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HomeMy WebLinkAboutUCV Installation 2017 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 ELECTRICAL PERMIT Permit Number: E2017-0219 Date: 31-Aug-17 Map/Lot: 055/052-OOA Owner ID: 2308000 Project Location: 260 GALLIVAN LANE Unit: Job Description: UCV Installation Owner Nam Bottling Group LLC Tenant Name N/A Careof: 1 Pepsi Way Somers NY 10589- Telephone: Applicant Name CHA Tech Services LLC Telephone: (781)982-5453 DBA: Lic/Reg Type Lic/Reg N 0 101 Accord Park Drive Exp Date: Norwell MA 02061- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: S-2 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2016 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $415,000.00 Electrical Fee: $6,225.00 Construction Type 5B Total Value: $415,000.00 Penalty Fee: $0.00 Permit Code: C5 C of 0 Fee: $0.00 Comment Plan Review Fe $622.50 Fire Marshal Fee of$6225.00 Paid State Ed Fee: $107.90 Total Fee Paid: $6,955.00 It shall be the owners repsonsibility to scneduie 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 ❑Q 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 frami ❑ 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 Certificate of Approva ertific. - c panty Building Official's Approval: Town of Montville Building Department • 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 PERMIT APPLICATION FORM Permit No.:Loa6 f 1—0 D11 Type of Work Occupancy Classification Construction Type Permit Type ❑New Construction ❑A-1 0 B 0 H-1 0 I-1 ❑ R-1 0 S-1 0 Type IA ❑Type IIIB 0 Building ❑Addition 0 A-2 ❑ B,Medical 0 H-2 0 1-2 ❑ R-2 0 S-2 0 Type IB ❑Type IV 0 Plumbing ❑Alteration ❑A-3 ❑E 0 H-3 0 1-3 0 R-3 0 U ❑Type IIA ❑Type VA 0 Mechanical ❑Change of Use 0 A-4 ❑F-1 0 H-4 0 1-4 0 R-4 EI Mixed ❑Type IIB ❑Type VB jrZI Electrical ❑A-5 //��❑I F-2 ❑ M ❑Type IIIA CR-S#: Property Address: 'Qf,LCJ g-a it t I.)cIJ \ (Number) (Street) (Unit) Job Description: 1)C\j (- mo i--k- ,C Owner: fiefs � 1� eex'✓ ay� co Tenant: o1 Address: 'O Ga1�1 OC.-A La-Z Address: City/State/Zip: TV\O Y J,v e , c+ 09 S a- City/State/Zip: Telephone( ) - Telephone( ) - Applicant: 11 .ate VI Ck4t<T -1-ec__\ Se- CSS a_c_ I DBA: Address: I 0 I P\-- «r frOCV 1 : , City: A)cVt.�,1 el ) //State:WI Zip Code: 0)0(.4 Telephone(1g) >M. _cY -- Contractors- Complete the Following: License/Registration Type: License/Registration No.: Expiration Date: I hereby certify that the proposed work will conform to the State 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. Owner/Agent Signature: '� Date: Si ) 1Z-1 q � Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: 41 44(s---( (Dae Electrical Fee: (e as 5- Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: (.f 01O .50 State Ed Fee: 1 `01 . 91 O Total Fee: 0 big 55. rill , uaa5.0 Revised:August 23,2007 Town of Montville Building Department Bank Card File Receipt Date: 18 Aua 17 Receipt No: 5561 Received From: CHA Tech Services Job Address: 280 Gallivan Lane Fees Collected State Educational Trainina Fee Bank Card $13.180.40 Bank Card 1107.90 Short/Over: 10.00 Construction Value: $415.00 Demolition Value: 10.00 Received By Carmen Kneeland CICAArvi (\c/‘ A Act A _i_l__, L -tiLU ! -, Xi E = N CD cu •• f 3 I I 1 C - CO cn -00m -0W 07 , v n> O m m cS. rt a a 3 a 71 362 -1 CD 'V 3 3 -n tD —N N `Do o 2! 0 C) A 0 Z a) 73 X 0 E M °1 0 3 Ill % 3mo M = d3z C) cn w �1 3 5 -n a �`< r. XI h 0 D 3 Fic = 0 =. 