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HomeMy WebLinkAbout2003 - Fireplace-LP Lines & Tank Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Mechanical Permit Permit Number: M2003-0037 Date: 27-Mar-03 Map/Lot: 037/002-023 Owner ID 506 Job Location: Unit -15 ADAMO"ENUE Job Description: v nt free fireplace, as lines & tank Owner: Contractor: IGtchen Galley/Vintag Builders Advanced Gas 183 East Haddam Road 170 Flanders Road Salem Ct. 06333- Niantic CT 06357 Telephone: (860) 859-9070 Uc/Reg Type/No. G1 386875 Exp Date: 31-Aug-03 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"s the owners responsobolft to sche ule the following inspections (monjimum 48 hours notice requored)m ❑ Footing - Prior to pouring concrete ❑ Rough HVAC ❑ Backfill - Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab - Pri r to pouring concrete ❑ Chimney - One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service Final Inspection ❑ Rough plumbing a d leak test ❑ Certificate of Occupany © Gas piping and to Building Official's Sign ture: gontville Building Departn it Receipt Town of No 'f k Date j From: Job Address: Cash cck Check # Amount ~Circlc one I Permit # Received by t Town of Montville Building Department Permit # O 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family LP-Gas Permit Application Form Job Location LK\T Job Desen do aterials Owner Mailing Address/ City r Stater Zip Tel ~5 Contracto Mailing Address ' City State`, "V Zip e11~S1~1/_ (l 0Z Contractor's License/Registration Type & Number SS (ooo-~~S G -L Exp. Date '~2 /~3 I / I hereby certify that the pr posed 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 Date--~)_/ / 0 Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ 0 c7 $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education q00 $ Total $ $ 1 0 , 0 0 01 e z i 1 STATE OF CO NECT.`'UT + DEPARTMENT OF CONSUMER PROTECTION y Be it known that MARK A MARTIN 67 FORSYTH RD SALEM, CT 06420 has been certified by the Department of Consumer Protection as a licensed HEATING PIPING & COOLING LIMITED CONTRACTOR TYPE: G1 . License# 386875 Effective: 09/01/.2002 Expires: 08/31 # id 2003 1 Jam T. Fleming, Comm ssioner : s 03/27/2003 41:58 FAX 8833B27 fa 001/001 A €1R INSt RAK ;E BINDER OP 74 DATE 09/30/02 THIS BINDER 1S A TEMPO INSURANCE CONTRACT, SUBJECT-TO THE CONOITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM, t"PCJiSy ER L2 ' uo g,ct_ 960-446-8233 ~mphw BINDER} 3005 Wee rt Insuranoo Cq oratio Bal-lay Ag l alez' -DATE 711A DATE Tit= 1743 SM14ve S~seet rwlf ' T dY At Groton CT 06340 1Q~01(Q2 L~-tl1 Pna lf3l30l~st 1 I+ 4%34N AwrGlac~a a .3tettell8 TN>$ r~+NaF~r as tssv~c ro Exr~ar, coaswas€ Iru Th'E',~1"3ifE nlA~,~ Co~sgaaw CODE; au0 CODE: PEF; 01WIRING POLICY N: wa X0013966 00 d1mw- AaVAN-6 D SCRlP71GMCWOPEAAnONONENICLESPROPE]MgncWdingLOCAVbD} lly9URED Advanead Gas sil as 6 .9oxvice1 193 8 Haddam Road., Salum, CT Stacey Martina 183 Mast Raddma. Road S•alaut CT t1542D COVERAGES LIMIT$ TYPE OF INSURANCE COVERAGE.IPDRI 4 DEDUC'neLE COINS % AMOUNT CAUSES OF LD3,S BASIC L_j BRORQ LJ WM GENERAL LIABO-M EAGy. QGCIIA.l'~!4GE $ COMMERCIAL GENERAL uAe1LITY FIRE DAMAGE imy one frEl $ C1-AIMS bWtlE ~ OCCU MED E%P (AnS+ ana Fe~at:n} $ PERSONAL 4. ADV INJURY $ GENEAALAGGREGATE $ RcS'I~CS4ATE i+JItCLJ 16tLt8: AuTOMaBILe LIASI Urr PRODUCTS -OOLOWRAGO S LX-INW8INE0VAMELfMW g ANY AUTO I W=I,Y L4W.~.`s 4~ar IpArj t, S _ ALLOWNEDAUTOS 84D1LYINJUFCf~P87Betld0nt5 $ SCHEDULEDAUTOS PRDPl:IzTV0A1NAGE $ FIIRE6 AL.ITQ$ $ I'IOON-091Tf4EO AUTOS MEDICAL PAYmrzWs PERSONALINJURYPA0r $ UNtNSURBD MOTORISY S AUTO ION: AGE DEDUCTI ALL VEMICLES SCHEDULED VEHIGLE9 y,MN. ^~,~A CDOLLI WSN]N OTHER THAN COLS 9TATEDAMOUNT 3 OTHER QARAaE AANYAUT+3 W'D17 Y AUTO ONLY • EA AGCWENT $ OTHER THAN AUTO ONLY: I EACH ACCIDENT S -r4SGREditi g E=Wl LI481LtTY ~~C3CC~itSYcrsCE $ UMBRELLA FORM A0.0 'GATE , $ OTHER'i}iAN UMpRELLA FORM RETRO DATE FOR CLAMS; MADE: SELF-tN6URED RETETlTi6N S Fa 5NG 8TATLrrORY LIMIT$ _ WORKER'S CQMPENSATIBN AIdD E.L. EACH R_ CCID1rMT SSQQQ(jQ E*~•~+es~a~mlTr E.L.aISEAS~-EnE~PLQrr:>; s5000~4 a L. MSFASE . POLICY LIMIT $ St5CaU0 ppT~FeIl~~naNSl sus ~ ESTIi,dtyTED TOTAL PRBNIUM 3 NAME 8 ADDRESS MORTGAG96 ADDITIONAL INSURED LOSS PAYEE Luau Al AUTHB PR NT s ht3]tZY] 7 i. S. t1t6jY1 NrfTF' LIIIR1r1T2TANT STATI= 1 f]R R R:Cp amp -Ar;AR11 rf1RpnR&'rirn&4 44D9