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HomeMy WebLinkAboutLP Tank and Line to Cooktop 2007 Field Inspection Notice Town of Montville Building Department May 24, 2007 Address: 190 Pruett Place Job Description: Gas tank& line for cooktop Permit Number(s): M2007-0066 Permit Date: 5/23/07 INSPECTION Date: Not Approved Approval Deficiencies Special Date Conditions Gas line test • • 5/24/07 CC • • FINAL INSPECTION • Notice: Before a certificate of occupancy can be issued, a C/O signoff sheet must be completed and returned to the Building Department. 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: M2007-0066 Date: 23-May-07 Map/Lot: 111/009-000 Owner ID: 5730000 Project Location: 190 PRUETT PLACE Unit: Job Description: install tank,&run gas line to cooktop Owner Name: Steven S And Lori A Middel Tenant Name: N/A Careof: 190 Pruett Place Oakdale CT 06370- Telephone: Contractor Name: Spicer Gas Telephone: (860)445-2436 DBA: Lic/Reg Type: G1 Lic/Reg No: 388986 36 Thames St. Exp Date: 31-Aug-07 Groton Ct 06340- Construction Value 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: $650.00 Mechanical Fee: $8.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: IRC Total Value: $650.00 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: $8.10 It shall be the owners repsonsibilitv to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING, MECHANICAL,ELECTRICAL PERMIT INSPECTIONS ❑ Footing- Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical ❑ Backfill-Footing drains and waterproofing ❑.Elec Trench-with conduit installed ❑ Concrete Slab-Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor framing ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble 0 Gas Piping and leak test ❑ Fireblocking_Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation 0 Certificate of Approval ❑ Certificate of Occupancy Building Official's Approval l r Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No : > 06117‘.> ape°f Work Occupancy Type Permit Type ❑New Construction p'Single Family ClAddition GITwo-Family ❑Building 0 Alteration ❑ robing ❑Townhouse echanical ❑Accessory Structure ❑Electrical Job Address: q0 ?Y. /a€� (Number) ll (Street) Job Description: ( (A-S. (Unit) �-s e004 Owner: c4-"lC-VQ nA,4 _1 Address: S „de.- City: CO.( a.C e-- State: C-4- 4 063-7o Zip Code: Telephone: Contractor: .p CXR ala_s DBA: Address: �(pr`Twp$ �L City: Ird`fi CJ State: Zip Code: b. Telephone: elf License Type: / Vg YP License No.: Expiration Date: lb? 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. 0 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 42 of the Residential Code. Owner/Agent Signature: 07Date: Construction Value Building Value: Permit Fees Plumbing Value: Building Fee: Mechanical Value: Plumbing Fee: Electrical Value: Mechanical Fee: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: Rrvisea Deccm6er31,2005 Town of Montville Building Department File Receipt Date: 22-May-07 Receipt No: 2340 Received From: Spicer Gas Job Address: 190 Pruett Place Fees Collected State Educational Training Fee Cash: $8.10 Cash: $0.10 Check: $0.00 Check: $0.00 Check No: 0 Short/Over: $0.00 Construction Value: $650.00 Demolition Value: $0.00 Received By Sandra Pandora Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 /7, g4CO CTION PERMIT APPROVAL it r Prop—p ddres ,. (91/fi 7/ 40, � o Ate. 1 . 