HomeMy WebLinkAboutLP Tank and Line to Stove 2003 1171;;;
Town of Montville
.44 ,
Building Department
Date: )212-73)03 Field Inspection Notice Permit#:
Address: i3 e p/ems 5
• Not Comments/Corrections Required—re-inspection required:
Inspection Approved Approved
0 Footing H
H
+l lL- ± k❑ 0 Concrete Slab N,.l nnrr
o Framing 0 0
❑
Rough Elec 0
Elec Service 0 0
❑ Rough HVAC 0 0
❑ Rough Plumbing 0 0
DGas Line 0
Fireplace ThroatS 0
❑ Chimney 0 0
❑ Fire/Draftstopping 0 0
❑ Insulation 0 0
❑ Final Inspection 0 0
❑ C of O 0 0
❑ 0 / i----
"Ispector's Signature /
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext. 382
Mechanical Permit
Permit Number: M2003-0240 Date: 11-Dec-03 Map/Lot: 039/087-000 Owner ID 118027
Job Location: 88 PIRES DRIVE Unit
Job Description: Gas Stove,Gas Lines&Set Tank
Owner: Contractor:
John F and Nancy A Allen Advanced Gas
183 East Haddam Road
88 Pires Dr Salem Ct. 06420-
Oakdale CT 06370 Telephone: (860)859-9070
Lic/Reg Type/No. G1 386875 Exp Date: 31-Aug-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: $595.00 Mechanical Fee: $10.00 Construction Type: 5B
Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5
Other Value: $0.00 Other Fee:
$0.00 Comments:
Total Value: $595.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $0.10
Total Fees: $10.10
It is the owners responsibility to schedule the following inspections(minimum 48 hours notice required):
❑ 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 0 Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑d Gas piping and test
Building Official's Signature: , /
,.- .. --, .op .... .1411 -.V...V. puai+uinv 11GI1
toy i
Town of Montville
Building Department Permit# 0,Z"
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 82 Uncasville, CT 06382
Fax. 848-7231
One& Two Family LP-Gas Permit Application Form
Job Location P !aitiale Li
Job Description/Materials 16 F CU L Cc((S 6 tz\Ji c `-k._S l t VVLL.
Owner < k'hel AL.ti, 1 Mailing Address
C;ry State Zip Tel 1 k D /S % 7) ')'
Contractor AVAkLfl eS(.� J
MailingAddressi ��
(� (. ?5�; E (-1( aL 'l ;
c ,
City ,SCIA)-44i State �� Zip 01 t(--f:),G Tel L'/ 'ffi/(10
Contractor's License/Registration Type&Number AJC , r) Ui
Exp.Date L 55 %5 1 /al
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 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 . ti,, ( 14/1-0-167(A— Date >A I i d/ 05
Construction Value Fee '—
Building
Plumbing $ $
Mechanical $ $
S
$ $
Electrical
Other $) $
Certificate of Occupancy
Plan Review Fee S
$
State Education
Total $ '5(1 1)
00 $
$
it 10
106 .ARIL
w a*ufo c e CISH N6 I S4IVL-
Town of Montville Building Department Receipt
Date /___ILL�
No. 03430
From: —
�
17
Job Address: '
Amount $
-- -' Cash/ \ heck Check #
/ (circ __1_, 4Received by f
Permit # D t -y0
J7ACORD. INSURANCE BINDER OP ID PB DATE
09/30/02
- THIS BINDER IS A TEMPORARY INSURANCE CONTRACT,SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM.
