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HomeMy WebLinkAbout100 Gal. LP Tank and Line to Logs 2006 Field Inspection Notice Town of Montville Building Department December 4, 2006 Address: 55 Polly's Lane Job Description: Gas& Logs Permit Number(s): M2006-0186 Permit Date: 11/21/06 Not Approved Approval INSPECTION Date: Deficiencies Special Date Conditions Gas Test • 15 PSI OK 12/4/06 DJ 12/4/06 DJ • An accessible shutoff valve is required outside of the • Appliance installation firebox. Certificate of •• 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: M2006-0186 Date: 21-Nov-06 Map/Lot: 103/054-000 Owner ID: 5620000 Project Location: 55 POLLYS LANE Unit: Job Description: gas line,tank&vent free fireplace logs Owner Name: Joyce E Morris Tenant Name: N/A Careof: 55 Pollys Lane _....__.._.-�.__�..__.._._.__... Uncasville CT 06382- Telephone: Contractor Name: Mark Martin Telephone: (860)859-9070 _ W DBA: Advanced Gas Lic/Reg Type: G1 Lic/Reg No: 386875 183 E. Haddam Rd. Exp Date: 31-Aug-07 Salem Ct 06420- _ _ .__ConstfctoValua _ 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: $600.00 Mechanical Fee: $8.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: IRC Total Value: $600.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.10 Total Fee Paid: $8.10 It shall be the owners reasonsibility 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 0 Gas Piping and leak test ❑ Fireblocking_Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑d Certificate of Approval erti is of cup Building Official's Approval: // 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.: 02>6-100 Type of Work Occupancy Type Permit Type 'New Construction Ingle Family ❑Building ❑Addition ❑Two-Family Imbin ❑Alteration 0 Townhouse g ❑Mechanical ❑Accessory Structure ❑Electrical CRS#: Job Address: 81 Ali- frS //97/1E Gf,�/rS,1ZZe free 'c - (Number) (Street) /l�l�/ / (Unit) Job Description: AIP_J%jAff 4 S _ I ) C/-211 d1 Z, 'hi .. Ili I R / - - - • AS Ai/ AW-,° ice' .4(CS- , :. Owner: y("4 /WC,e,IS Address: , Pia/Z- /-t- % /1 City: a/�r'111S'!. State: 66 OL. �r/ �-�/ Zip Code: Telephone: &� — 0 7c?—// 7 CJ Contractor: / 7,I Kifr" `4 u7iv' DBA: g2)'~/3 7) ( & Address: / 3 Z, / /-) 1L7I7 /,-e 3 City: /l.0 e/! State: Com. Zip Code: -7O Telephone:W15-9-967,0 License Type: K3-4". License No.•3 ,� fExpiration Date: 4-V"3/PC1:3 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 requirements of the 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Code, instead of the electrical requirements in chapters 33 through • .f the Residential Code. '4411111111111....„ I Owner/Agent Si. . . -• — \ — ..... _ Date: 1 t al O • Construction Value Permit Fees Building Value: • Building Fee: Plumbing Value: Plumbing Fee: 'O • Mechanical Value: Mechanical Fee: • Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: /D Total Fee: i S, /4 . *vises cDecemfier 31,2005 Town of Montville Building Department File Receipt Date: 21-Nov-06 Receipt No: 1872 Received From: Mark Martin,Advanced Gas Job Address: 55 Polly's Lane Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $8.10 Check: $0.10 Check No: 10517 Short/Over: $0.00 Construction Value: $600.00 Demolition Value: $0.00 Received By Sandra Pandora ADVANCEp GAS 183 E.HADOAM ROAD SALEM,CT 08420 SALES & SERVICE Telephone 860-859-9070 Fax 880-889-3827 TO o ro O (non+ul L BUILDING DEPARTMENT RE: BUILDING PERMIT APPLICATIONS • PROPERTY ADDRESS: . ' /'LL .5 —/- ,vy� OWNER: t,kk:�`/lCL-`. i l5 DESCRIPTION OF JOB: ...tI3 ,.1._ -Ag2/1,019Q,S � k 4A e STARTING DATE: Ii/3D/c2QD6 LICENSED CONTRACTOR: MARK MARTIN HTG.386875 LICENSED CONTRACTOR'S AGENT: ►. PLEASE ALLOW MY EMPLOYEE TO PULL OR DELIVER THIS RERMIT. Sincerely, STATE OF CONNECTICUT DEPARTMENT OF ca;r SUMER PROTECTION . / HEATING,PIPING&COOLING LIMITED CONTRACTOR G1 MARTIN MARK A MARTIN PRESIDENT • ; 67 FORSYTH RD SALEM, CT 06420 LIC./REG NO, EFFECTIVE I EXPIRES 386875 09/01/2006 08/31/2007 SIGNED From:Sue Ross At:Tracy-Driscoll FaxID:Tracy-Driscoll Ins A To:Gere and Brenda pate: 1U/1(200(6 08:53 AM Page:2 of ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID SR DATE(MM/DDMW) ADVANO2 10/16/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Tracy-Driscoll HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 126 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Bristol