7;;:/k b: nption 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 Permit Issuance Approval Approval ® Tax Collector � �� �;, %k-aak e-1 v igRat;.ire`date Comments: C. WPCA, Administrative Signature'date Comments: [ WPCA, Operations c,ture date Comments: [ Planning & Zoning Signature;date Comments: I I Health Department S ignaat Ef ei date Comments: Department of Public Works Comments: ❑ State Dept. of Transportation (Structures over 100,000 sq.ft.or with more than 200 parking spaces-Official copy of STC Certificate of Operation required—per CGS 14-311) Signature/ciar. 54/01 Comments: Fire Marshal 5,4/g Signature/date Comments: 71 A ,/y WivisedAugust 5,2005 State of Connecticut N - 7A 78 - 7C Workers' Compensation �,n-� n.) p n Commission DIRECTIONS 7'rllt DIRECTIONS for FILING FORMS 7A, 7B and 7C lx Building Permit Requirements for Workers' Compensation pensation Section 31-286b of the Workers'Compensation Act requires anyone who requests a building permit to first submit"proof of workers' compensation coverage for all of the employees who are engaged to perform services on the site of the construction project for which the permit was issued." The only exceptions to this law are the sole proprietor or property owner who will not be acting as general contractor or principal employer. What to give to the Building Official to obtain a Building Permit: 1. The General Contractor or Principal Employer must provide a written certificate of workers' compensation insurance for all of the employees on their project.This certificate may not be for liability, disability or any other type of insurance. 2. The Sole Proprietor or Property Owner who will no(act as a general contractor or principal employer is not required to have workers'compensation coverage. In order to obtain the building permit, a FORM 7A should be completed and given to the building official. 3. The Sole Proprietor or Property Owner who will act as a general contractor or a principal employer must provide a written certificate of workers'compensation insurance for all of the employees on their project and must file a FORM 7B with the building official—OR he will sign a sworn notarized affidavit on FORM 7B, stating that he will require proof of workers'compensation insurance for all those employed on the job site. • The General Contractor or Principal Employer who has property excluded himself from coverage using the appropriate WCC form(see NOTE below)must file the FORM 7C with the building official. This form certifies that they have properly excluded themselves, and attests that they will require proof of workers' compensation insurance from every employee that works on the designated job site. NOTE: The general contractor or principal employer may exclude himself from workers'compensation coverage by filing one of the following forms with the appropriate Workers'Compensation Commission district office: Form 6B for employees who are Officers of a Corporation or Managers/Members of an LLC Form 6B-1 for employees who are Members of a Partnership /5.4*' ) „NAV 36 Thames Street, Groton, Ct. 06340 (860) 445-2436 • (800) 448-2028 Fax - (860) 445-2313 Date: "S"-/°-)47 7 City/Town/Borough: a V lle e_.() , Job Site Address: ('t D Tri,,..e.,ff?/0- £%4d 41 , C--()_ 7 663 Project to start on or about the following date: ^ c)-3 07 This letter authorizes Robert Mitchell to obtain a permit on my behalf for the following customer/project: Property Owner: S4- -V'a M'adel Mailing Address: (qp Pre4 'P/cze 0,674daietCA'. 6'6370 / if / __ A )aures L. Saporita - LP Gas Technician Division of Spicer Plus, Inc. • Ct. Lic. #388986 • R.I. Lic. #00007469 STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION HEATING,PIPING&C ,.. l?ED CONTRACTOR • JAM , AP ' 'A 6t .,, , t. STOisikc Q4 T`O 8 LIC./REG NQEC1`IV , ,� a ..-..... EXPIRES 388986 '."1-44401)(19A--.?.,"3.'"1:0/31/2007 �rAAlJST�jt�T��` SIGNED • / firopo5ai Page# of pages cA f j t6(kr i A f\Cti‘1'-rV Proposal Submitted To: �. ' 'Ni\A \ \ l\\ Job Name Job# Address Job Location) ql\p-- (?\ C.'../. Q,d \l Q ' °L S 1 p Date Date of Plans &H .--1 Phone# Go t��Y O c"..$1.0� Fax# Architect QNI /We hereby submit specifications and estimates for ___......_..._.....-------.--_--..._...-__._..-.-------_..----_._...__.__._..._--------..----_..._...._...._.-._......__......__.._._._...._...................................___........_..._....._..__. \ k)k \..r yyw 6AitiV&11-11,_4.% __YX s, _ _ .7.: _,..7.;Am ,....9A0Aq_':..10\41 )Ex44.._ . riVO _c, \�a,n �a. �r. ._ _ '.