kW- Date: ,/j i(? 'o 7 Contractor Signature: l /—GC)—0 -- ,/ y Date: Demolition Value: 7 c-0 0 . G Demolition Fee: 2S Items required for submission: A_ Demolition contractor registration(Class A or B)(C.G.S.Sec.29-402) • 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 0 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) XCertificate of notice by all public utilities having service connections within the premises proposed to be demolished,stating that such utilities have kilsevered such connections and service.(C.G.S.Sec.29-406) t 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) XUncas Health District approval Rvired Decem6er31,2005 Town of Montville Building Department File Receipt Date: 14-Nov-07 Receipt No: 3006 Received From: DW Transport Job Address: 53 Pequot Rd Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $75.00 Check: $0.00 Check No: 0 Short/Over: $0.00 Construction Value: $0.00 Demolition Value: $7,500.00 Received By Vernon D Vese II �fcf Client#:8390 1258972 ACORDT, CERTIFICATE OF LIABILITY INSURANCEoaiaioiD'YYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Helmsman Insurance Agency LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 20 Riverside Rd HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Weston,MA 02493-2231 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 617 243-7926 INSURERS AFFORDING COVERAGE I NAICI INSURED INSURER A: Everest National Insurance Company DW Transport&Leasing,Inc. 33 Pequot Road INSURER B: Uncasville,CT 06382 INSURER C: 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. INSRTR INDSRD'L POLICY EFFECTIVE POLICY EXPIRATION 1 LO TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MMNDOP/Y) UMITS [ GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 1 GENt AGGREGATE--� LIMIT APPLIES PER: - P� I1- IJECT fl LOC PRODUCTSCOMP/OP AGG $ POLICY PRO- -- -- AUTOMOBILE LIABIUTY - - - - - COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS - - NON-OWNED AUTOS r BODILY INJURY $ (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABIUTY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ . A EXCESS/UMBRELLA LIABIUTY 71 G8000007071 04/15107 04/15/08 EACH OCCURRENCE $10,000,000 --)-(1 OCCUR n CLAIMS MADE AGGREGATE $10,000,000 $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND I T WC SIAM-I rat EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? If yes,describe under Ell.DISEASE-EA EMPLOYEE $ SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Sample DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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- I 1 - UTHORIZED REPRESENTATIVE -I ACORD 25(2001/08)1 of 2 #S220138/M219240 1VMN 0 ACORD CORPORATION 1988 a f This certificate is executed by Liberty Mutual Insurance Group as respects such insurance as is afforded by those companies. BM0068 Certificate of Insurance This certificate is issued as a matter of information only and confers no rights upon you the certificate holder. This certificate is not an insurance policy and does not amend,extend,or alter the coverage afforded by the policies listed below. This is to certify that(Name and address of Insured) mt D W Transport and Leasing,Inc.,CT Scrap + 33 Pequot Rd !r Liberty Uncasville,CT 06382 r°118 Mu La<ialtM is,at the issue date of this certificate,insured by the Company under the policy(ies)listed below. The insurance afforded by the listed policy(ies)is subject to all their terms,exclusions and conditions and is not altered by any requirement,term or condition of any contract or other document with respect to which this certificate may be issued. Expiration Type EffJExp.Date(s) Policy Number(s) Limits of Liability Continuous* Coverage afforded under WC law of Employers Liability Extended the following states: Bodily Injury By Accident X Policy Term Each Accident Bodily Injury By Disease Policy Limit Workers Compensation Bodily Injury By Disease Each Person 04/15/2007/04/15/2008 YY2-1 1 1-25 8972-02 7 General Aggregate-Other than Prod/Completed Operations General Liability $2,000,000 Products/Completed Operations Aggregate _ Claims Made $1,000,000 X Occurrence Bodily Injury and Property Damage Liability Per $1,000,000 Occurrence Retro Date Personal and Advertising Injury Per Person/ $1,000,000 Organization Other Liability Other Liability 04/15/2007/04/15/2008 AT2-111-258972-017 Each Accident-Single Limit-B.I.and P.D.Combined Automobile Liability $1,000,000 Each Person X Owned X Non-Owned Each Accident or Occurrence X Hired Each Accident or Occurrence C 0 M M E N T S Notice of cancellation:(not applicable unless a number of days is entered below).Before the stated expiration date the company will not cancel or reduce the insurance afforded under the above policies until at least 30 days notice of such cancellation has been mailed to: Office: Providence,RI Phone: 401-351-2200 .1. f j, €� yL- Certificate Holder: CHERYL PETERSON DW Transport & Leasing Inc Authorized Representative 33 Pequot Rd PO Box 462 Uncasville, CT 06382-0462 Date Issued 10/05/2007 Prepared By: cp ACORD CERTIFICATE OF LIABILITY INSURANCE DATE/05/z 07 PRODUCER Serial# 101212 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION TYLER COMPANIES 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. E HARTFORD,CT 06108 INSURERS AFFORDING COVERAGE NAIC# INSURED OEM AMERICA/DW TRANSPORT&LEASING INC INSURER K. AMERICAN INTERNATIONAL COMPANIES 330 ROBERTS STREET INSURER B: EAST HARTFORD, CT 06108 INSURER C: 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 CONTRACTOR 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, IR POLICY EFFECTIVE POLICY EXPIRATION LTR NSR - NERD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurence) $ _ CLAIMS MADE El OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE_$ GEN'LAGGREGATE LIM -APPLIES PER: PRODUCTS-COMP/OP AGG $ —I POLICY n JE�CT I I LOC AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ _ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ (PeOaccidentDAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO - OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY • EACH OCCURRENCE S _ OCCUR n CLAIMS MADE AGGREGATE S • DEDUCTIBLE RETENTION S $ WORKER'S COMPENSATION AND 00196778200 03/15/07 03/15/08 X TORY LIMITS_ °ER A EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE r OF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN DW TRANSPORT&LEASING INC NOTV T THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 33 PEQUOT AVENUE UNCASVILLE, CT 06382 IM-•SE O OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR PR ENTATIVES. A THO-I D R PRESENT• WE OF TYLER COMPANIES ACORD 25(2001/08) / ©ACORD CORPORATION 1988 11/06/2006 MON 15:28 FAX 860 447 5755 CL&P WATERFORD i002/002 MAY-08-2007 TUE 01: 12 PM 01.&P FAX N0. 877 285 4448 P. 01 Co LU= CUt FL1`I11JJ =3 Jj Light&Pow@tr Tbr Nostbcw Utithim S.aam OP66O REV.7.Q Ajs the owner of this property, 1 am requesting the permanent removal of the existing CT Light& Power ompany(CL&P)electric service and meters)to allow for the demolition of the building in accordance 14VIth au applicable Connecticut Genera)Statutes. I certify that the building is vacant. Removal of Service for Building Demolition CU5ToMER REQUEST SYSTEM(CRS)TRACKING NVMSER REMOVAL DATE NEEDED STI¢EEY ADDRESS WWCREI ELECTRIC SERVICE IS Yo 5 PERMANENTLY REMOVED 5-3 4>f- - TOWN - - TOWN STATE ZIP CODE ACCOUNT NUMBER METER NUMBER(S) DId 6-7/r 7/Ce-' COMNIENTS ) PRINT NAME OFPROPgRTY OWNER SIGNATURE OF PROP kt.4A A MAIL D 3 70w f STATE ZIP COOS Il/ C7.1'ri` O 6 f6-1 TVIEPHONE NtJ AtpER OF PROPERTY OWNER 6.0 ; 6 o g 8 Z y0 KATHLEEN A. FOITA NOTARY PUBLIC MY COMMISSION EXPIRES DEC.3i,2011 / 51 NOTARY PUBLIC d'ATE NOTARtzE5 jj'�� CLP INTERNAL USE ONLY. •51-31 Date service removed_ V- .Plosso add a jab neo CRS indicating the date and to wham this signed-off form was returned.File this completed form with this Com±l6ted --Ice removal work order. 410 PR{•T AMrQFCLAP"'"' SENTATIV SIeIt T "_ . - t��r��► jar" DATE • To Avoid Delays Ple-•-a Complete All Information On This Fo U.S. RECEftkiED • Postal: overnight Express: Mail To: CL&P Clearing Desk Mall To: CLAP Cl anng Desk• Con n.e.cticut_LIgbL&p..o_Wer_C•,__ -.