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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