PRODUCER NONNo Ext: 860-446-8255 COMPANY
BINDER# 3005
'1 .0-448- .18 Westport Insurance Corporation
Bailey Agencies, Inc. EFFECTIVE EXPIRATION
DATE TIME DATE TIME
178 Bridge Street X AM
Groton CT 06340 X iz:ot AN
10/01/02 12:01 PM 10/30/02 NOON
Lawrence J Stevens
THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY
CODE. _ 1 SUB CODE: PER EXPIRING POLICY#:
AGEFICY WCX0013966 00
CUSTOMER ID: ADVAN-6 DESCRIPTION OF OPERATIONS/VEHICLES/PROPERTY(Including Location)
INSURED
Advanced Gas Sales & Service 183 E Haddam Road, Salem, CT
Stacey Martin
183 East Haddam Road
Salem CT 06420
1
COVERAGES
LIMITS
TYPE OF INSURANCE • COVERAGE/FORMS DEDUCTIBLE COINS% AMOUNT
PROPERTY CAUSES OF LOSS f
BASIC I_I BROAD LI SPEC
GENERAL LIABILITY
EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE(Any one tire) $
CLAIMS MADE I I OCCUR
MED EXP(Any one person) $
PERSONAL 8 ADV INJURY $
GENERAL AGGREGATE $
RETRO DATE FOR CLAIMS MADE: PRODUCTS-COMP/OP AGO $
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO
BODILY INJURY(Per person) $
ALL OWNED AUTOS
BODILY INJURY(Per accident) $
SCHEDULED AUTOS
PROPERTY DAMAGE $
HIRED AUTOS
MEDICAL PAYMENTS $
NON-OWNED AUTOS
PERSONAL INJURY PROT $
UNINSURED MOTORIST $
AUTO PHYSICAL DAMAGE $
DEDUCTIBLE ALL VEHICLES SCHEDULED VEHICLES ACTUAL CASH VALUE
COLLISION:
STATED AMOUNT $
OTHER THAN COL: _
OTHER
GARAGE LIABILITY
AUTO ONLY-EA ACCIDENT $
ANY AUTO
OTHER THAN AUTO ONLY:
EACH ACCIDENT $
EXCESS LIABILITY AGGREGATE $
EACH OCCURRENCE $
UMBRELLA FORM
AGGREGATE• $
OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE:
SELF-INSURED RETENTION $
X I WC STATUTORY LIMITS
WORKER'S COMPENSATION
AND E.I.EACH ACCIDENT $500000
EMPLOYER'S LIABILITY
E.L.DISEASE-EA EMPLOYEE $500000
E.L.DISEASE-POLICY LIMIT $500000
SPECIAL
CONDITIONS/ FEES $
OTHER
COVERAGES TAXES $
ESTIMATED TOTAL PREMIUM $
NAME&ADDRESS
MORTGAGEE ADDITIONAL INSURED
LOSS PAYEE
LOAN# /// - -
AUTHORI PR :r NT•�
-----:::4400;
oo
Af'f7Rfl 7N.S/9/QRI Nf7TF• IMPfPTANT STATF I OR , In • PP• RSF SUIF
rlAf`f1R11(`f1RP(1RAT1(1N 1009
�- is-vo, iv.•rohm,v�r � ivanae oei vivea
' 100U IIJ ICL`J It I!
State of Connecticut
Department of Consumer Protection
•
LICENSE VERIFICATION
This Is to certify that the Connecticut Department of Consumer Protection's records
Indicate the following Information regarding:
MARK MARTIN
67 FORSYTH RD
SALEM, CT 06420
Credential Number: HTG,386875
Credential Type: HEATING, PIPING & COOLING LIMITED
CONTRACTOR
Credential Status: APPROVED
Application Date: 12/05/1996
Effective Date: 09/01/2003
Expiration Date: 08/31/2004
If you have any questions relative to this matter, please contact the Department of
Consumer Protection.
7-c) ./{ZZ_
2_Z_ t,(J Judy MitrowsTc`i
77Y
Processing Technician
G'-) .S ��G�
9/1 2/03
1
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;StVit OP11�iT'E
C�� C1�ieUT`'����' s e S e r v l c e a e /
QE RTMENT OF CONSUMER PROTECT/ON r :• a n
Avenue ♦ Hartford Connectic 06106
HEATING,PIPING&COOLING LIMITED CONTRACTOR 3-600029
MARK A MA TI 711: ItenSe SerVICe02)DO eote.ct.u8
67 RK A D VebSte www.state.ct.us/dcp/
SALEA c6420
TYPE 1G1
LIC./REG NO K F IVE
EXPIRES
38687509/Ol/2O03 :02/31/2004
rTRANSr $ „�
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