CT 06010 Phone: 860-589-3434 Fax:860-589-6406 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. St. Paul Tzevalers Imuranco 10647 INSURER B. Guard Insurance Group Advanced Gas Sales & Service INSURER C. Landmark American Ins Co LLC 183 East Haddam Road INSURER D: Salem CT 06420 INSURER E. COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR RL)U L POLICY)=I-I-ELIIV6 POLICY EXPIHAIIUN LTR NERD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DDM/) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 DAMWGt fU KtNI t A X COMMERCIAL GENERAL LIABILITY 6605655C366 10/01/06 10/01/07 PREMISES(Eaoccurence) $ 100000 CLAIMS MADE X OCCUR MED EXP(Any one person) $5000 PERSONAL d ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGO $2000000 POLICY ^ JECT —LOC Emp Ben. 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000000 A X ANY AUTO BA77200035 10/01/06 10/01/07 (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY(Perperson) $ person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ A X MCS-90 BA77200035 10/01/06 10/01/07 PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ALTO ONLY-EA ACCIDENT $ ANY AUTO R OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 C X OCCUR CLAIMS MADE X$1082552 10/13/06 10/01/07 AGGREGATE $ 1,000 ,000 DEDUCTIBLE _ _ ^_ X RETENTION $10 r 0 0 0 — $ WORKERS COMPENSATION AND !TORY WL SAILL IIH- rO B EMPLOYERS'LIABILITY TORY LIMITS I ER ANY PROPRIETOR/PARTNER/EXECUTIVE WC1082552 10/01/06 10/01/07 E.L.EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? If yes.describe under E.L.DISEASE-EJB EMPLOYEE $500000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: Proof of Insurance w/regards to the named insured CERTIFICATE HOLDER CANCELLATION ADVANO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Advanced Gas Sales & Service Stacy Martin NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 183 East Haddam Road Salem CT 06420 REPRESENTATIVES. /� J AUTH IZED REPRESENTATIVE6/ l - ACORD 25(2001/08) `/\l ' ©ACORD CORPORATION 1988 • ADVANCED GAS SALES AND SERVICE 183 EAST HADDAM ROAD SALEM, CT 06422 860-859-9070 FAX # 860-889-3627 w :r . :. .t. . ,• - _ . • • J ••• ...,,,•:„.:-....•,,,,,,,,,:`,":40X.:0 ,.ttW ,:� " . r :: `t :erti Y s A ' : :,. t11 if4 ' . 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'ti.'"‘ V 4 ' .f., /'i „yam • • ! :cam s�l' a..0 '' 1 fly � •( y, t�..} �� - _ �• � r••t." •'t' • •>a a p ti� F� �.Y oic^ • 'rt 7..t..,„:,...-.-.4.11'• at=y.l -3:7,..7f... r �'{ � +} +.t f. t yam, � • • �" � i�. �4•t., J a *.-','"•••1- ;,m. ., ;G�tNA!..:'''',4".4,-(5.4.- .. rC� .T,� Y T,iA• f } �' t )r • J 4� � .q{jj(Q�y�gy}p��y��y 4 -',7'",----''''''' ,7'" . .:. 4. 1.o1.4. 117,,,,..•,-w, .74 " � . r •,•vf". qAr r� t•.( •xu•' '3k,. ••s? H. ?Y • . s•+fer_' , .* '�Jr .` ! . 1 $;.. v�.r ;:00 51' lr•' �. toli,% :�C. ar.u. 'pirFf r 57rt •.i •r-(?W•:.r, >t sC � .�,f. ,• sN:-t ,.„" t ; e ,F � s• .:..,...,,,,44./.....,...,,,,.4.4..„..,.0i. lsr . , �* e.ryV wr z . � . z ,t • , •i..�+ . • v„.rP../^ :; 7;.y� aTli••y:1',. u•� v�•. rys} ^4.f" \.,rsW:••.A �.� w�a .,> . •.�• ,} .�. s• `itt •d^ '•d •••4:0::••1:*- .t.;� ^ r��}tC7?, +4tYi. .pra+ . sf;Kti.,yf/t.,. .:it . H � rt. .. .t}� �?: .. ,�` "F;�,i:`\: . :`. %t: s;rT�•'tvi. ....rtyv;• •..:Y{: : :.st,ry.'�,7iS:?s?A.':;k..+�. t.• T .:4 4,',v.- , r �Gst4:iT� vi`' .t.;{;rT`!•� T`n::AvA. .:46.......4,':: yi 't,.i4.'.<,,.T. rny •• A: ' a...•:.a - ,....: ?Y] is STATE OF CONNECTICUr `5; DLPf1RTA!LNT OF C.ONSUAIER PROTLCT!ON M, :: , • HEATING,PIPING&C910IED CONTRACTOR a t ,•.; S 'EM, 0420r LIC./REG NO,., •':;; g ECIVh? i�`�.'4-•:_• EXPIRES 386875 `'" ovt�'1/466„'µ '08'/31/2007 SIGNED 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 55— Y Property Address Job Description 96' �GE- 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 Department Approval p Permit Issuance Approval • Tax Collector /10-„..L_ i-,/.z,.i 10 40 Comments: WPCA, Administrative6,,NOLA\n \ - a -_a_o Comments: El WPCA, Operations WA icriature/date Comments: r:// Planning &Zoning Signature/date Comments: Health Department Signature/date /' Comments: / Ej Department of Public Works Signature/date Comments: • D./ State Dept. of Transportation Signature/date • . Comments: / II Fire Marshal9 '! � I I 2i \ EID ,�1 n -St _` in�� ^�,A l I N Signature) date ��Comments: I V ►'t !`1 / 1't1 2cviseeAugust 5,2005