-._Conned) ui Lig Power CCO5:' -_:_ ._.__ P.O. Box 2965 :__ —._ ...• _..._ _ : : .- _ 407 Seld n Street Hartford, CT 06iO4-2965' Berlin, C 04.Q37 , State Use Only ' STATE OF CONNECTICUT Postmark Date: Check#: DEPARTMENT OF PUBLIC HEALTH Transmittal # DEMOLITION / NOTIFICATION FORM Record# This form is to be completed and postmarked or hand delivered to the Connecticut Department of Public Health at least ten(10)days prior to the start of demolition as required by the Regulations of Connecticut State Agencies (RCSA), Section 19a-332a-3. In case of emergency notifications, this form is to be completed and postmarked or hand delivered within one(1) working day following the start of demolition. A copy of the written order requiring demolition prepared by a state or local building official shall accompany each emergency demolition notification. Faxed originals are not acceptable. Revisions to the original notification form may be faxed. Each demolition notification must be accompanied by a fee of twenty-five($25) dollars. A check in that amount made payable to "Treasurer, State of Connecticut" must be submitted with the notification form. If it is determined that during demolition, asbestos abatement that disturbs more than ten (10) linear or twenty-five (25) square feet of asbestos will occur, then an asbestos abatement notification form shall be filed with the Department of Public Health, in accordance with §19a-332a-3 of the RCSA. This form shall be submitted at least ten days prior to the start of asbestos abatement. An asbestos abatement notification form filed in this situation shall satisfy the filing requirements of the demolition notification. In all cases of demolition,one and only one notification form (either for demolition or for asbestos abatement,as applicable)shall be sufficient to satisfy the DPH regulatory requirements. 1. TYPE OF VOTIFICATIOP A. NEW I EMERGENCY C. REVISE ITEMS REVISED 2. FACILITY OWNER/OPERATOR. NAME: D.W I4cx.Oit.t6-'S L.L C ADDRESS: .g-`'?j CITY: ()►2u v t u_e. STATE: C-r, ZIP: G PHONE NO.: CONTACT PERSON: D.W. TRANSPORT & LEASING, INC. TREASURER, STATE OF CONNECTICUT 11/14/2007 1 1 6 0 25.00 PEOPLE'S UNITED B 25.00 &DELUXE BUSINESS FORMS 1+800-328-0304 www.deluxefo,ms.com Telephone Device for the Deaf: (860) 509- 7191 410 Capitol Avenue, MS#51 AIR P.O. Box 340308 Hartford, CT 06134-0308 Affirmative Action/An Equal Opportunity Employer CONNECTICUT Department of Public Safety, - Division of Fire & Building Safety <, ''° - . DEMOLITION CONTRACTORS CERTIFICATE NO: 1134 CLASS :A DATE ISSUED: 2007/07/01 EXPIRES :2008/06/30 • Certification as a Demolition Contractor is hereby granted to the person or firm named hereon. Name of Designated Technical Expert : David Waddington SIGNED (DTE) ISSUED TO: D.W. Transport & Leasing, Inc . P.O. Box 462 Uncasville, CT 06382 AUTHORIZED BY : - -. ,. SP-981-C Demolition Notification Form Page 2 6. NAME OF FACILITY: q 7LI /t NAME: 1 Ftb1sac. 5 . I.0 r ADDRESS: 5 3 ?e QLCrt 20 CITY: U,tiCii$ti 1i.1.C- STATE: e.~t ZIP: 04::; S°Z 7. USE OF FACILITY. A. SCHOOL(K-12) B.PUBLIC BUILDING C. MANUFACTURING D. OFFICE E.COLLEGE F. COMMERCIAL — G.CHURCH/SYNAGOGUE. H. RESIDENTIAL ,/ Il OF DWELLINGS _ I.OTHER (SPECIFY) 8. BUILDING DATA SQUARE FEET N OF FLOORS AGE _-_ .. _ 9. DEMOLITION DISPOSAL FACILITY NAME: MO eat-v.( , eCCt-t L-I✓11.% ADDRESS: Roe.?i�� �� -.� CITY: 1 i�1i. } 1T(42- 762.,D STATE: �'j_ ZIP: 10. DEMOLITION WASTE HAULER: NAME: .LA.; . 'C-t UPJ.p0c7 1 Lew !N6,, ADDRESS: CITY: U ISC'•iarej J LCA...