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HomeMy WebLinkAbout20,000sf Block Building 1993 TOWN OF MONTVILLE Building Department 848-7166 APPROVED BUILDING PERMIT OR TRADES PERMIT For 180 Days Permit No: // 26 /! Approval Date: IP "o�B 7 Expiration Date: /-°2 - _ ` 7 Estimated Cost: 0"' Ov Fees: lS,9 ° PRF: C .O Owner : kfp iciN 7DV `,A)(° Address: 6`►^e 12,Ai L' Tel : 6'--3C-D`21 Job Location: 754 41 k IO uJ Code: Contractor : G9 t y j": ert G`s k Address: 7/ f'e1f4#,4) 1)r Tel : Q -3, / Stick Built: Modular Home: Manufactured Home: Commercial : Addition: Garage: Car Port: Shed: Remodeling: Roofing: Siding: Fireplace: Chimney: Windows: Pool : Demolition: ,\ Plumbing: Heating: Electrical : Air Conditioning: Gas: Patio: Porch: Deck: Retaining Wall : New: Repair/Replacement: Type of material used/discription: Re0,,,u ' 1?1d1. Cox,ct i h9J- w ©off me/19/- size: 19/- if Size: a, Q, 000 Type of Heat: Fireplace: No.of Stories: No . Rooms: Breezeway: / No . Baths: Garage. Use .CO)c �lek 1AA)7 I hereby certify that the proposed work will conform to the Basic Building Code and all other Codes as adopted by the State of Connecticut , and the Town of Montville . (� Applicant 's Signature: '"1c,r��,�; l�J. .n5t ; Qk`‘ Date: 17 ,Zc1 ` G3 If signed by Contractor , type of license/registration & No: g Building Official 's Signature: ,./f/ j "4' 4/0 ' Date: /, --0.R1 .-Z? Date of Health Dept . Approval : f0 /A- Date of Zoning Approval : 1( /h THIS IS TO INFORM YOU THAT UNDER THE CONNECTICUT AMENDMENT OF THE BUILDING CODE , SECTION 119 .1 A CERTIFICATE OF OCCUPANCY IS REQUIRED PRIOR TO ANY USE OF THE STRUCTURE . A MINIMUM OF 24 HOUR NOTICE TO THE BUILDING DEPARTMENT IS REQUIRED FOR INSPECTIONS . TOWN OF MONTVILLE Building Department Application for a Permit ..,,,, Owner : Tel : alLE2dIE1 Job Location: 0 Contractor : e',QCs ,,,ziC_ A' Address: •- „ k Tel : 8L1g_=�'� Stick Built: DCCC0.S` ie,Gj C) 3.6Z Modular Home: Manufactured Home: Commercial : 1!; . Addition: Garage: -- Car Port: Shed: Remodeling: Siding: _._. Roofing: Fireplace: Chimney: Windows: ._. Pool : Demolition: Plumbing: _ Heating: _ Electrical : _ Air Conditioning: _ Gas: Patio: _ Porch: _ Deck: Retaining Wall : _ New: _ Repair/Replacement: Type of Material/job description: Lp. size: 0410 5 Type of Heat: Fireplace: No. of Stories: No . Rooms: Breezeway: No. Baths: Garage: Use: for R Dept. of Public Safety Div. of Fire & Euildin Safety `11~ DEMOLITID CONTRACTORS CERTIFICATE r ; 1s' � NO: 488 CLASS: A DATE ISSUED: 93/10/01 EXPIRES: 94/09/30 Certification as a Demolition Contractor is hereby granted to the person or firm named hereon. Name of Designated Technical Expert: Gar rd C. Leitkowski S GNED (DTE) iia. ISSUED TO: Lictkowski Construction RFD 62 41 Bergman Drive Unc:asville ., CT 0636 , e AUTHORIZED BY: :8 --C Y •��� 1 DEPUTY COMMISSIONER • • • • • • • • i • • • • . r. • , , NOTIFICATION Or DLOOLITION AND RENOVATION Operator Pro)mct I Postmark Data Rtc.ivtrd NOtlticatioa 1 : . TYPE OF trOTIF:CATION o .7:nti Rvsnlsed CsCancelled ►r II. FACILITY INFORMATION t Identify owner, removal ooetractor, and other operator ► OWNER ►:AME: L k.d i iv 70/0 A/0 AGdresa I : r Ig-/ 6-1 R Ale. res . A C.tyr 6-g oToN State c„..