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Home My WebLink About100 Gal. LP Tank and Line to Fireplace 2004 Town of Montville ta Building Department Field Inspection Notice Address: 165 Pruett Place Job Description: Gas Permit Numbers:M2004-0194 Footing Not Approved: Approved: Comments: 1. Backfill Not Approved: Approved: Comments: 1. Framing Not Approved: Approved: Comments: 1. Rough Electric Not Approved: Approved: Comments: 1. Electrical Service Not Approved: Approved: Comments: 1. Rough HVAC Not Approved: Approved: Comments: 1. Rough Plumbing Not Approved: Approved: Comments: I. Gas Line and Not Approved: Approved: 10/04/04 VV fireplace insert Comments: I. lOpsi on gauge Fireplace Throat/ Not Approved: Approved: I Chimney Comments: 1. Fire/Draftsto in Not Approved:PP g PP roveApproved: Comments: 1. Insulation Not Approved: Approved: Comments: 1. Certificate of Not Approved: Approved: Occupancy Comments: 1. Not Approved: Approved: Comments: 1. Not Approved: Approved: Comments: 1. Not Approved: Approved: Comments: 1. Comments: 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: M2004-0194 Date: 16-Sep-04 Map/Lot: 111/020-000 Owner ID: 5725000 Project Location: 165 PRUETT PLACE Unit: Job Description: install tank&gas lines for fireplace Owner Name: Paul A and Joan P Russell Tenant Name: N/A Careof: 165 Pruett Place Oakdale CT 06370- Telephone: Contractor Name: Mark Martin Telephone: (860)859-9070 DBA: Advanced Gas Lic/Reg Type: G1 Lic/Reg No: _ 386875 183 East Haddam Rd. Exp Date: 31-Aug-05 Salem Ct 06420- Construction Value 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: 1999 State Building Code Mechanical Value: $500.00 Mechanical Fee: $8.00 w/2004 Amendment Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $500.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.08 Total Fee: $8.13 It shall be the owners repsonsibilitv 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. ❑ Footing - Prior to pouring concrete ❑ R Plumbing and leak test ❑ Backfill - Footing drains and waterproofing ❑ R Electrical ❑ Concrete Slab-Prior to pouring concrete ❑ Elec Trench-with conduit installed ❑ Framing ❑ Electrical Service CRS No: 0 ❑ Fireplace Throat-One flue above throat ❑ R HVAC ❑ Chimney-One flue above thimble ❑d Gas Piping and leak test ❑ Firestop Draftstopping ❑ Final Inspection ❑ Insulation ❑ Certificate of Occupancy Building Official's Approval: / vii ami yr ia.yr rnn v+o�rvi DULLJl111V LPGr1 tEdV1 Town of Montville -... Building Department Permit# 310 Norwich-New London Tpke. Tel, 848-3030, Ext 82 _ Uncasville, CT 06382 /1' Fax. 848-7231 One& Two Family Trades Permit Application Form ETtunt6ing []Etcctncat f Mecttanicaf Nutting IT Cond.:tmning as tPcping 0 Other Job Location l( B `—W A. 4. -- QT Job Description/MaterialU `Twir\V___ -t-- ?pS IIVVE. -+C) Owner. __ j �4 Mailing Address �(()S CityState Zip Deo Tel 0(00 / '/3 Contractor picivikpQsas. Qp& Mailing Address 1 sa3 1- , City StateQT Zip C(OY'O Tel F100 /85-9/ /d/V Contractor's License/Registration Type&Number CT 11(± 38(089S Exp. Date 'a / 3f / OS 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 'I\I\CAW__ lDate 9 / /5 , 04 Construction Value Fee Building $ Plumbing $ $ Mechanical $ s Electrical $ Other — $ Certificate of Occupancy $ w` $ Plan Review Fee $ $ State Education $ Total $ 30 40 s T R. Op / 3 -IC-VJI lv nnll V� Y L I c IIJb JtflNEle , 00v o IGG State of Connecticut Department of Consumer Protection 7. LICENSE VERIFICATION This is to certify that the Connecticut Department of Consumer indicate the