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Home My WebLink AboutFireplace 2016 Field Inspection Notice Town of Montville Building Department 860-848-3030 Ext. 382 Address: 190 Pruett Place Job Description: Gas Log in Existing Fireplace Permit Number(s) M2016-0214 Permit Date: December 20,2016 Not Approved Approval INSPECTION Date: Comments Special Date Gas Pressure Test • til '' 12/22/16 D.' Gas Log 12/22/16 DJ Final inspection and 12/20/16 DJ • Scheduled inspection,there at 10.50 no one was • certificate of approval home for access to interior. 12/22/16 DJ 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: M2016-0214 Date: 22-Dec-16 Map/Lot: 111/009-000 Owner ID: 5730000 Project Location: 190 PRUETT PLACE Unit: Job Description: Install Line from Existing System to New Vent Free Fireplace Owner Nam Steven S And Lori A Middel Tenant Name N/A Careof: 190 Pruett Place OakdaleCT 06370- Telephone: (860)861-0547 Applicant Name Spicer Plus, Inc. Telephone: (860)859-9070 DBA: Spicer Advanced Gas Lic/Reg Type Gl Lic/Reg N 388986 183 East Haddam Road Exp Date: 31-Aug-17 Salem CT 06420- 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 Valu $2,000.00 Mechanical Fe $30.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $2,000.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 State Ed Fee: $0.52 Total Fee Paid: $30.52 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 frami ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble d❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑d Certificate of Approval -'fic. - of Occupancy 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 PERMIT APPLICATION FORM Permit No.: ,10 zit —t7219 Type of Work Occupancy Classification Construction Type Permit Type ❑ New Construction ❑A-1 0 B ❑ H-1 ❑ I-1 ❑ R-1 ❑ S-1 ❑Type IA ❑Type IIIB ❑Building ❑Addition ❑A-2 ❑B, Medical ❑ H-2 CII-2 ❑ R-2 ❑ S-2 ❑Type IB ❑ Type IV ❑Plumbing ❑Alteration ❑A-3 ❑ E ❑ H-3 ❑ 1-3 ❑ R-3 ❑ U ❑Type IIA ❑Type VA ❑ Mechanical ❑Change of Use El A-4 ❑F-1 El H-4 I111-4 ❑ R-4 ❑ Mixed ❑Type IIB ❑Type VB El Electrical ❑A-5 El F-2 El M//// // ❑Type IIIA CRS#: Property Address: �� d 7t-[.t24rP (Number) / (Street) / (Unit) Job Description: I IA4 (t t raw,- 2.)G��5� i t $u S,�r,�,�.` tn.. E '�^ i✓e- Va::( �-� VT= CZ f-a � (a0k Owner: Lei s 04-ce.veAA1L,k-( Tenant: /l( A Address: fqV (—KU-€..44'7)/&,i_ .Address: City/State/Zip: 1Jadial€1 C.„4 C) 70 City/State/Zip: Telephone(gbO) g-6 I - DTelephone( ) - Applicant: i c'a2✓Pl e,Lc t .1- fr.-e- • DBA: c�P/ tC O'y' 4 vext.-e-� 44-s Address: -I I�3 E s PLLI /ci V 44• /�� ,J City: ��t et-t"- State: C .1 Zip Code: 0(P-1.)-.O Telephone(?&) ) o>J� - qCri Contractors - Complete the Following: 2 Q� Q License/Registration Type: L License/Registration No.:J O oq O,4„, p Expiration Date: p 3 I 17 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 1 am authorized to make application for a permit for such work as described above. Owner/Agent Signature: Date: /Z jr/ Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: OmaO-B Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: 5 State Ed Fee: . D, Total Fee: Revise&August 23,2007 Town of Montville Building Department File Receipt Date: 20-Dec-16 ReceiptNo: 11950 Received From: Spicer Gas Job Address: 190 Pruett Place Town Fees Collected State of Connecticut Fees Collected Bldg Cash: $0.00 State Cash: $0.00 Bldg Check: $30.52 State Check: $0.52 Bldg Credit: $0.00 State Credit: $0.00 Fire Cash: $0.00 Fire Check: $0.00 Fire Credit: $0 00 Construction Value: $2.000.00 Demolition Value: $0.00 CheckNo: 2805 Received By: Carmen Kneeland Address: 190 Pruett Place ITEM OTT $/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA Basement,Finished SF $ 41.96 $ - $ - Interior Renovations SF $ 36.09 $ - $ - $ - AMENITIES Kitchen EA $ - $ $ Full Bathroom EA $ - $ Half-Bathroom EA $ - $ GARAGE Detached SF $ 71.53 $ - $ MECHANICAL Warm-Air n Y/N Hot Water n Y/N $ Electric n Y/N Air Conditioning n Y/N $ ELECTRICAL SERVICE Upgrade Amps $ - Subpanel EA $ 699.00 $ Gen Set EA $ 3,850.00 $ SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 6,497.70 $ - Masonryw/lfireplace EA $ 7,096.65 $ - Masonry w/2 fireplaces EA $ 11,095.70 $ - Wood Stove,free standing EA $ 2,692.25 $ - Wood stove insert EA $ 1,859.77 $ - DECKS,PORCHES,SUNROOMS Deck SF $ 44.07 $ - Porch SF $ 149.38 $ - Sunroom SF $ 176.90 $ - $ POOLS&HOT TUBS Hot Tub EA $ 8,016.25 $ - $ - Inground Pool EA $ 31,550.00 $ - $ - Above Ground Round EA $ 6,299.46 $ - $ - Above Ground Oval EA $ 7,019.75 $ - $ - Pool Heater Ep, $ 8,984 25 $ - $ Inflatable Type Pool EA $ 1,200.00 $ - $ SHEDS w/o electrical SF $ 25.55 $ - w/electrical - SF $ 26.85 $ - $ RENOVATIONS Roofing,Overlay SF $ 3.50 $ - Roofing,Strip&reroof SF $ 4.50 $ - Roof Sheathing SF $ 1.51 $ - Siding SF $ 6.75 $ - Windows - EA $ 550.00 $ - Skylights EA $ 1,051.10 $ - Doors,Exterior EA $ 601.50 $ - Oil Tank,275 Gallon - EA $ - Oil Tank,550 Gallon EA $ - MISCELLANEOUS CALCULATIONS $ 2,000.00 TOTALS $ - $ - $ 2,000.00 $ - PERMIT FEE CALCULATIONS Construction Value Fee Building $ - $ >' Plumbing y $ - $ Mechanical y $ 2,000.00 $ 30.00 Electrical y $ - $ r Working before Permit Issuance . $ Certificate of Occupancy Fee $ _ Plan Review Fee $ State Education Fee $ 0.52 TOTALS $ 2,000.00 $ 30.52 I" Figures are based on the 2006 RS Means Residential Cost Data 5PIger dvanced Gas A DIVISION OF SPICER PLUS. INC. 36 Thames St., Groton, Ct. 06340• 1 83 E. Haddam Rd., Salem, Ct. 06420 (860) 445-2436 •(860) 859-9070 Fax -(860)445-2313 •(860) 889-3627 www.spiceradvanced.com Date: 0/)-4)7/6 City/Town/Borough: TOW► o .4MD ,�/;((.P . - Job Site Address: 1 qo —1>rc,c.24-? I'-e-e- o 4d tic Ci . D!. ? 70 Project to start on or about the following date: Pursuant to State of Connecticut General Statutes Sec. 20-338b and State of Rhode Island General Statutes Sec. 23-27.3-1 1 3.3, this letter authorizes ?oloer-1 /1/f % > di to obtain a permit on my behalf for the following customer/project: Property Owner: Lori f S4- V2- M I142_/ Mailing Address: MO 7ru.. T /" - Cej.jatz_ ,. a,37a (7/7/ Alk James L. Sapor . - LP Gas Technician Ct. Lic. #HTG.0388986-G1 • R.I. Lic. #00007469 • Ct. H.O.D. #0000744 STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION BEATING.PIPING&COOLING LIMITED CONTRACTOR JAMES L SAPORITA M ST-IC CT 06355 10 _ 4 /7 ,lQK f'Lt h•, el v C ^✓ r f .1 CT1 3S/ LIC REG NO. EFFECTIVEXP E� 1-1TG.0388986-61 09/01/2016 08/31/ 2017 SCNED -41 State of Rthodc Island and Providence Plantations Rhode Island Department of Labor and Training PJFPROP GAS SRV/MSTR2- 40007469 r= : qr- JAMES L SAPOkI == 2060 COLD STARl MYSTIC CT .D6 '� 3 • > .DUMAS SHAW Adrnrrrnstratol Expiration Town of Montville Building;Department CONSTRUCTION PERMIT APPROVAL Applicant is responsible for obtaining all of the required approvals. No permit will be issued until all the required signatures are obtained. 