€ STATE: ('Z ZIF 06 02 11. PERSON C ( OMPLETING THIS FORM: -DAV AVSD ►UgYt'D0itV& 1r ADDRESS: p 0,. -00x, (.4 6 Z. CITY: U tiASV tLLe i STATE: C/7, ZIP Xr v. / SIGNATURE: d' ' DATE: //2-'61-) f Revision date 9/16/04 kdemo.frm.doc D.W. TRANSPORT & LEASING, INC. __ A TREASURER, STATE OF CONNECTICUT 11/14/2007 1160 25.00 PEOPLE'S UNITED B 25.00 5JDELUXE BUSINESS FORMS 1+800-328-0304 www.deluxeforms.com i State Use Only_ STATE OF CONNECTICUT Postmark Date: V t"` - Check#: DEPARTMENT OF PUBLIC HEALTH ` Transmittal# _• ' DEMOLITION / NOTIFICATION FORM Record# This form is to be completed and postmarked or hand delivered to the Connecticut Department of Public Health at least ten(10)days prior to the start of demolition as required by the Regulations of Connecticut State Agencies (RCSA), Section 19a-332a-3. In case of emergency notifications,this form is to be completed and postmarked or hand delivered within one(1)working day following the start of demolition- A copy of the written order requiring demolition prepared by a state or local building official shall accompany each emergency demolition notification. Faxed originals are not acceptable. Revisions to the original notification form may be faxed. Each demolition notification must be accompanied by a fee of twenty-five($25)dollars. A check in that amount made payable to "Treasurer, State of Connecticut" must be submitted with the notification form. If it is determined that during demolition, asbestos abatement that disturbs more than ten (10) linear or twenty-five (25) square feet of asbestos will occur, then an asbestos abatement notification form shall be filed with the Department of Public Health, in accordance with §19a-332a-3 of the RCSA. This form shall be submitted at least ten days prior to the start of asbestos abatement. An asbestos abatement notification form filed in this situation shall satisfy the filing requirements of the demolition notification. In all cases of demolition,one and only one notification form (either for demolition or for asbestos abatement,as applicable)shall be sufficient to satisfy the DPH regulatory requirements. 1. TYPE OF OTIFICATIOP A. NEW ' I EMERGENCY C. REVISE ITEMS REVISED 2. FACILITY OWNER/OPERATOR. NAME: D uj i-1 ocf u 6-As L.L._C _ ADDRESS: 33, -peQocy:• RD. CITY: 0 t C.45 V t u.e. STATE: C'.-r„ ZIP: 06,,38 Z PHONE NO.: CONTACT PERSON: 3. DEMOLITION CONTRACTOR: NAME: 'D_W -11Z-A-0 S pocr AMD LewI at/("- ADDRESS: P O . Bo x 4 6 7 CITY: U6..SCSISV CL Q STATE: CT, ZIP: 0(9 3 W Z PHONE NO.: 6(6 if'ii.c' IGH Z CONTACT PERSON: Jr ii I.0 W t't p7t j G-To(4 In accordance with Section 61.145 of the U.S. Environmental Protection Agency's National Emission Standards rfor Hazardous Air Pollutants (NESHAPs) regulation, the owner or operator of a facility shall, prior to the commencement of renovation or demolition, inspect the affected portions of the facility for asbestos, including y Category I and Category II nonfriable asbestos. 4. PRE-DEMOLITION ASBESTOSISURVEY CONDUCTED BY: NAME: 4.1 j' ((. te�tt` t(2 GLi LIl'i CON 50(..7tN7s ADDRESS: I ZO Li- ('k)QT ti Q.0 n CITY: GrurtOki STATE: CST. ZIP: 06. 4 CI PHONE NO.; 'ici"9 - 4,44.,q if b O INSPECTOR DPH LICENSE NO.: &V Ca-7 S(A) START DATE: i( - Z (0 ~ 01 5(B) COMPLETION DATE: i t- Z. I -C)7 dlm/yyyy d/m/yyyy Phone:(860) 509-7367/Fax(860)509-7378 Telephone Device for the Deaf- (860) 509- 7191 410 Capitol Avenue,MS#51 AIR P.O. Box 340308 .A.0_ Hartford, CT 06134-0308 Affirmative Action/An Equal Opportunity Employer 12/21/05 16:15 FAX 8604498860 _ MYSTIC AIR _ 001 2N-1-11 QUA Fax Transmittal Cover Sheet Mystic Air Quality Consultants 0o ' T �� 1204 North Road, Groton, CT 06340 Relying climb Phone: 860 449 8903 Visit at our website eabwit Fax: 860 449 8860 www.mysticair.cozn 1987E-mail: magc2@aol.com Date of facsimile transmittal: / t / Q."5 Reply Requested? Yes No TO. 1 • _ FaxLeAs et FROM: use Number of pages_ (including this cover sheet) a.. Message: 1 ,i Fax Copy also sent Q to [ 3 IlViasterCard VISA ei Visit our 2005 Training Calendar on our web site 12/21/05 16:15 FAX 8604498860 MYSTIC AIR [j002 (-1.:Aut Myttic Air Qjality Conulianth, Inc. t.�y 1204 North Road (Rt. 117) Groton, Connecticut 06340 December 21,2005 Mr. David Waddington D.W. Transport 41 Trumbull Street New Haven, Connecticut 06510 Re: Post Abatement Inspection Pre-Demolition Review 53 Pequot Road Uncasville, Connecticut Dear Mr.Waddington: On December 21, 2005, our asbestos abatement project monitor, Christopher Muller (monitor license#000427), completed a visual inspection at 53 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, Imo\ 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