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Home My WebLink About275 Gal. Tank MechanicalV Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Mechanical Permit Permit Number: M2003-0124 Date: 08-Jul-03 Map/Lot: 080/011-000 Owner ID 119502 Job Location: D Unit Job Description: INSTALLATION OF 275 GAL OIL TANK AND PIPING Owner: Contractor: Thomas D and Tina M Grove SERVICE STATION EQUIPMENT 33 LEFFINGWELL 9 Point Breeze Road UNCASVILLE CT 06382- Uncasville CT 06382 Telephone: (860)848-2278 Lic/Reg Type/No. P-9 2084690 Exp Date: 31-Oct-03 Tenant: N/A Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $1,500.00 Mechanical Fee: $10.00 Construction Type: 56 Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $1,500.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.24 Total Fees: $10.24 It is the owners responsibility to schedule the following inspections(minimum 48 hours notice requires): ❑ 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 ❑ Gas piping and test Building Official's Signature: Town of Montville Building Department Permit# /yzoc. _o z� 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Oil Tank Application Form Job Location q f bre .z . Hca s,i'1) C� , 6C,3 Job Description/Materials Z vt5 4-c.( 1614-(.0v1 (.4 a t 5 6Q ) +,,1 k ,p f pig Owner"."12;1"\. c rO Irk Mailing Address q P 1..) "�•e Z - �a CityV I� State C1— Zip DG 3 8'a Tel '360 / $S(8"/ l ,2(a l n / Contractor6e�v zG�S4c 4 t o l L1 �,pwten ailing Address 33 'e1-6✓11Lc�! City (j✓4etSJ►°il State (.571- Zip bG3gTel ZO / 'AT /2,278' Contractor's License/Registration Type&Number 7 C aO ff°IC 9 Exp. Date /6 / 3 I / (, 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 2 Date 7 / /03 Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ /500 ,00 $ co Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education Total $ JS Town of Montville Building Department Receipt Date 7 / .4' / a3 No. U2946 From: c Job Address: Amount $ /0 . Cash OP Check # 2cn 0 Circle one) Received by , � t,,� Permit # ervice Station Equipment Inc. - - Specialties: Gas Pumps - Lifts - Self Service Specialists 33 Leffingwell Road Sales, Service & Installation Uncasville, CT 06382 (860) 848-2278 • 1-800-801 -TANK A ,, g/d 3 u!:I'tJ;e,IIL'XJ 01'(Iu.��. 11,1113;PRO11(ii0X DateI 7 1 PLUMBING&PIPING LIMITED CONTRACTOR MARTIN D MCKINNEY JR RFD#1 8 TOTEM LN City/Town L�✓1Cck,50 k GRISWOLD,CT 06351 TYPE: P9 UC./REG NO. EFFECTIVE 1 EXPIRES RE: Applicant-for Plumbing Permit 208469 I 11/01/2002 10/31/2003 SIGNED Licensed contractors, as defined in section 20-338b of the Connecticut General Statutes, Must personally sign each building permit application. This letter authorize the below Named agent to sign the above referenced permit application. Project Name Tom (��.