7rete P/2- LJJ / 06370 Property Address j ix, (-ea( 1-42- 40-14- S121,--of d/ .et-,-- 4-0 ite-it) VIP CZ Nceitcy.,e_ llob [description Required Approval Department Permit Issuance Approval •s ® Tax Collector 7Y /77? Comments: Signature/date Planning & Zoning �� ( � /2%2 .7ic, Comments: Signature/date 111 Fire Marshal / � G/1. Comments: gnature/date Health Department Required for properties with private,septic or well Comments: r1 WPCA, Administrative N/A- Required for properties on sewer Signature/date Comments: WPCA, Operations When Required by WPCA Comments: Signature/date n Department of Public Works Required when project includes driveway work or certain drainage requirements Signature/date Comments: n Montville Police Department Required for all permits EXCEPT one and two family residential Signature/date Comments: State Dept. of Transportation Required for 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/date Building Department Review'Complete Signature/date 9QeaiserfAday 23,2011 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: M2008-0189 Date: 22-Oct-08 Map/Lot: 111/009-000 Owner ID: 5730000 Project Location: 190 PRUETT PLACE Unit: Job Description: Install Vent Free Gas Fireplace with Gas Lines, Fittings&Shut Off. Connect to Existing Propane Tank Owner Name: Steven S And Lori A Middel Tenant Name: N/A Careof: 190 Pruett Place Oakdale CT 06370- Telephone: (860)444-8738 Contractor Name: James Saporita Telephone: (860)859-9070 DBA: Spicer/Advanced Gas Lic/Reg Type: G1 Lic/Reg No: 388986 183 East Haddam Road Exp Date: 30-Aug-09 Salem CT 06420- 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: $700.00 Mechanical Fee: $8.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: IRC Total Value: $700.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.13 Total Fee Paid: $8.13 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 Gas Piping and leak test ❑ Fireblocking_Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation C Ce cate of Appr. . Ce ca e ofie cupancy Building Official's Approval: / �..G.ef /_,..e.-G 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.: ( acov--61 T e of Work ccu anc T e Permit Type New Construction Single Family 0 Building Addition Two-Family Plumbing 0 Alteration 0 Townhouse Mechanical 0 Accessory Structure lectrical CRS#. Job Address: 9() PUc lO Pw 6 JI1L 0-06312 3'7 (Number) (Street) -1 (Unit) Job Description: TA Sia 1.9 J P i - OA _A re • - _� _.. o.tt LII 1 -- -- 1Uc . i -7 'V d- CAI P 0 .,,A a- nc Ofke i1, , Owner: -s1 V m 1 t 11. el Address: / I -I°1 U ' , A err' c� City. Cl l )ALEE State: C-1 rip Code: v C Telephone: e400 1444-03g Contractor: -The I) f DBA: S P( c . Y]11/''QiL1!'_p d Address: g, EAST ol D p 141) 1 � City: State: CT Zip Code: C., (" Telephoner $g:1100 License Type: (V-.-r License No.:3RSCI810 Expiration Date: gi/36I 1 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 worir 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 42 of the Residential Code. Owner/Agent Signature , (,�,y�� -- Date: /0 "�_.02Dog' Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: 16? Mechanical Fee: ."i Electrical Value: Electrical Fee: Total Value: Penalty Fee: CofOFee: Plan Review Fee: `� State Ed Fee: , t Total Fee: r?. /3 Tesvizrt fug+wt 23,2007 JOB v `v\li 1 '1p I��I ADVANCED GAS SALES & SERVICE to _ 1-- 183 E. Haddam Rd. SHEET NO. F t Q \��r)��(`'�J��pp�`''QQ��' f . OF Intersection Rt. 82 & Rt. 11 CALCULATED BY '/l'-'0 DATE SALEM, CONNECTICUT 06420 • (860) 859-9070 FAX (860) 889-3627 CHECKED BY DATE SCALE ' .f„, N . 