00 ; 00 • r 3 co C �'zu m Ew -113x * m g `) `- 0) < ` CD W _ = N _E 0 a o = 3 l • 1 n' O �• D d 0 0 r- v co m m m CD o o '� w 0 o 0 Z 40 h M d0 a11 tI, to d! d! df d► d► d► 40 d! fJ! M tR d!fA d! W la Cr) r•j N O co .) t0 O — — O N O � 0 A V O N N Oo NI -iCCo, b O 01 0 0 0 �.....") CHAHOLDING CMURPHY ACORN" DATE(MM/DD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE oE(MMIDo17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. 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). PRODUCER CONTACT Ames&Gough PHONE FAX 859 Willard Street (A/c,No,Ext):(617)328-6555I(ac,No):(617)328-6888 Suite 320 a'e Ess:boston@amesgough.com Quincy,MA 02169 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Fire Insurance Company of Hartford A(XV) 20478 INSURED INSURER B:Liberty Mutual Fire Insurance Co,XV 23035 CHA Consulting,Inc. INSURER C:Continental Insurance Company A(XV) 35289 575 Broadway INSURER D:The First Liberty Insurance Corporation 33588 Albany,NY 12207 INSURER E:New Hampshire Insurance Company 23841 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTRINSD WVD POLICY NUMBER IMM/DD/YYYY) IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 6014087067 08/01/2017 08/01/2018 PREMMISES(Ea occu enceJ $ 500,000 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE8, X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: B $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO — AS2-Z11-260446-017 08/01/2017 08/01/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSE� ONLY AUTOS yyN p BODILY INJURY(Per accident) $ X AUTOS ONLY X AUUTOS ONLY (Per PROPERTY DAMAGE $ $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 15,000,000 EXCESSLIAB CLAIMS-MADE 6014087053 08/01/2017 08/01/2018 AGGREGATE $ 15,000,000 DED X RETENTION$ 10,000 D WORKERS COMPENSATION Xy PER STATUTE ETH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC6-Z11-260446-027 08/01/2017 08/01/2018 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E Professional Liab 002910563 08/01/2017 08/01/2018 Per Claim 6,000,000 E 002910563 08/01/2017 08/01/2018 Aggtregate 10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) If Al box is checked,GL Endorsement Form#CNA75079XX,Auto Al#CA20481013 to the extent provided therein applies and all coverages are in accordance with the policy terms and conditions. Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CHA Tech Services,LLC.-Albany,NY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. III Winners Circle Albany,NY 12205 AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL %,.E.4,1 Lek n r° Property Address U GV _s+cL.1(c c)it) Job Description Required Department Approval ' Permit Issuance Approval II I- Tax Collector �//i - Signature/date Comments: Fire Marshal /?/ /1 7 Signature/date Comments: ❑ Planning & Zoning Required for all permits except Signature/date Plumbing,Electrical,Mechanical, Roofing,Siding,Windows&Doors ❑ Health Department Required for properties with private septic or well Signature/date Comments: ❑ WPCA, Administrative Required for properties on sewer Signature/date Comments: ❑ WPCA, Operations When Required by WPCA Signature/date Comments: ❑ Department of Public Works Required when project includes driveway work or certain drainage requirements Signature/date Comments: - ❑ Montville Police Department Required for all permits EXCEPT one and two family residential Signature/date Comments: ❑ Copy of State Dept. of Transportation Certificate Required for Structures over 100,000 sq.ft.or with more than 200 parking spaces-Official copy of STC Certificate of Operation required-per CGS 14-311 Signature/date Building Department Final Inspection Revised March 23,2015