HomeMy WebLinkAbout2004 - LP Tank/Fireplace
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: M2004-0150 Date: 15-Jul-2004 Map/Lot: 096/101-000 Owner ID: 118000
Project Location: 28 BALDWIN COURT Unit:
Job Description: 120 GAL LP-TANK AND FIREPLACE
Owner Name: Linda M Sposato Tenant Name: N/A
Careof:
303 Mohegan Park Road, Lot #20
Norwich CT 06360- Telephone:
Contractor Name: LEO MARTIN Telephone: (860)848-5510
DBA: SUBURBAN PROPANE Uc/Reg Type: G-1
PO BOX 385 Lic/Reg No: 390521
Exp Date: 31-Au2-2004
UNCASVILLE CT 06382-
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
w/2000 Amendment
Mechanical Value: $400.00 Mechanical Fee: $8.00
Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B
Total Value: $400.00 Penalty Fee: $0.00 Permit Code: R5
C of 0 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.
❑ Footing - Prior to pouring concrete ❑ R Plumbing and leak test
❑ Backflll - 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 Gas Piping and leak test
❑ Firestop Draftstopping Q Final Inspection
❑ Insulation ❑ Certificate of Occupancy
Building Officiars Ap roval:
Town of Montville
r, Building Department
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231
Residential LP-Gas Permit Application Form
Single Tami,5 F-I Two-Family [I Townhouse
Permit #
Job Address 2.~d
(Number) (Street) (Unit)
Job Description s A'A.. 4-a D/e, c e •2 is /z o t y h-
Owner : n ~e ~a a 7~b Mailing Address Z~~'z y-
City State Zip D j3 FZ Tel ~Go I ~4'I l F'F`Y 7
Contractor Z, e o /t'l ~r f. Mailing Address l ,go,.1r 3 ~S
City s is l/~ State_C_,'*4_ Zip . 0,4~*PZ Tel ef,4o l f ~,10/ S7,5-
Contractor's License Type & Number .3j;O 5-Z / Exp. Date_,? 3/
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 required for electrical
Y
Owner /Agent Signature Date 7 / /,0
Construction Value Fee
Mechanical $ $
Electrical $ $
Plan Review Fee $
State Education $ 0G
Total $ ~O191 v $
Town of Montville Building Department Receipt
Date No. 4
From:
Job Address: t~ _
k ( h,' Check Check #
Amount
irde one)
t
Perm
Received by
r`
E
SUBURBAN PROPANE
262 GALLIVAN LANE\ P.O. BOX 385
UNCASVILLE, CT 06382
(800)-573-3757 - (860) 848-5510
FAX - (860)-848-5517
DATE:
JOB NAME: SOO Sa
JOB ADDRESS: 2
STARTING DATE: 7_
CONTRAC'TOR'S AGENT: Ica ~j4~ r
TO: CITY/TOtN,N OF
PLEASE BE ADVISED THAT THE ABOVE REFERENCED AGENT HAS BEEN AUTHORIZED
TO OBTAIN A PERMIT FROM YOUR BUILDING DEPARTMENT FOR THE SPECIFIED PROJECT
IN THE NAME OF THE CONTRACTOR.
/ NAME: LEO MARTIN
HEATING, PIPING & COOLING LIMITED CONTRACTOR SIGNED:
LEO R MARTIN JR
91 SCOTLAND RD LICENSE #
BALTIC, CT 06330
TYPE: G I
LIC./REG NO. EFFECTIVE EXPIRES
390521 09/00111//J2003 - 08/31/2004
SIGNED
CERTIFICATE NUMBER
MARSH CERTIFICATE OF INSURANCE NYC-0 929355-01
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
PRODUCER NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE
MARSH USA I ROAD POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
44 W HIPPANY R AFFORDED BY THE POLICIES DESCRIBED HEREIN.
PO BOX 1966
MORRISTOWN NJ 07962-1966 COMPANIES AFFORDING COVERAGE
GAMBRO,E FAX: (203) 229-63 OR
ILZE EMAIL I CERT REQU STNE@M RSH$COM (203) 22"611 COMPANY
A ACE AMERICAN INSURANCE COMPANY
08990-CORP--04-05
COMPANY
INSURED B NIA
SUBURBAN PROPANE, L.P.
1 SUBURBAN PLAZA COMPANY
P.O. BOX 206 C
W HIPPANY, NJ 07981
COMPANY
D
COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy. period noted below.
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO POLICYEFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER OATS (MMIDDIYY) DATE (MMIDDIY
LTR 2,000,000
GENERAL LIABILITY HDO G2170698A 03101/04 03/01/05 GENERAL AGGREGATE $
A PRODUCTS • COMP/OP AGG $ 2,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMSMADE $ 1 QQQ QQQ
OCCUR PERSONAL 8 ADV INJURY EACH OCCURRENCE $ 1,000,000
OWNER'S S CONTRACTOR'S PROT FIRE DAMAGE An one fire $ 250,000
$ 10,000
MED EXP (Anyone n
AUTOMOBILE LIABILITY ISA HO 8010730 03101104 03/01/05 COMBINED SINGLE LIMIT $ 1,000,000
A
X ANY AUTO
BODILY INJURY $
X ALL OWNED AUTOS (Per person)
X SCHEDULED AUTOS
BODILY INJURY $
X HIRED AUTOS (Per accident)
X NON-0W NED AUTOS
PROPERTY DAMAGE $
AUTO ONLY • EA ACCIDENT $
GARAGE LIABILITY
OTHER THAN AUTO ONLY: .k
ANY AUTO $
EACH ACCIDENT
AGGREGATE $
EACH OCCURRENCE $
EXCESS LIABILITY . , $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM WC STATU• O7H ,
A WORKERS COMPENSATION AND WLR 04 3972704 (AOS) 03101/04 03/01/05 X TORY LIMITS ER;'~O'~Q
EMPLOYERS' LIABILITY SCF C4 3972741 (W i) 03/01/04 03/01/05 - EL EACH ACCIDENT $
A EL DISEASE-POLICY LIMIT $ 1,0()0,000
THE PROPRIETOR/ X INCL
OFFIC ERS ARE: ARE: _ EXCL EL DISEASE-EACH EMPLOYEE $ 1,000,000
OFFICERS ERS THE
HER
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS
RE: PROOF OF INSURANCE
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE POLICES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAL .--30- DAYS WRITTEN NOTICE TO THE
TO WHOM IT MAY CONCERN CERTIFICATE HOLDER NAMED HEREIN. BUT FALURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABLIrY OF ANY KIND UPON THE INSURER. AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES, OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
~8^L-
Y: Jura Slattery
MM1(3102) ' VALID AS OF-- 03102/04