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2007 - New MFH - LP Tanks and Line
TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 MECHANICAL PERMIT Permit Number: M2007-0022 Date: 26-Feb-07 Map/Lot: 074/015-T72 Owner ID: 5499000 Project Location: 72 PINK ROW Unit: Job Description: set gas tanks and run gas line Owner Name: Vine Property Management Tenant Name: N/A Careof: 16 McCulley Place Uncasville CT 06382- Telephone: Contractor Name: Samuel Sugawara Telephone: (860)447-0341 DBA: Osterman Propane Lic/Reg Type: G1 Lic/Reg No: 394019 7 Enterprise Lane Exp Date: 31-Aug-07 Oakdale Ct 06370- „ Constructigniake 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: $450.00 Mechanical Fee: $8.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: IRC Total Value: $450.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 • State Ed Fee: $0.07 Total Fee Paid: $8.07 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 ❑d Gas Piping and leak test ❑ Fireblocking_Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑ Certificate of Approval �� ❑ Certificate of Occupancy � • Building O i ciai's Appravai: U ,i '" - Town o!Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.:P/ 6)7.-29©,�� T e of Work Oc anc T e Permit Type onstruction Ingle Family ❑Building ❑Addition ❑Two-Family 0 Plumbing ❑Alteration 0 Townhouse ,Mechanical 0 Accessory Structure /❑Electrical CRS#: Job Address: -7.2 P//vv_ F-OiA / 4i OA}( V ltir (Number) (Street) (Unit) Job Description: . — /Z� �...j '- t -L/ J r E7 -/-)404--r� 1+ Owner: V//u - P 1 DPe,2Ty d1'4/1J,}6ryys>l7 (i77&2 ,,,,,i4:::- Address: �1 5 V 7 r - Pin) 14. 2 UL,1 1 City: (1N� l - State: r Zip Code: 2S"' Telephone: 2/6 O—j77 Contractor: AP - DBA: Address: ,L - / fi .5 /„4-A) City: 04 kU Ae...t— State: C T Zip Code: C� ?j 7v Telephone: z,./4/7_03,/ License Type: G1 License No.: 39io ici Expiration Date: 8/3/ALCT7 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. ❑ By checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Code, instead of the electrical requirements in ters 33 throu h 42 of the Residential Code. Owner/•gent Sign•ture: � — — l Date: e,2-/2-//07 Const ction Value Permit Fees Building Value: Building Fee: Plumbing Value: Mechanical Value: CJD Plumbing Fee: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: CFPir Total Fee: j RFvued DDecem6er31,2005 Town of Montville Building Department File Receipt Date: 21-Feb-07 Receipt No: 2084 Received From: Osterman Propane Job Address: 72 Pink Row Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $8.07 Check: $0.07 Check No: 1740 Short/Over: $0.00 Construction Value: $450.00 Demolition Value: $0.00 Received By Sandra Pandora 6 ik Town of Montville Building Department File Receipt Date: 22-Apr-08 3368 Receipt No: Received From: Billy Vine Job Address: 72 Pink Row Fees Collected State Educational Training Fee Cash: $60.87 Cash: $0.47 Check: $0.00 Check: $0.00 Check No: 0 Short/Over: $0.00 Construction Value: $2,931.00 Demolition Value: $0.00 Received By -Carmen Roberts W�I Y` Q4A •f n , ic�nl Y ' Address: 72 Pink Row ITEM QTY $/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA New Construction SF $ 113.03 $ - $ _ Basement,Finished SF $ 22.96 $ - $ Basement,Unfinished SF $ 12.40 $ - $ _- Crawl Sapce SF $ 9.30 $ - Interior Renovations SF $ 3509 $ - S - $ MANUFACTURED HOMES Ground Anchors SF $ 6.45 $ - $ - $ _ Basement SF $ 12.41 $ - $ - $ Crawl Space SF $ 9.31 $ $ $ _ AMENITIES Kitchen EA $ $ $ Full Bathroom EA $ $ - Half-Bathroom EA $ $ GARAGE Attached SF $ 54.35 $ - $ _ Detached SF $ 69.53 $ - $ _ Under SF $ 10.03 $ - $ Carport SF $ 19.89 $ - - MECHANICAL Warm-Air n Y/N $ - Hot Water n Y/N $ Electric n Y/N Air Conditioning n Y/N $ - $ ELECTRICAL SERVICE Upgrade Amps $ Overhead,new Amps Underground,new Amps $ $ Subpanel EA $ 599.50 $ Gen Set EA $ 3,850.00 $ - SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 6,497.70 $ - Masonry w/1fireplace EA $ 7,096.65 $ - Masonry w/2 fireplaces EA $ 11,09570 $ - Wood Stove,free standing EA $ 2,692.25 $ - Wood stove insert EA $ 1,85977 $ - DECKS,PORCHES,SUNROOMS Deck SF $ 43.07 $ - Porch SF $ 149.38 $ - Sunroom SF $ 176.90 $ - $ - POOLS 8 HOT TUBS Hot Tub EA $ 8,016.25 $ - $ _ Irground Pool EA $ 21,373.44 $ - $ _ Above Ground Round EA $ 5,099.46 $ - $ _ Above Ground Oval EA $ 6,019.75 $ - $ Pool Heater EA $ 8,984.25 $ - - Inflatable Type Pool EA $ 1,550.00 $ - SHEDS w/o electrical 144 SF $ 20.35 $ 2,930 69 w/electrical SF $ 20.35 $ - $ RENOVATIONS Roofing,Overlay SF $ 3.00 $ - Roofing,Strip F.reroof SF $ 4.00 $ - - Roof Sheathing SF $ 1.31 $ - Sidirg SF $ 3.50 $ - Windows EA $ 500.00 $ - Skylights EA $ 1,051.10 $ - Doors,Exterior EA $ 601.50 $ - Oil Tank,275 Gallon EA $ - Oil Tank,550 Gallon EA $ MISCELLANEOUS CALCULATIONS TOTALS $ 2,930.69 $ - $ - $ - PERMIT FEE CALCULATIONS Construction Value Fee Building $ 2,931.00 $ 24.00 Plumbing y $ - $ Mechanical y $ - $ Electrical y $ - $ Working before Permit Issuance y $ 24.00 Certificate of Occupancy Fee $ 10.00 Plan Review Fee $ 2.40 State Education Fee $ 0.47 TOTALS $ 2,931.00 $ 60.87 Figures are based on the 2006 RS Means Residential Cost Data • Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL P/Nw (P7 Z I/i/ Property Address — / L 7-44/0_,5 �i 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 ApprovalPermit Issuance Approval Tax Collector Comments: N aW ❑ WPCA, Administrative A a`a 'kyi Comments: ❑ WPCA, Operations Comments: ❑ Planning & Zoning Sigroture. date Comments: El Health Department Comments: Sii, :.atLvE.I date El Department of Public Works Signature! date Comments: ❑ State Dept. of Transportation (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) Signa turei date Comments: Fire Marshal Comments: ( ? , �yu l g Iviseditugust 5,2005 Yui )(C State of Connecticut N 7A - 7B - 7C ~'` L" tip Workers' Compensation Commission DIRECTIONS kn.%.txx4ii�u,,�rigor � DIRECTIONS for FILING FORMS 7A, 7B and 7C Building Permit Requirements for Workers'ers Compensation Section 31-286b of the Workers'Compensation Act requires anyone who requests a building permit to first submit"proof of workers'compensation coverage for all of the employees who are engaged to perform services on the site of the construction project for which the permit was issued." The only exceptions to this law are the sole proprietor or property owner who will not be acting as general contractor or principal employer. What to give to the Building Official to obtain a Building Permit: 1. The General Contractor or Principal Employer must provide a written certificate of workers' compensation insurance for all of the employees on their project. This certificate may not be for liability, disability or any other type of insurance. 2. The Sole Proprietor or Property Owner who will not act as a general contractor or principal employer is not required to have workers'compensation coverage. In order to obtain the building permit,a FORM 7A should be completed and given to the building official. 