5. tkif arc A....;......... i t i t ., 4 _____:...i 1 I ` . . .. .................<. ..............................<........... . e 4, , S e a a 4 .,,,,....4 a t.ti k I .. a s............. ... ....... • Y•1 i : • 4 4 t 4 • \ , i 1 t t 4 : t I .. I . i • « a....:.:...._. s e < V)e),R.k s1.-b P t 1 STArl'E O1' CONNECTICUT 1.. P:lR/',11/i.\/ 0/•'(Y1.\•.\1'.111:'11 PRo/'/i('7'1(J,\' HEATING,PIPING&COOLING LIMITED CONTRACTOR JAMES L,,SAP.ORITA 6 DEER RIDGE'R:D STONINGTON,CT 0078 LIC./REG N. V 'IRES HTG.0388 86-GI 09/01/2008, ." 08/31/2009 SIGNED y� 1, r t� t- t l ✓.„,. j I IL :l ,' •••••;:-6-:•-,.' ^ :.; , NATE OF CONNECTICUT 4 DEPARTMENT OF CONSUMER PROTECTION Be it known that ::...;.:4:1 `. JAMES L SAPORITA j i� . : , 6 DF.y R;,,., ., ,, ;'. STO W," Q 378 j,., `ter ?j s j u„ } � t ,' r ` has been certified by"Ai(45 =.' :,,:: :''''''' '','-'sumer Protection as a , m "r f". O ITED CONTRACTOR n . ''.: G r , Lice B ' _, { tz " . T + .. n 8b-G1 '{n� "may m.` .... -� 4 t1I' `1. ' d26 ` v{ n: 08/31/2009 ‘?!jr"--P"'"Ai ... .......•_. .. ........ ... fu ' ,.�. �erry f.ee (1,)t, oentl`ui rta. iles. 0 C._ `011;•,....,:i.'ili:14:- ,. =it. - �w -., try No, p 41 I" -47- } ..,,...,i, • l; �! ' / „it •.' :v` , .rc`•xs,�r ..rb 1 '3 •',?0 ti' � q ' ill l�'Jl: . , :.' , , , , _J ? $r f ' i \ :y ,v . y ;II . l t1nw..1 ..7 ,4,......,:',,;:p. j ., eat. , tili,; . ,. . x,110 Ns.:::.,..‹... "..'". o ,, ,• .• � iiM,: r., " ',A. :' '' rw,,," ,,, _, . -'- - -":*'-'4`' ''� w ; , ,.. . , ,J LAN-10-CtItICI ACJ:CUM 4-KUI'I:51-'11...,tki HUVHNL.LU ((H5 18604452313 TO:98893627 P. 1 ACORD. CERTIFICATE OF LIABILITY INSURANCE CArEINAVODNYVYI PRODUCER 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ENERGY INSURANCE BRO ag, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 BOX 1729 HOLDFA, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. ALBANY, NY 12201-1729 —.__.-._ -.. _ __ __ ' INSURERS AFFORDING COVERAGE NAIL# INSURED9PZCER PLD9, INC. BTAL INSURER A: TRAVELERS PROP CAS CO OF AAL3RT _ _ S.P. ACQUISITION CORP INSURER 9: TRAVEL/RB INDEMNITY CO OF AVER _^ PO BOX 903 INSURER C: ATrW HAMPSHIRE IPS CO GROTON, CT 06340 wsvASA u: AJ FXRAL • INSURANOCE COMPANY - 99ICp1 INSURER E: 'ry ~-' ~ COVERAGES TME rOLICIE$OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER POCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS Su9JEGT TO ALL TI-IF TERMS, EXCLUSION3 AND CONDITIONS or SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE REEN REDUCED NY PA ID CLAIMS. 1.61sn ca' _ POLICY NUMBER A •,+ '••PQUCY EFFEC !yr— PO PY •II• LIMITS B GENERAL LIABILITY 660-4S5I003A08 04/30/2008 04/30/2009 EaCH OCCURRENCE d 1,000,000 OAM ToTilMirf EIS-- ,. X COMMERCIAL GENERAL LABILITY PREMIBEE,(Fa n,n„nnr.l . _ 50,000 CLAIMSMAOE I OCCUR MEDEXPAny onn P.ru ) d 5r O00 `, PERSONAL d ADV INJURY 0-_ 2,000,000, GENERAL AGGREGATE 0 2.000,q00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP AGO (• 2,000,000, 7 POLICY PRO- LOC _ , A AUTOMOBILE OMIT/ mad 42tG'09Y 04/30/2009 04/30/200.9 COMBINED WNW LIMIT _X ANY AUTO IEaucCiIAI -- 1 1,000, coo AU.OWNED AUTOS BODILY INJVRY , (Per p.r.onl SCHEDULED AUTOS ._ . -. HIRED AUTOS 60PRv INJURY E IPor accidenq NON OWNEDAUTOS .. —.