��C - - __' .__ b_ a .._-...-_... (- -942-PA\-----e-)kcz•IlSvtIA..)fik'A • 'S,---YvINe.-sz.c7t cv,,e) - (4v1/48,yi--)13 Q.tynne-E417 7,5. -.)( \...„4.4...., 1# 1.4_.. 040 —_ ._.._.__..__._._._.._ �1._.........._...._.....` � _ __._..__..__...__...__...._ _ .°...._...._Y_ __,_ -----_--_--.-.._____..-_.......... -_--_---__--______ • - __.L-t)Y...J:V1+ .__ __ _______ - ._----. __ .. ..___ ---kR- __ .__N o - _-\D� - 64 -___...._.._-___.....__.. __ .... ___. .. ......... ..-- ---.__ We propose hereby to furnishrri erial and labor—complete in accordance with the above specifications for the sum of: $ 5a�7� � 1{ � � ®cO '1,,k. V`'� c � A, Dollars with payments to be made as follows: I st ii a r ) ,. Any alteration or deviation from above specifications involving extra costs will be Respectfully villiklN executed only upon written order, and will become an extra charge over and submitted ' 4,V^—'110114116 above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note—this proposal may be Svr hdrawn by us if not accepted within _ _days. ---___, / iZicceptance of Vropos'/,, The above prices,specifications and conditions are satisfactory and are Signature � * .-VI Afe-t22/4 -,e hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature NC3819 MADE IN USA ACOR©. CERTIFICATE OF LIABILITY INSURANCE DATEIMM/DD/VYYY) PRooucER 17g/7r/7007 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ENERGY INSURANCE BROKERS, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE END OR P 0 SOX .1729 ALTER THE COV RAGE AFFORDED BY THE POLICIES RTIFICATE DOES NOT AMEND, TBELOW. AL33A1TY, NY 22201-1729 INSURERS AFFORDING COVERAGE NAIC# INSURED SPICER PLUS, INC. SIAL INSURER A: TRAVELERS INDEMNITY CO OP CT P.O. BOX 903 INSURER B: TRAVELERS INDEMNITY CO Ol AMER CROTON, CT 06340 INSURER C: AMERICAN NOME ASSURANCE CO INSURER D: ADMIRAL INSURANCE COMPANY _ w SPIC01 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 AU.THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 0468 ROOT ��LL''(I TT LTII459RD Typo OFINR(IRANI'F POUCYNLJMDATMA7DIIV IER EIM ) a®TFIMNqqO/TVO UNITS `•. B GENERAL LIABILITY 110-411S2c02A07 04/30/2007 04/30/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY D N PREMISES IEe_atr Ifenoel 0 50,000 � CLAIMSMAOE R-1 OCCUR MED EXP IArtyone puipnI 0 5,000 —' ^•— - PERSONAL S AOV INJURY... $ 1,000,000 GENERAL AGGREGATE_ i 2,000,000 7 GEN'L AGGREGATE UNIT APPLIES PER: PRODUCTS-COMP/OP AGO 0 2,000,000 POLICY f EER 7 LCC A AUTOMONLELIANLITY aAf1241C07I 04/90/2007 84/30/2008 COMBINED SINGLE LIMIT ; X ANY AUTO Mr Accident) 1,000,000 ^— ALL OWNED AUTOS ^� SCHCOULLD AUTOS BODILY INJURY , IPot paaoN HIRED AUTOS BODILY INJURY NON•OW NED AUTOS (Por acclaim X MCS-90 PROPERTY DAMAGE 4 X SUDDEN i ACCID. P+ IPweoeldrml GARAGE UA /TY AUTO ONLY•EA ACCIDENT PR0 1 ANY AUTO -• ` OTHER THAN EA ACC p AUTO ONLY: AGG F D ExCESS/UMBREUA LIABILITY 11000005523-02 04/30/2007 04/30/2008 EACH OCCURRENCE 0 5,000,000 w!OCCUR U CLAIMSMADE AGGREGATE E 5,000,2R0, .. DEDUCTIBLE �.........`.. ...._. 4_ — RETENTION 0 0 C WOREERSCOMPEN5ATIONAND I1C1741722 01/12/2007 01/11/2008 X tO Vunni7s_ 1°Fd'' _ EMPLOYERS'UANUTY ANY PROPRIETOR/PARTNER/EXECUTIVE E-L EACH ACCIDENT ; 100+000 OFPCEM1/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE 0 100,000 Ilya',tlNGIDE uA00r SPECIAL PROVISIONS hdow F.L.DISEASE•POLICY LIMIT 0 500,000 A OTHER aA4421C032 04/30/2007 04/30/2008 DBD PPT JS & LIGHTS $500 PHYSICAL DAMAOE COV. DED ALL OTKKRII7/AcV $1,000 OSSDR1PTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVII IONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES OE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO NAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.RUT FAILURE TO DO 60 SHALL IMPOSE NO OBLIGATION OR UAIIUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, � AUTHORIZED REIMST EN1......„ //,//�����Z...E DS ACORD26(2001/08) °ACORD CORPORATION 1988