The URL can be used to link to this page

Home My WebLink About120 Gal. LP Tank and Lines to Furnace 2007 Field Inspection Notice Town of Montville Building Department March 30, 2007 Address: 12 Polly's Ln. Job Description: Gas Permit Number(s): Gas tank,gas lines Permit Date: 10/16/06 Not Approved Approval INSPECTION Date: Deficiencies Special Date Conditions Gas line pressure& • • 10/24/06 VV fireplace installation Certificate of • 10/24/06 VV approval Rev.Date: 1/18/06 Page 1 of 1 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 MECHANICAL PERMIT Permit Number: M2006-0159 Date: 16-Oct-06 Map/Lot: 103/037-000 Owner ID: 5602000 Project Location: 12 POLLYS LANE Unit: Job Description: Install gas tank,gaslines,furnace Owner Name: Eugene D Thomas&Louise E Behan Tenant Name: N/A Careof: 12 Pollys Lane Uncasville CT 06382- Telephone: Contractor Name: Samuel Sugawara Telephone: (860)447-0341 DBA: Osterman Propane Lic/Reg Type: GI Lic/Reg No: 394019 7 Enterprise Lane Exp Date: 31-Aug-07 Oakdale Ct 06370- Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code Mechanical Value: $950.00 Mechanical Fee: $8.00 Electrical Value: $O.00 Electrical Fee: $0.00 Construction Type: IRC Total Value: $950.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.15 Total Fee Paid: $8.15 It shall be the owners repsonsibility 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 framing ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble El Gas Piping and leak test ❑ Fireblocking_Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑ Certificate of Approval ❑ - a .. Occ pa Building Official's Approval: A •A Town`of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.: o20.4 -6/,�'� Type of Work Occupancy Type Permit Type ❑New Construction �Ingle Family CI Building CI Addition L�Two-Family ❑ Plumbing ❑Alteration ❑Townhouse KO/echanical ❑Accessory Structure Cl Electrical CRS#: Job Address: 12 7'O(_- _y S r (Number) (Street) (Unit) Job Description: 7—/Zp 7me- AS ,� ,�//E Owner: E. V(4-s.t•_ _ 734p/ S Address'': nn 'Z POLL � ( S L— . V City: ,U LP SU ) �� State: Cr Zip Code: 06 Telephone: ^06-7 Contractor: V C.L_ SO 44 e 0 � DBA: '''') Address: / 5g- (—ANC City: C)Au/ 74L_ _ State: —r Zip Code: at..., f Telephone: Lig 7- 034I License Type: _adcense No.: Expiration Date: 1 '3i 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. ❑ By checking this box, I will follow the requireme - of e •i•: -s the alternative compliance per section E3301.2.1 of the Residential Code, instead of the electrical requirements in chapt: )-•r' • e Residential Code. Owner Agent ignature: Date: /O ��/ Constructs � Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: p Mechanical Value: 950 Mechanical Fee: 8,o o Electrical Value: Electrical Fee: ektU Total Value: Penalty Fee: C of 0 Fee: • Plan Review Fee: State Ed Fee: ,/s Total Fee: 8 l� &vised(December 31,2005 • Town of Montville Building Department File Receipt Date: 12-Oct-06 Receipt No: 1774 Received From: Ostermin Propane Job Address: 12 Poll 's Lane Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $8.15 Check: $0.15 Check No: 1638 Short/Over: $0.00 Construction Value: $950.00 Demolition Value: $0.00 Received By David M Jensen /(9 ori/I gi7 I ACORL ,, CERTIFICATE OF LIABILITY INSURANCE DATE`MMIDD/TYY) PR000CER 10/2$/.2005 (781)356.4550 