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Home My WebLink AboutGas Line/Tank for Fireplace t Town of Montville` Building Department Field Inspection Notice Address: 20 Allison's Way Job Description: Gas Permit Numbers: M2004-0264 Footing Not Approved: Approved: Comments: 1. Deck Piers Not Approved: Approved: Comments: 1. Backfill Not Approved: Approved: Comments: 1• Anchor Bolts Not Approved: Approved: Comments: 1- Concrete Slab Not Approved: Approved: Comments: 1. Rough Plumbing Not Approved: Approved: Comments: 1• Rough HVAC Not Approved: Approved: Comments: 1• Rough Electric Not Approved: Approved: Comments: 1• Pool Bonding Not Approved: Approved: Comments: 1. Electrical Trench Not Approved: Approved: Comments: 1• Electrical Service Not Approved: Approved: Comments: 1• Gas Line Not Approved: Approved: 12/7/04 JS Comments: 1• Masonry Fireplace Not Approved: Approved: Throat & Chimney Comments: 1• FireBlocking & Not Approved: Approved: Draftstopping Comments: 1• Framing Not Approved: Approved: Comments: 1• Insulation Not Approved: Approved: Comments: 1. Certificate of Not Approved: Approved: Occupancy Comments: 1• CmnmenU: 1. Page 1 of 1 Revised 9/20/04 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: M2004-0264 Date: 09-Dec-04 Map/Lot: 043/009-021 Owner ID: 62000 Project Location: 20 ALLISON'S WAY Unit: Sob Description: Gas Line and tank for fireplace Owner Name: Thomas S and Susan Dougherty Tenant Name: N/A Careof: 20 Allison's Way Oakdale CT 06370- Telephone: Contractor Name: Osterman Propane Telephone: (860)447-0341 DBA: Lis/Reg Type: G1 Lic/Reg No: 394019 7 Enterprise Lane Exp Date: 31-Aug-05 Oakdale Ct 06370- 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: $350.00 Mechanical Fee: $8.00 w/2004 Amendment Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $350.00 Penalty Fee: $0.00 Permit Code: R5 C of O Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.06 Total Fee: $8.06 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 Q Gas Piping and leak test ❑ Fireblocking _Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑ Certificate of Approval )e~ate of Occupancy Building Official's Approval: Town of Montville , Building Department 310 Norwich-New London Tpke. Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential LP-Gas Permit Application Form [PSingfie'Family Two-Family Townhouse Permit # (,>-2 Job Address is (Numb/er) (Street) (Unit) Job Description/ - / 7C 6-¢4, A; Lj _f l44 74A Owner.Do . uen Mailing Address City State Zip Tel ContractorSA*~t~L S Mailing Address 7 ~'►r7,~y~.~/Sri L~~ City~,~~TCA° State Zip 0 Tel 47/ Contractor's License Type & Number _4- 3~~ Exp. Date_ 10 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. Separate applications are requirOwner / gent Signa e., Date Construction Value Fee Mechanical $ st> c) $ Electrical $ $ Plan Review Fee $ State Education $ 0-cl Total $ $ IZ§ l edSeptem6er 9, 2004 Town of A--, ntvill.e Building Departme' - Receipt f Date No. 0 4 ' 7 From: l~r~l`'tr-fib ~t Job Address: Amount $ C Cash ChcckD Check # (Circle onc) kk Received by A . zi rr<sY• c,~___ Permit # l L I I , r I I r HEATING, plPING & COOL NG LIMITED CONTRACTOR Gl Cg SAMUEL I SUGAWARA 40 PEARL ST APT #7 NEW LONDON, CT 06320 LIC. / REG NO EFFECT 2 04 0$.505 394019 0`)J011 SIGNED - '1L;%1~ .G04 :l2:OF FM FROM: Far: Gaude-te TnSI-icance TO: 18604470398 PAGE: 1,02 OF OGCl' Client#4. _,27758 G. AGAS ACORD,. CERTIFICATE OF LIABILITY INSURANCE ;o,','(, ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gaudette Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA' One Plummers Corner HOLDER. THIS CERTIFICATE DOES NOTAMEND, EXTEND GR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Whitinsville, MA 01588-2100 508 234-6333 INSURERS AFFORDING COVERAGE NAIC # INSURED NSURERA. Liberty Mutual Insurance Company AIG003 E. Osterman Gas Service, Inc. INSURER B American Home Assurance One Memorial Square INSURER C: Whitinsville, MA 01588 !NSUP,ER D INSURER E: COVERAGES T-+E POLICIES OF INSURANCE LISTED BELOW -NAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION O° ANY CONTRACT OR OTHER DOCUMENT WIT.{ RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE A=FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN N1AY -iAVE BEEN REDUCED BY PAID CLANS. POLICY EFFECTIVE POLIT Y EXPIRATION LIMITS TR INSRC TYPE OF INSURANCE POLICY NUMBER A GENERAL LIABILITY BINDER290468 - 10101/04 10/01105 EACH OCCURRENCE $1,000, Q00 _ f X COMMERCIAL GENERAL L!ABIL TY I DAMAGE TO RENTED $50,000 CLAIMS MACE FX OCCUR MED EXP (Any one person, S PERSONAL & ADV IN„URY $1,000,000 GENERAL AGGREGATE $Z 000 GOO GEN'L AGGRFGP.TE LIMIT APPLIE_ PER. t PRO PRODUCTS - COMP/0P AGG s2 000 WO PCL!CY JECT I LOC A AUTOMOBILE LIABLffr BINDER28510S 10101104 10101105 COMBINED SINGLE LIMIT X ! ANY AUTO (Ea scddent) $1,000,000 AL OWNED AUTOS BODIL'I INJURY ISCHEOLLEDAUTCS (Per Demur) $ X H RED AUTOS BODIO NdURY NON Cb1MEO AUTOS (Per accidenb $ !X Drive Other Car PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY- EA ACCIDENT $ ANY AUTO I i OTHER THAN EA ACC $ I AUTO ONLY, AGO $ S EXCE£S,'UMBRELLALIABILITY BINDER286109 10101/04 10101105 EACH OCCURRENCE $10,000,000 X j OCCUR F7CLAIMS MADE AGGREGATE $1 0L000,000 I $ I i De°ucnBLE $ X I RETENTION $10000 $ A WORKERS COMPENSATION AND BINDER285107 10101/04 10101105 tti'cSTAnJ- aTH- ErAPLOYERS' UABILrY ANY PROPR!FTORiPARTNER/EXECUTIVF E L. EACH ACCIDENT $1 ,000,000 OFFICEWMENIBEREXCLUDED? FI_DiSEASF - Fa.FNIPLCYFE $1,000,000 it yes. cescriba L,, ;er SPECIAL PROv!ISIC,NS below EL. DISEASE POL Cv LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS ILOCATIONS IVEHICLES ! EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAO. __aQ_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) 1 of 2 #S505391M50402 MDB O ACORD CORPORATION 1988 0 r Town of Montville Building Department 848-3030, Ext 382 RESIDENTIAL LP-GAS PERMIT CONSTRUCTION PERMIT APPROVAL Property Address 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 A rival Department Permit Issuance Approval pp ® Tax Collector a,L 1q e_ _ I q l a ❑ WPCA c: date ❑ Planning & Zoning ❑ Health Department ❑ Fire Marshal Comments/Conditions: Rovisedseptem6er9, 2004