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Home My WebLink AboutLP Lines to Gas Logs 2003 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext.382 Mechanical Permit Permit Number: M2003-0230 Date: 05-Dec-03 Map/Lot: 111/022-000 Owner ID 121526 Job Location: 145 PRUETT PLACE Unit Job Description: Gas Lines&gas logs Owner: Contractor: Craig L and Patricia A Barrila Advanced Gas 183 East Haddam Road 145 Pruett PI 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: $400.00 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: $400.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.06 Total Fees: $10.06 It 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 ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany 0 Gas piping and test Building Official's Signature: �.., V. r...... .n.1 v,11.? ni.,al.uanv uzra lei el Town of Montville Building Department Permit#4,7623_-_-_,2„v-e. 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasvi]le, CT 06382 Fax. 848-7231 One& Two Family LP-Gas Permit Application Form Job Location 1 `"t PYl 'e- P�aLS— Job Description/Materials I St Cii(1-S (-1:-ODS 4 ttL L 0 $ Owner PO " CA/Ca‘ P)Cu l t 1GL Mailing Address c;ty ( C1Q State e i Zip 0 Le 31() Tel_ lb0/ L41-0/ 5G1 Contractor 1cWaylesd ClcG_-5 Mailing Address 9 s 5 t 1.-lactdaNn. 1 d city Seg .irn state CCI zip Owl ID Tel CkLe0/ g5c(/C10 16 Contractor's License/Registration Type&Number 3V_P51 611- Exp.Date a/ 3 1 /0(-4 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 144-a-d--- Date Construction Value Fee Building $ S Plumbing $ OD— $ Mechanical $ S Electrical $ $ Other Certificate of Occupancy S Plan Review Fee $ State Education Total $ Loo S ' D , 0 L Town of Montville Building Department Receipt Date A / / / 03 No. 0339 From: :.ter... Job Address: '� Amount $ � ,�^ �� • _-L_ Cash Check Check # //g/N7,7 Received -,� �� f ,�J r.�� Permit # 3— y c-vo, iv.woNiv ,v�r LI(,�IIJt' Jt'I VII.V'J ,OOV ! IJ /cce ft 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, Judy Mitrowski Processing Technician 9/12/03 License Services Division 165 Capitol Avenue + Hartford Connecticut 06106 Telephone: (860) 713-6000 4 FAX: (860) 713-7229 E-Mall: Ilcen$e,$ervlce$@pp.$tote.ct u$ WebSlte: www.state.ct.us/dcp/ 10-16-03; 2: 19PM;Bailey Agencies, Inc ;860 448 1608 # 2/ 2 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID CP DATE(MM/DD/YYYY) AD PRODUCER VAN--6 10/16/03 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bailey Agencies, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 178 Bridge Street HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Groton CT 06340 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone: 860-446-8255 Fax:860-448-1608 INSURED INSURERS AFFORDING COVERAGE NAIC# INSURER A: Ranger Insurance —- INSURER B: woa[port Innu ran Corpora tip Advanced Gas Sales & Service Stacey Martin INSURER C: 183 East Haddam Road Salem CT 06420 INSURER D: -- COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW I-IAVE 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.AGCRECATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. fNSH AUU'L LTR INSRD TYPE OF INSURANCE POLICY NUMBER POLICY�FFECTIVE'PLICY OR'(ftgTIOlf- DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY A X CQMMERCIALGENERAL LIABILITY R/ENG0236662 00 EACH OCCURRENCE S 1000000 _ 10/01/03 10/01/0'3 PREM IJAMASES(Esorcurcnco) $ 100000 CLAIMS MADE X OCCUR MED EXP(Any one person) $5000 PERSONAL B ADV INJURY $ 1000000 GENL AGGREQATE LIMIT APPLIES PER: GENERAL AGGREGATE $2000000 POLICY n I J LOC PRODUCTS-COMP/OP AGO s 2000000 AUTOMOBILE LIABILITY IA X ANY AUTO R/SBA0361688 10/01/03 10/01/04 (EEnnaccidentSINGLE wGLEUMIT $ 1000000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON•OWNEO AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 A X OCCUR CLAIMS MADE R/CUP0420392 10/01/03 10/01/04 ACCREGATE $1000000 DEDUCTIBLE 3 $ X RETENTION $10000 _ WORKERS COMPENSATION AND �` $ EMPLOYERS'LIABILITY WC STAT()- �JTH- 8 WCX0013966X TORY LIMITS ER ANY PROPRIETOWPARTNER/EXECUTIVE 10/01/03 10/01/04 E.L.EACH ACCIDENT $500000 OFFICER/MEMBER EXCLUDED? If ye,describe under E.L.DISEASE•CA EMPLOYEE S 500000 S ECTAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $500000 –, DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Proof of insurance with regards to the named insured. Original Issue Date 10/16/03 CERTIFICATE HOLDER CANCELLATION ADVANC1 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 OBLIGATI OR LIABILITY• ANY KIND UPON THE INSURER,ITS AGENTS OR 183 East Haddam Road Salem, CT 06420 REPRESENTATIVES AUTHORIZED REPRE ENfA'pVE-- 4CORD 25(2001/08) Patricia A s-rretty b- T, •CORD CORPORATION 1988