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Roofing for Building 4 2017
TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 BUILDING PERMIT Permit Number: B2017-0161 Date: 09-May-17 Map/Lot: 074/040-000 Owner ID: 5501000 Project Location: 75 PINK ROW Unit: Job Description: Repair One Section of Roof on Building#4 Owner Nam GL&C Construction LLC Tenant Name N/A Careof: 105 Pink Row Uncasville CT 06382- Telephone: (8601334-8454 Applicant Name Johnny Butler Telephone: (860)334-8454 DBA: GL&C Construction LLC Lic/Reg Type Lic/Reg N 0 75-105 Pink Row Exp Date: Uncasville CT 06382- Construction Value Permit Fees Construction Information Building Value: $13,500.00 Building Fee: $210.00 Use Group: B Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2016 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type 5B Total Value: $13,500.00 Penalty Fee: $0.00 Permit Code: C4 C of 0 Fee: $0.00 Comment Plan Review Fe $21.00 Fire Marshal Fee of$73.50 Paid State Ed Fee: $3.51 Total Fee Paid: $234.51 It shall be the owners repsonsibiiity 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 frami ❑ Electrical Service CRS No: p ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑j Certificate of A..roval - at- . Occupancy Building Official's Approvalj- 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.: gaD17 -014,1 Type of Work Occupancy Classification Construction Type Permit Type ❑New Construction ❑A-1 ❑ B 0 H-1 0 I-1 ❑ R-1 ❑S-i ❑Type IA El Type IIIB 0 Building ❑Addition ❑A-2 ❑B,Medical 0 H-2 0 1-2 ❑R-2 ❑S-2 ID Alteration CIA-3 0 E ❑Type IB 1=I Type IV ❑Plumbing 0 H-3 0 1-3 ❑ R-3 ❑ U ❑Type IIA El Type VA 0 Mechanical ❑Change of Use 0 A-4 0 F-1 ❑ H-4 ❑ 1-4 0 19-4 ❑Mixed El A-5 1=I F-2 El M ❑Type IIB 0 Type VB 0 Electrical ^� ❑Type IIIA CRS#: Property Address: /5 /b,� -P/ A))C a (Number) (Street) (Unit) Job Description: 6 r,(,Z '— t. ,L QA2 *Ai I S e C4/o 4V 3000 ,s-. , 6 19- Owner: &J G&LC •Je lNv,' ` 614 acr Tenant: 4` Address: 75--165"---Tr N I�� 1�d Address: City/State/Zip: a.A O.44)//rho C" _ City/State/Zip: Telephone(SC6A__) .3 3-e1 l Telephone( ) - Applicant: ( L-t-e jN .0 Dd kf tJA / kT L k esk+ Q"c DBA: Address: I O 5- -PIA/ City: LIN CA-SU r'1c State: Ci- ' Zip Code: ()43.81 Telephone(A ) 33 f ' yJ 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. c .. C-.) Owner/Agent Signature: .? Date: 7KC---e-- I( a©( 7 Construction Value Permit Fees Building Value: 1 5CC7 Building Fee: to— Plumbing Value: Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: 4.1"-- State 4.I"--State Ed Fee: 3,51 Total Fee: .D 34. S I -'.mh. 73..5c Revised August 23,2007 Town of Montville Building Department File Receipt Date: 04-Mav-17 ReceiptNo: 12239 Received From: GL&C I LC Job Address: 75-105 Pink Row Town Fees Collected State of Connecticut Fees Collected Bldg Cash: $0.00 State Cash: X0.00 Bldg Check: X734.51 State Check: /351 Bldg Credit: /0.00 State Credit: Fire Cash: X0.00 �O.QQ Fire Check: /73.50 Fire Credit: /0.00 Construction Value: $13 500 00 Demolition Value: $0.00 CheckNo: 3481 Received By: Carmen Kneeland C60 04 (Y I I I -0 � WQ XIg = N CD <. a a m s 0 M 1= 1 M1+I+I+I+k Ad i -I 71 W u) 7/ C) m K "003 rt - _• o� i O m m c S. C) — a) 3 O 0 m C1 m g m a' 5 m 0a n Q < v CO an CD 0CD 3 o o CD C) ; � g 0 ",_ 0 7 3 m 3� - = " nXi m nm md17 5 0 0_0 = cD 0 0 CD 0. N -� O 0 3i m m fl. ,9 d -1 0 w f ' " m am a m 3m � -n m C) rr SOM CO 73 C 7C x- CCD 0 0 Cr �? N a C —I n ^ ,"1 0 r m i I rD— c 03 < C) cu 0CD r CD m O O O 0 W CJI w —IN co cn I 0 0 Z 40 df NM N Mdfd► M df d! 4/ 40d► 4014l► M40d►4040,1 W 0 CA N 00 W A • I I I i i I • -4 W — T A T O p aC C O cr ACS CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/4/2017 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 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 NAME: Cheryl Byrum Swanson Insurance LLC (A//CNNo,Ext):OE (860)443-1500 FAX (860)443-1900 (A/C,No): 210 Boston Post Road E-MAIL the 1 ADDRESS: ry @ swansonins.com INSURER(S)AFFORDING COVERAGE NAIC# Waterford CT 06385 INSURER AMain Street America Assurance 29939 INSURED INSURERB:NGM Insurance Company 14788 GL & C Construction LLC INSURERc: 75 PINK ROW # 105 INSURER D: INSURER E: UNCASVILLE CT 06382 INSURER F: COVERAGES CERTIFICATE NUMBER:CL175409896 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MPT3868X 7/13/2016 7/13/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: DATAC $ 25,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED — AUTOS X AUTOS B1T3868X 2/1/2017 2/1/2018 BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ _ AUTOS (Per accident) Underinsured motorist $ 1,000,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 500,000 B (Mandatory in NH) WCT3868X 7/13/2016 7/13/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Montville THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Cheryl Byrum/AGENT � cc c � � ,_ __��, ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL S-05 Ant- a;„, Property Address P6J-fic$4 Ste; 1- rr Jot Description Required Approval Department Permit Issuance Approval e/ Tax Collector c,L�„� � � c.�/,+/ 7 Comments: Signature/date `/ Fire Marshal I l� 2� Signature/date Comments: I 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: I •� WPCA, Administrative ( Kr y� r ( '1c 'eery Required for properties on sewer -519/1 7 Signature/date Comments: ❑ WPCA, Operations When Required by WPCA Comments: Signature/date ❑ 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 RevisedMarch 23,2015