3. The Sole Proprietor or Property Owner who will act as a general contractor or a principal employer must provide a written certificate of workers'compensation insurance for all of the • employees on their project and must file a FORM lB with the building official —OR he will sign a sworn notarized affidavit on Malta stating that he will require proof of workers'compensation insurance • for all those employed on the job site. • • • • e enera on rac or or •rincipa mp oyer w o as proper exc coverage using the appropriate WCC form(see NOTE below)mus file the F RM I withise re building official.This form certifies that they have properly excluded themselves, and attests that thelll require proof of workers'compensation insurance from every employee that works on the designated job site. Wit: The general contractor or principal employer may exclude himself from workers'compensation coverage by filing one of the following forms with the appropriate Workers'Compensation Commission district office: Form 6B for employees who are Officers of a Corporation or Managers/Members of an LLC Form 6B-1 for employees who are Members of a Partnership Nov 9. 1006 9 : 56AM No. 2223 P. 1/2 Client#:25489 EOSTE ACORD. CERTIFICATE OF LIABILITY INSURANCE 10/23/06DATE DA) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Conifer Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10 Centennial Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Peabody ,MA 01960 . 978 53245 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Liberty Mutual Insurance Company 23043 E.Osterman Gas Service Inc, INSURER a: Lexington Insurance Co P.O.Box 29 INSURER C: Arch Speciality Insurance Company One Memorial Square - Whitinsville, MA 01588 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 CERTIPICATE 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, INSR ADD% -FOGGY EPPECTNE POLICY EXPIRATION LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD1YY1 DATE(MM/DDIYT) LIMITS A GENERAL LIABILITY TB164G435284055 11/01/06 11/01/07 EACH OCCURRENCE x1.000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED as MiS s r o o nce) 550,000 1 CLAIMS MADE LiOCCUR MED EXP(Any one person) $5,000 PERSONAL aADV INJURY $1,000,000 GENERAL AGGREGATE 52,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP A46 52,000,000 —I POLICY n In n LOG A AUTOMOBILELIABII.IT7 AS164G435284045 11/01/06 11/01/07 COMBINED SINGLE LIMIT 51,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) . X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ X Drive Other Car PROPERTY DAMAGE (Pet accident) $ OARAGE LIABILITY AUTO ONLY.EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AOG 5 ` B EXCESS/UMBRELLA LIABILITY 6760868 10/01/05 11/01/07 EACH OCCURRENCE 55,000,000 C OCCUR E CLAIMS MADE UXP0018093 10/01/06 11/01/07 AGGREGATE 55,000,000 5 DEDUCTIBLE S X RETENTION 510000 $ A WORKERS COMPENSATION AND WC164G435284065 11/01/06 11/01/07 LWC STATUTH. S 0 EMPLOYERS'LIABILITY LIMITS, FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 51,000100O _ OFFICER/MEMBER EXCLUDED', E.L DISEASE-EA EMPLOYEE 51 OOO O00 If yes.5eecribo under 1 s SPECIAL PROVISIONS below EL.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OP OPERATIONS/LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 860-848-7231 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Montville DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 310 Norwich-New London NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Turnpike IMPOSE NO OBLIGATION OR UASIIJ Y OF ANY KIND UPON THE INSURER,ITS AGENTS OR Uncasville,CT 06382 REPRESENTATIVES. TPXOLE D REPRESENTATIVE `'''� ACORD 25(2001/08)1 of 2 #52458 •r/G'• BDO @ ACORD CORPORATION 1988 I