FAX (781)356.4553 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher Risk Idanagement Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE A J Gallagher A Co of MA, Inc HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 50 Braintree Bill Office Park ALTER THE COVERAGE AFFORDED RY THE POLICIES BELOW, Braintree, MA 02184-8754 INSURERS AFFORDING COVERAGE NAIL# INSURED E. Osterman Gas Service Inc. INSURERA: Colony InsuranceCompany 1 Memorial Square INsuRERe Great American Assurance Co. North Bridge, MA 01588 INSURER C' T INSURER D• � INSURER e. - VE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN mum TO THE INURED NAmEDABOVE POR THE POLICY PERioo IND1cATED.NOTWITHSTANDIN1 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 CONDITICNS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN3RIAD• LTA P, .'I: TYPE DP INSURANCE JOLIOY NUMBER MADN PbAYL IEX1 IRAlY'f LMII11 GENERAL LIBIL AITY ( EACH OCCURRENCE I; i COMMERCIAL GENERAL,LIABILITY I DAMAGE TO RENTEDI f CLAIMS MADE OCCUR 9RFMIRFC.I eertdert , -,NED EXt(Ary ane wan) i • PERSONAL a*DV!WURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPL16$PER; PRODUCT8-COMP/OP AGG$ FbJCY 7 je �� ._.___.....__,.. AUTOMOBILE LIABILITY _�� .._...J ANY AUTO COMBINED SING_E LIMY' $ LE8 acGdar>a I ALL OWNED AUTOS SCheDULED AUTOS I BODILY INJURY (Perpersen) $ I�IAED AUTOS 17--" -- ' ■NPNO�ANZO AUTOS (Par a Y INJURY{Par aociCart) PROPERTY DAMAGE a .f (Per audert) • OARAOELIABILITY j AUTO ONLY-EA ACCIDENT a __________ ~ ■ANY AUTO - -- . OTITIER THAN EA ACC 3 : ALToONLY: AGO $ ECDESS)UMaRELLA LIABILITY AR3460075 10/01/2005 10/01/2008 EACH OCCURRENCE a 5,000,000 X I OCCUR n CLAIMS MADF. AGGREGATE $ 3,000,000 A r— DEDCCTIHLE — 9 RETENTION 9_ $ S WORKERS COMPENSATION AND 1 AWL foif 0TH.E7PLOYER4'LLiLtTY ANY PROPRIE1ORJPARTNERIFJCEGUTIVE EL EACH s OFFICERAAE.bdSER EXCLUDED? t yes des, be under •EL DISEAS:•EA EMPLOYEE$ SPECT.NtbOej I h8 below I-- OTHER E.L WAS!,POL'CY LIM'T $ B lceas Umbrella BXC4719010 10/01/2005 10/01/2005 $10,000,000 Excessof ability $5,000,000 Primary Umbrella DeSCRPTtON OF OPERATIONS/LOCATION?I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/aPECIAL PROM810NS The certificate holder is included as Additional Insured with respect to liability arising out of the operations of the named Insured per Additional Insured End. #LG1005. Waiver of Transfer of Rights of Recovery Against Others Per End. 4`CG24041093• •CERTIFICATEJ.IOLDER _.,,^CANCELLATION SHOULD ANY OF THI AMOY!DESCRIBED POLICIES se CANCELLED OEFORE TMG EXPIRATION DATE THFRECF,MI ISSUING INSURER WILL ENDEAVOR TO MAIL, Town of Montville SO DAYS WRJTTEN NOTICE TO THE CERTI'ICATE HOLDER NA/AID TO THE LEFT, 310 Norwich-New BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE AO OBIJOATION OR LIABILITY London Turnpike OP ANY KIND UPON THE IN*URER,TiIAOENTS ON REPRESENTATIVES, Uncasvi l le. CT 06382 AUT oamaO REPRESERTATT '* — I Barbara Miller/GFG eafte-Cy'%aN ACORD 25(2001106) FAX. (860)848.7231 t&tACORD CORPORATION 1888 09%29%2006 13:35 FAX 978 531 4857 B K.McCARTHY Z 001 • ClIent#:25489 COSTE ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYW) 09/29/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Conifer Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10 Centennial Drive HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. Peabody ,MA 01960 978 532-5445 _ _ INSURERS AFFORDING COVERAGE NAIC# INSURED _INSURER A; Liberty Mutual Insurance Company 23043 E.Osterman Gds Service Inc. INSURER a: Lexington Insurance Co P.O.Box 29 INSURER G; Arch Speciality Insurance Company One Memorial Square INSURERD: Whltinsville,MA 01588 -- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED AaOVE FOR THE POLICY PERM 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 eY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR 'NERD TYPE OF INSURANCE POLICY NUMBER DATE(MMJDDrm PPATE IMM DIY^Y))N LIMITS _ A GENERAL LIABILITY TI3164G435284055 11/01/06 11101/07 EACH OCCURRENCE S1,001000 COMMERCIAL GENERAL UDAMAGE TO RENTEDABILIrY PREMISES(Ee at,{,yrrence) $50,000 CLAIMS MADE OCCUR MED EXP(Any One person) s5,000 -- PERSONALBACV INJURY 11,000,000GENERAL AGGREGATE 52,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY n P JECT LOG — A AUTOMOBILE LIABILITY AS164G435284045 11/01/06 11/01/07 COMBINED SINGLE LIMIT X J ANvau7a (Ea Seddon!) 51,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per parotin) S X HIRED AUTOS BODILY INJURY S X NON-OWNED AUTOS (Per eccidero X Drive Other Car PROPERTY DAMAGE 5 (Par accident) u GARAGE LIABILITY AUTO ONLY-EA ACCIDENT _$ .--1_AN'!AUTO - OTHER THAN EA ACC 5 AUTO ONLY: ABS S B EXCESSNMERELLA LIABILITY 6760868 10/01/06 11/01/07 EACH OGCURHENCE s5,000,000 X I CCCUR 7 CLAIMS MADE AGGREGATE $5,000,000 _ S _ DEDUCTIBLE $ RETENTION 5 A woRKER3COMPENSATION AND WC164G435284065 11/01/06 11/01/07 WCSTATU- DTH. -TORY LIMITS ER EMPLOYERS'LIABILITY ANY PROPRIETORIPA.RTNEPJEXECL'TIVE El,EACH ACCIDENT a1,00000O OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE 51,000,000 Ir ya:,ac:cribe under __SPECIAL PREVISIONS below E.L.DISEASE-POLICY UNIT 151,000,000 C OTHER Excess Umbre UXP0018093 10/01/06 11/01/07 $10,000,000 Ea.Occur $10,000,000 Gen Aggr. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDDRSEMENT I SPECIAL PROVISIONS 860-848-7231 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Montville DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3D DAYS WRITTEN 310 Norwich-New London NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,RUT FAILURE TO DO 5o SHALL Turnpike IMPOSE NO QeLIGAYION OR LJABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Uncasville,CT 06382 REPRESENTATNES. -_ AUTHORIZED REPRESENTATIVE �— . P1C=412.,41 ACORD 25(2001106)1 of 2 #M52171 BDO @ ACORD CORPORATION 1968 Town of Montville • Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL Z �I A • ♦ J 1�� Property Address /-120 ( -4/4 T -//fir-pi&)ct t—OkiV CC— Job D6scription The applicant is responsible for obtaining all of the required approvals checked off on this form. No building permit will be issued until all of the required signatures have been obtained. Required Approval Department Permit Issuance Approval Tax Collector s J�la-e .,� �o%.x, id G Signature/ date Comments: ❑ WPCA, Administrative I mb ‘0 -1& —C(0 Comments: date ❑ WPCA, Operations Signature/date Comments: ❑ Planning &Zoning Signature/date Comments: ❑ Health Department Signature/ date Comments: ❑ Department of Public Works Signature/ date Comments: ❑ State Dept. of Transportation Signature/ date Comments: ❑ Fire Marshal , [OhZC -�'CJ M� Comments: l h( c. L If y Signature/ date seIAugust s,2005