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Home My WebLink About20x24 Addition Electrical Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Electrical Permit Permit Number: E2004-0171 Date: 23-Jun-04 Map/Lot: 039/077-000 Owner ID 118002 Job Location: _15_____KREsD TV Unit Job Description: Electric Service&Electrical for addition Owner: Contractor: Michael A Desautels Gerard LePine 436 Lisbon Road 15 Pires Drive Canterbury Ct. 06331- Oakdale CT 06370 Telephone: (860)546-9646 Lic/Reg Type/No. El 103827 Exp Date: 30-Sep-04 Tenant: Self Telephone: • Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B Electrical Value: $2,000.00 Electrical Fee: $10.00 Permit Code: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $2,000.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.32 Total Fees: $10.32 ;t is the owners responsibility to schedule the following inspections(minimum 48 hours notice reauired): ❑ Footing - Prior to pouring concrete ❑ Rough HVAC ❑ Backfill -Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab -Prior to pouring concrete ❑ Chimney-One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation • Electrical Service CRS#: 335876 ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑Gas piping and test Building Official's Signature: Town of Montville Building Department 310 Norwich-New London Tpke. Tel.848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential Trades Permit Application Form Permit# C.26 0 /- 6 / 7 ' ❑(PCum6ing Electrical LiIlechanica( CRS # S5c$ P Yfeating Air Conditioning —Gas Piping Single Eami[y ( J Two-Eamify ❑ Townhouse Job Address l5. (Number) (Street) (Unit) Job Description N G(k) L S E VI C wl re-,k-1 (T --T b --104 Owner 1'4., � S A v�tiS Mailing Address �LA.ir City State Zip Tel / / Contractor C-erD... rd e Ahe Mailing Address 1-,3 6 1 S4bri l City C a n7"erCjLCY`y State T Zip OG33 / Tel �60/�`j c</ qgG � � Contractor's License Type&Number E ` I U3 g27 Exp.Date q / Jb /09- 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 Mo• .i ne and further attest that the proposed work is authorized by the owner in fee and that I am authorized to make applic:tion i r a permit for such work as described above. Owner/Agent Signature ��M&„, DateQ�-- Construction Value Fee Plumbing $ $ Mechanical $ -c „ ,,�$- 2 — $ Electrical $ Plan Review Fee $ State Education $ Total $ (Complete reverse side) Town of Montville Building Department Receipt i Date /_71.0___/ 0 V No. 03920 ` , From: Job Address: ... 4_I. if ' 'Amount $ _ -3R Cash Check Check # (Circle one) Received by i ,/,;,� , "/ , 1 ,i :./ ` Permit # -. 1 7/ STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION ELECTRICAL UNLIMITED CONTRACTOR GERARD E LEPINE JR 436 LISBON RD CANTERBURY,CT 06331 TYPE: El LIC.✓REG NO. FFECTIVE 1038 7 Iw /01/2003 I EXPIRES 09/30/2004 SIGNED ACORQ, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/Y`fIY) PRODUCER (860)456-Zil FAX ($6'0456-3348 -- 06/17/2004 StonLewis 456-201s DiCERTIFICATE IS IsSUEo AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6 .Airport Road HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 1 ALTERTHE COM IZAOEAPFORITED BY THE POLICIES BELOW._ North Windham, CT 06256-0001 INSURERS AFFORDING COVERAGE INSVftED Lepine Electric NAlC# INSURER A: Hartford Casualty Ins. Co. 29424 DNA: Gerard Lepine INSURER e: Hartford Underwriters Ins.Co. 30104 436 Lisbon Road IINSURER c: Hartford Ins. Co. of Midwest 37478 Canterbury, Cf 06331 INSURER D: w3URER E- G4vefe koas THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NO'TUVITHSTANDIN ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTATh.,THE(MI-RANCE.AFFORDED BY THE POLICIES DESCE awp HEREIN IS SUBJECT TO ALL THE TERMS,E)(CLUSIONS AND CONDJTIONS OF SUCH I�gPOLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �sgC [1 w.. TYPE OF INSURANCE POLICY NUMBER 007E(MMRN1m E P�Ar FY �yjII rf LIMITS GENERAL LIABILITY 02SBMNLO436 08/04/2003 08/04/2004 EACH OCCURRENCE $ CGAhMERCC+{L G6NERJ4,LLALLiTI'IV S 1,000,000 300,000 00 {�� DAMAGE TO ROMEO 300,0073 CLAUd#A64DE r.E /OCCU�4 MEF%CF3[mac nrri"a sc n A 1111 I MED./AP(Any ax parsed)) s 1 000 PERSONALS ADN INJURY E L,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 - POLICY JePO L PRODUCTS-COMP/OP AGG s 2,000,000 AUTOMOBILE I.IASRLITY I 02 UEC BU2806 08/08/2003 08/08/2004 i ANY AUTO COM91NED SINGLE LIMIT $ t6a ararfenU 300,000 .BLL awm>Ea AUTOS 3CHEOt7 rc4 AU>'aS (Per Y INJURY B I person} S HIRED AUTOS t NON-OWNED AUTOS BOALY/NJUF T S III Oberaccident) F'(P8rRaccICCr.;)pERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT S OTHER THAN EA ACC S AUTO ONLY' AGG B E%L`ESSJUMERFILA LIABIIJTY EACH CGCVRR5NG6 $ OCCUR ( I CLAIMS MADE $ II AGGREGATE J 1111ceoucrIBI E S RETENTION S F S IWORKERS COMPENSATION AND OZAIEC ID4391 vT/O1/ZUO UT/1/1/ZI.�7.04 jI 5 EMPLOYERS LIABILITY �Vc srAtu r 17f1RY I IMff4 I �FR EL-VAOH AGG-RENT E I00 OOUI ANY PROPRIETORiPARTNER/EXECUTVEOFICER/MEASER EXCLUDED? Ir Yes,aescnoe unser I EL AISZASE'-s4 ZMPLOY S 100,000 sPficIAL ee nvlsloNs Fvucw 11 OTHER I B.L.DISEASE-POLICY LIMIT S Sa0.000 I I DESCRIPTION OF OPERATIONS,LOCATIONS!VEw E5/ ENDORSEMENT/I - ---. EXCLU510115NMED BY SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of Montville 10 DAYS WRITTEN NOTT &TO THE OIERTIFICATh NOLDBR NAMED 70 THE LEFT, Building Dept. BUT FAU.LRE TO&MIL SUCH Ali 77CE SWdt4L WI:0SE AV 0SLIGA nON OR LLSBIL1TY New (ondo,r, Yu rn ,-,ke of Aur bneln UpOtst I Uncasvi i l e, CT 06382 =s +TS OIet RfisEr a v , AUTHORIZED REPRESENTATIVE I Anna ForeIIIan/PATTYL -cJe. e.61,440.41., ACORD 25(2001/08) FAX: (860)848-7231 CACORD CORPORATION 1988 Z/l d 882 'ON Ad8S:6 vOu 7_ , VI