�2_ Address: Q LD1 v1: (3 -c - (.Y SU tie_ , ( - C)(a33Z Staring Date: . Licensed Contractor's Name: Martin D.Mckinney, Jr. License Number : 00208469 __ __ International Conference of Building Officials ip w`\ • Agent Name: 1,eiz,t1) MARTIN D MCKINNEY JR is CERTIFIED in UNDERGROUND STORAGE TANK UECUMMISSIUNINti The Individual named hereon Is CERTIFIED In the category shown, "Tanks A lot" pursuant to successful completion of the prescribed written examination. Expiration date:July 11,2003 ICBO No.5073836.26 ASI No.32026243 in�!Mckiszlfe , r Not Service Station Equipment, Inc. ICBO certification ttest • 'competent signed b ed of •coder andestandards. Applicable experience should be verified by/oral jurisdictions. Jur. 24 , 14 :38 EDT by: AKHKimberly J. Hicke ( I4 : 40) Page 2 of 2 • ...._.....................�;:::;:::•i::•_..:: ::•.: . . ,.•:•.. :i . .'i? ..i•:•7{ .i::�•.'^:•::}•.:;,C•:;: :!:;::;{ :i•.:;:: .:... _ ,. • DATE... 0/147.0 ,.,. , 06/24/03 PRODUCER THIS CERTIFICATE I5 ISSUED AS A MATTER OF INFORMATION BYRNES AGENCY INC ONLY AND COCERTIFICATENFERS CERTIFICATE DOES NOT AMEND, EXTEND OR 553 HARTFORD PIKE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 739 COMPANIES AFFORDING COVERAGE _ DAYVILLE CT 06241-0739 COMPANY I1 A AGENCY INTERMEDIARIES INC INSURED COMPANY —-- SERVICE STATION EQUIPMENT INC B NATIONAL GRANGE MUTUAL INS CO COMPANY 33-59 LEFFINGWELL RD C COMBINDED SPECIALTY UNCASVILLE CT 06382 { COMPANY I D COY 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 RESFECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE –ERJS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.00 11 i I TYPE OF BLSURANCE POLICY POLICY EFFECTIVE EXPIRATION UMTS LTA; DATE(111A00/10 DATE(MWDOITT) ^DEIenu.UABIUTY 0 3 P KG0 0 9 0 5 ' 1/07/C3 1/07/04 GENERAL AOOREGATE 1$2,000, 000 X MERCIAL GENS uu PRODUCTS-COMP/OP AGO 52,000,000 CLAIMS MADE I X i OCCUR PERSONAL a ADV INJLFIT s 1,0 0 0, 0 0 0 lONINETTB&CONTRACTORS PROT EACH OCCURRENCE 81,000, 000 FETE DAMAGE(Any on RN) i 50,000 MED EXP wry ON pamon► S 5, 000 B AUTOMOBILE LIABAITY B1F94727 9/01/029/01/C3 1,000, 000 COMBINED SIJO_E LIMIT S ANY AUTO i AU.OWNED AUTOS I BODILY INJURY X 1 SCHEDU_ED ALTOS (Par Pi40') S X IHIRED AJTO9 --1 I BOolLY INJURY X;NON-OWNED AUTOS ;(Pe,accident) PROPERTY DAMAGE IS —yl t GARAGE UAILRY AUTO ONLY•EA ACCIDENT S 'ANY AUTO OTHER THAN AUTO OILY: EACH ACCIDENT $ AOOREGATE 8 EXCESS LIABILITY EACH OCCURRENCE S UMBRELLA FORM I AOORE3ATE S ^OTHER THAN UMBRELLA FORM j S C aORKERSCOMPENSATION AND IB0200222512 8/25/02 8/25/03 X TWpFLTJAA 111PLOYEP3'LUIBIUTY EL EACH ACCIDENT $ 500,000 THE PROPRIETOR/ PARTNERS/EXECUTP/E INCL EL D6EASE•P000Y LIMITS 500,000 OFFICERS ARe I EXCL 1 EL DBEASE-EA EMPLOYEE i 500,000 OTHER DESORPTION OF OPIRATIONSAOCATIONSNENICLES3RCIAL ITEMS C tEALTAf$•:HOLDER::$:;<::`::;::i < :; ;:::::•: >: :>i:','::>:>::;: ::::::.;: ,..{ ..:..,:.:::.:..::::::.,.::::::,::.. ... .... ............ .... ..:.. r.�t9sr�riATlmu . ........:. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE [xi.'RATION DATE THEREOF, THE ISSUING CONFER', WILL ENDEAVOR TO BAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILFTT OF ANY KIND 'FON THE COMPANY, RS AGENTS ON REPRESENTATIVES AUTHORIZED RIPRESENTATWI i.:::........;:•;: :•:•:;;>:•::;:•;:•::::;:;;.;::::;•:::;.:>:.:;:•>:•::::<:.:;.:•::•>::.: :.:::::::; :.:;::Kimberly::J.•:::Hickey ........ . KH A