-r- "Pi 06,3 yo ' Ccntact§ /....go /4N7-0 ,t//No ral,o2D3 - 5-36 - 0/cac1 REMOVAL ccgrrRACTORr LrET/Cotf/S/C'J CoAiSrev(J-/o/v Aoaresa& t// / E26-MA-N /,'/1/F c:ty; U/VG/rs v /L_1_ Stating c___7-- tip, O 6 J'R-k. (.ont.:L. 6I -,ey L/F_ r//ows/t-/ ftl:SNk-.3ali9 ' OTSER OPERATOR: IA.:..lreas a I § ` WStates :1101 ` ntsct§ Tel, I III. TYPE OF OPERATIONt p.ri o.t;ryer, Demo P-Lsnovatlon t•tner.R.novatlon )r I . IS A.S CSTOS PRESENT? t Yes/mo 1 /V0 I V. FACILITY DLSCRIPT:ON t Include building name, number and floor or roam axroer ► Bldg ..as, T/iA-MEs P4ri4c-75 /'LA-iv T I) A6.:rass r-3 pJ,y/C R A i 1Cit" VA/CASV/ C-r-•E :tater GUN/V Countys A/Eiv LO/VDO.4/ Sate Locations A golfriz. 0p. pA o PERT-j- 1 :Wilding Laze,a0` co O re_ 1 of Floors§ / lime an Tears, lb, Present user Prior Vas rjJr � , V:. PROCEDURE, INCL DING ANALYTICAL METBOD IF APPROPRIATE, USED i�I TOSDE_J/,-Tv "TECT THL PRESENCE OF A:BESTOS MATERIAL: V i S O A-L VII. APPROXIMATE AMOUNT OF Mont ASBESTOS, INCLUDING: Asbestos Material Dot Indicate Unit of I.' llequlaced A01 to be remover, RACII To N barared wraausrrrsot bellow 2. Catsyorp I ACN Not Mroved To am 3. Category II ACu Not droved Removed Cat I Cat II EMIT Papas La"t La ■a Surf acs Area IgPt t p ba vol - 1111111. PACs Off Facalaty Component Curia Cu at VIII. £CUEDULED DATES ASBESTOS REMOVAL ImovuoITY► Start: -3 C21W1etss IY. SC1iEDULED DATES DEMO/RENOVATION tau/Do/TT► $t.arts,Q6G.20,/273 Cu plate, 7AM a0 /y' • NOTIFICATION OF DtIIOLITION AND RENOVATION foontanuedi IX. DESCRIPTION OF PLANNED DEMOLITION OR RENOVATION NORA, AND METBOD(S) TO BE USFD: • 41,.a.qr XI. DESCRIPTION OF MORA PRACTICES AND LNGI• E ONTROLS TO BE USED TO PREVENT EMISSIONS OF ASBESTOS AT THE DEMOLITION AND RENOVATION SITE: XII. WASTE TRANSPORTER $1 •"'� L/ E T/rowSK/ Coisr-Roc-770/v & 4r..s y/ BEa -its, -A/ PR ft/ cacy: UNG AS V/LL F States GONN tap! 063 g• Contact tersoni / A 2 1� / l:r/COes/sIC' / Telephone' 3 1/7 WASTE TRANSPORTER 12 Nemo Addresai • Caty, stat.; lap: Contact Persons TelephoneI XIII. WASTE DISPOSAL SITE Naae1 Locataor.t Catyi Stater tap, Telephone' , XIV. IF DEMOLITION ORDERED BY A GOVERNMENT AGENCY, PLEASE IDENTIFY THE AGENCY BELOW: ' RUSSELL A-1,1 PFE/Z BP/1--00//1'6- TNS P5Crel.. Authoraty'7a4/N op /t9 o/liT/i/L_LE Date of Order (rut/DD/171+SEPT /993 esu Or red to B.yu (gUDD/rrl' ASAP XV. FOR EMERGENCY RENOVATIONS • Data and hour of LrrgenCy IMM/DO/TYle Dacraptlon of the Sudden, ttnarp.cud want' taplaaataon of tow tne event caused unsafe ooeaatioas or mold oda.o puljsnt damage of an unreasonaLle tlnancaal burden' XVI. DESCRIPTION OF PROCEDURES TO NE FOLLOWED IN THE EVENT TAA' UNEXPECTED ASBESTOS Li POUND OR PREVIOUSLY NONFRIABLE ASBESTOS MATERIAL ASCO QS CRUMBLED, PULVERIZED, Q REDUCED TO POWDER. Go/V r,4 c-r ,4-S /3E STo S 6.0 M/°,4,v y — Golfrodh•/✓y A//t-1- /.?E a/v ar v0f' XVI. I CERT/77 THAT AN INDIVIDUAL TRAINED IN TBE PROVISIONS Of THIS REGULATION (40 CFR PART 61. SUBPART NI KILL BE ON-SITE DURING THE DENOLITIOM OR RENOVATION AND LVIDENC THAT THE REQUIRED TRAINING Kis NCEN ACCONG'LIBALD BT ?XIS PERSON WILL SE AVAXtws FOR INSPECTION DURING NORMAL BUSINESS YOURS. (Maguired 1 ar after prownlgatwa) m ✓...vvv111/ l2. —t-Rr (Signature of owner/Operator( ((Date) XVII. I CERTIFY THAT TBE ABOVE INFORMATION L COMBEC7. C—9? (Signature of owner/operator) (Date)