following information regarding; Protection's ri MARK MARTIN 67 FORSYTH RD SALEM, CT 06420 Credential Number: HTG.386876 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 Consumer Protection: Juay MltrowSki Processing Technician 9/12/03 STATE OF CONNECTICUT $ e S e r v I c e s D I V isiXn DEPARTMENT OF CONSUMER PROTECTION Avenue + Hartford Connecticut 06106 HEATING,PIPING&CQOL ICkmMITED CONTRACTOR i (6 )- 60) 713-6000 + FAX: (860) 713-7229 ]II: IQausKMce8®DO at fiA ct U8 I1�T VebSlte: www.otata.ct.us/dc p/ Li8GM NO p. -,O, ' 44/ 0$/ 0 5 0 _ 10-16-03; 2, 19PM;Bailey Agencies, Inc ; 860 448 1608 # 2/ 2 • • ICORD, CERTIFICATE OF LIABILITY INSURANCE OF ID CF DATE(MM/DD/YYYY) ICER ADVAN--6 10/16/03 _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ley Agencies, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Bridge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ton CT 06340 ne: 860-446-8255 Fax:860-448-1608 INSURERS AFFORDINGCOVERAGE IP NAIC Si INSURER A: Ranger Insurance '—" INSURER 8: Footport Innuranoo corpora tion Advanced Gas Sales Stacey Martin & Service INSURER C: 183 East Haddam Road —' Salem CT 06420 INSURER D: — INSURER E: :RAGES POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI,THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH CIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RPL SRC TYPE OF INSURANCE POLICY NUMBER PAYE IMM/DD ) DAT Mr,TAN T 1 sql– LIMITS GENERAL LIABILITY EACH OCCURRENCE 31000000 X COMMERCIAL GENERALLIABILITY R/ENG0236662 00 10/01/03 10/01/04 ->TaMAeerVN NI1u —. CLAIMS MADE X OCCUR / PREMISES(Ea ocrurcr+CC> _ 3 100000 MED EXP(Any one Person) 35000 PERSONALS ADV INJURY 5.1000000 — GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 '1000000 POLICY n L.. .I LOC PRODUCTS•COMP/OP ACG S 2000000 . je8 — AUTOMOBILE LIABILITY MINED X ANY AUTO R/SB,A0361688 10/01/03 10/01/04 (occident)INGLE UMIT 5 1000000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per person) $ — NON-OWNED AUTOS BODILY INJURY (Par 9CCldent) 3 PROPERTY DAMAGE (Per oc�idont) S GARAGE LIABILITY _ • ANY AUTO AUTO ONLY-EA ACCIDENT 3 OTHER THAN EA ACC $ AUTO ONLY AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1000000 X OCCUR ( I CWMSMADE R/CUP0420392 –.10/01/03 10/01/04 AGGREGATE $ 1000000 _ XIDEDUCTIBLE S RETENTION 310000 -- $3 )RKERS COMPENSATION AND S IP LOVERS'LIABILITY WCSIAIIJ_ OT WCXO013966 X TORY LIMITS l I ER H- IY PROPRIETOR/PARTNER/EXECUTIVE 10/01/03 10/01/04 E.L.EACH ACCIDENT 5500000 FICER/MEMBER EXCLUDED?ssc 03,driDe under E.L.DISEASE•EA6MPLOYEE S 500000 ECIAL PROVISIONS 'HER E.L.DISEASE-POLICY LIMIT S 500000 ^ Wow TION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS f of insurance with regards to the named insured. Original Issue Date 10/16/03 •ICATE HOLDER CANCELLATION - ADVANO1 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 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DD SO SHALL Stacy Martin 183 East Haddam Road IMPOSE NO 00LIGATI OR LIABILITY• ANY KIND UPON THE INSURER,ITS AGENTS OR 41/ Salem, CT 06420 REPRESENTATIVES AUTHORIZED REPR ENf Ve- --• �• Town of Montville %,,, Building Department vow 848-3030, Ext 382 CONSTRUCTION PERMIT APPROVAL X/C/7- Property Address r)-)/95 1-771-(P nc n. Job Description 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 Signa,ar,: date ❑ WPCA Signature/date ❑ Planning&Zoning Signature date ❑ Health Department Signature.:date ❑ Department of Public Works Signature-date ❑ State Dept. of Transportation Si<gnaturel date ❑ Fire Marshal Signature/date Comments/Conditions: 'seiSeptem6er9,2004