________...TI ,J NCB_90 - PROPERTY OHMAGE XI DDEN & ACCID. Pi Pu,.ccia.ntl 4 HLT .--I . WADE -.-- OAAAQE UABIUTT AUTO ONLY•EA ACCIDENT 1 _ ANY AUYOOTHER MAN WA ACC 4 AUTO ONLY: AOG 1 Dv EXCES3NM6RELLA LABILITY =0000055W,•03 04/30/2008 04/30/2009 EACH OCCURRENCE d 5‘000,000, AGGREOAT1 o , ,Q00 XJ OCCUR n CLAIMSMADF .. —. 5ODD f.d DEDUCTIPL21 RETENTION 1 _ / C STATU C WORSEIISCOMPENSATION AND I ;M69;327312731 01/11/2008 01/11/2009 XJ µ1 TORYLIM[I�I OTH- ER. ..__., _ PMPLOYERE'1A40LITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT- G__ 540, OOO OPFICBrumEMBER EXCLUDED? E.L.PISEASB•EA EMPLOYEE 0 100,0001 n y..,de.wlo.�naw S.ECiIAL PROVI510NS ,Iow �...—�G.L.DISEASE•POLICY LIMIT 4 500,0001 A OTHER BAB42gCC32 04/30/2008 04/30/2009 DED PPT'3 i LZAYT8 $500 PHYSICAL DAMAGE COV. ,ID ALL OTHERS/ACV $1,000 j . DESCRIPTION OF QPERATION5I hQOATIOFh1 I YGf11CI.c3 r CNOLUBIONG AQOFP PY ENDORESMENT!SPECIAL PROVISIONS - CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE AEOVE DESCRIBED POLICIES BE CANOELLW BEFORE THE IEPIRATION DATE THEREOF. THE I5134./INC INSURER WILL ENIOEAYOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SMALL IMPOSE NO oSLIOAYtON OR LIABILITY OF ANY KIND UPON THE INSUREA. ITS AGENT,OR REPRP3ONITATIYEU . AUTHORI4ED REPRBS TE H ACORD 25 2001/081 �f ��ORD CORPORATION 1988 dsIPO . CAS 36 Thames Street, Croton, Ct. 06340 (860) 445-2436 • (800) 448-2028 Fax - (860) 445-2313 Date: /0/06P008 City/Town/Borough: CAI<Lilt& ET Job Site Address: 1 ?O PRU 1 I PLAc.s (DAK( Pr CST 063,76 Project to start on or about the following date: Ilio') j&cOB This letter authorizes Airn'Yho e et6ts to obtain a permit on my behalf for the following customer/project: Propatty Owner: ST VE 'Y111) 00 Mailing Address: 1qa P124rT-J /QCg 19P g 1 Le )aures L. Saporita Gas Technician Division of Spicer Plus, Inc. • Ct. Lic. #388986 • R.I. Lic. #00007469 ( Town of Montville Building Department File Receipt Date: 21-Oct-08 Receipt No: 3975 Received From: Spicer Plus Inc. Job Address: 190 Pruett Place Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $8.13 Check: $0.13 Check No: 1170 Short/Over: $0.00 Construction Value: $700.00 Demolition Value: $0.00 Received By Carmen Roberts ( j\yytJj/\ ry\ , aheAt6 • Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL )ac,iso P>LLLI I�'�(Art; )Ft cT 376 thea_' •— Property Address _ p,fie -1� I' PCit&IT" SLC - O l pP2L- C4 063/26 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 Department Permit Issuance Approval Approval Tax Collector Fn .c to\a t v� Required for all permits Comments: WPCA, Administrative Required for properties on sewer •• Comments: ❑ WPCA, Operations When Required by WPCA Comments: • Planning &Zoning72–=. �- '� /0/ / Required for all permits p•/o } Health Department Required for properties with septic systems—Not required for Plumbing,Electrical, Mechanical,Roofing,Siding,Windows&Doors Comments: ❑ Department of Public Works Required when project includes driveway work or certain drainage requirements Comments: ❑ State Dept. of Transportation Required for 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 Comments: • Fire Marsha Required for all permits ( �1n CA Comments: 'p�`11 611t � Revittd>tugust s,2005