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100 Gal. Tank and Line to Fireplace 2007 Field Inspection Notice Town of Montville Building Department September 19, 2007 Address: 53 Rainbow Drive Job Description: Gas Free Fireplace Logs/Lines/100 Gal. Gas Tank Permit Number(s): M2007-0117 Permit Date: September 6,2007 INSPECTION Not Approved Approval Date: Deficiencies Special Date Conditions Gas Line Pressure 9/14/07 • No Pressure On Test Gauge • Drove By And Test • Checked And There WAS 11 Lbs.On Gauge • • Final inspection and • • 9/17/07 CC certificate of approval • Notice: Before a certificate of occupancy can be issued, a CIO signoff sheet must be completed and returned to the Building Department. Signoff sheet are available in the Building Department. 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 1 Permit Number: M2007-0117 Date: 06-Sep-07 Map/Lot: 016/029-T53 Owner ID: 5761000 Project Location: 53 RAINBOW DRIVE Unit: Job Description: Install Vent Free Gas Fireplace Logs-Gas Lines&100 Gal.Propane Gas Tank Owner Name: Kitchin,Mark W. Tenant Name: N/A ( Careof: 53 Rainbow Drive i Uncasville CT 06382- Telephone: (860)705-6950 Contractor Name: Spicer Gas Telephone: (860)859-9070 DBA: Lic/Reg Type: GI Lic/Reg No: 388986 183 East Haddam Road Exp Date: 31-Aug-08 Salem CT 06420- Construction Value __, Permit Fees Construction Information f, Building Value: $0.00 Building Fee: $0.00 Use Group: IRC Plumbing Value: $0.00 PlumbingFee: $0.00 Code: 2005 State Building Code Mechanical Value: $550.00 Mechanical Fee: $8.00 p Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: IRC Total Value: $550.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.08 Total Fee Paid: $8.08 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 V Gas Piping and leak test Fireblocking_Draftstopping INSPECTION REQUIRED UPON COMPLETION Insulation d Certificate of Approval C iso •a pa. c Building Official's Approval: ��� � C�t� Town of Montville Building Department File Receipt Date: 05_Sep-07 Receipt No: 2724 Received From: SP Aquistion Corp. Job Address: _53 Raionbow Dr. Fees Collected State Educational Training Fee Cash: $0.00 Check: Cash: $0.00 $8.08 Check: Check No: 0 $0.08 Short/Over: $0.00 Construction Value: $550.00 Demolition Value: $0.00 Received By David Jensen 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 mGOTO) 7 Single rFami(y D Two-rFamily LI Townhouse Permit# Job Address 53 PAN 13 V p_ 1�©vl711 LLC J C 3&a_ (Number) (Street) (Unit) Job Description S LI /J T,it _ - 6 b I DOg a?Qtp,-i s Proparu 3 a s L-1,9-)i-k. Owner `11110?jyj7 //it/ Mailing Address 53/2/iAi6a0 D/24 L City /'nPIIT/4LLLs State (7 Zip 06.3ga Tel RHO / "705/ (o95Z) Contractor AQOf 1(fC (jam'/P/e fe Mailing Address itsJ� 610/,-, J 4D City 99State Cr Zip Div'( o Tel ZO / 8Sq/ 90.7---() Contractor's License Type&Number38gc181y /4 pc . Exp. Dat99 /3/ /c & gd 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. Owner/Agent Signature 6D ay.44. %i Date 0 / 2— Construction Value Fee Mechanical $ L1)U $ , Electrical $ $ Plan Review Fee $ State Education $ Total $ 5 $ g' D8' 4?piseiSeptem6er9,2004 Town of Montville Building Department 848-3030, Ext 382 RESIDENTIAL LP-GAS PERMIT CONSTRUCTION PERMIT APPROVAL 53 Abu J3D uJ Per -mon iI t6, c7- Property Address 157 fOs L N is I&ilopeS it 4 t^is' - rreptice L s 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 royal Department Permit Issuance Approval Pp Tax Collector M „"� `o.� gr\p ek.Sint attiO (late ❑ WPCA "I • d6-7 Signature/ late ❑ Planning&Zoning Signature/date ❑ Health Department 5 ���.u��/ date Fire Marshal / ' //0 Si`,; date Comments/Conditions: Revised-September 9,2004 y,� State of Connecticut 2 7A - 7B - 7C 41 Workers' Compensation Commission ..) DIRECTIONS =• {=* :ooldir DIRECTIONS for FILING FORMS 7A,7B and 7C 1r SJS Building Permit Requirements for Workers' Compensation Section 31-286b of the Workers'Compensation Act requires anyone who requests a building permit to first submit"proof of workers' compensation coverage for all of the employees who are engaged to perform services on the site of the construction project for which the permit was issued." The only exceptions to this law are the sole proprietor or property owner who will not be acting as general contractor or principal employer. What to give to the Building Official to obtain a Building Permit: 1. The General Contractor or Principal Employer must provide a written certificate of workers' compensation insurance for all of the employees on their project.This certificate may not be for liability, disability or any other type of insurance. 2. The Sole Proprietor or Property Owner who will not act as a general contractor or principal employer is not required to have workers'compensation coverage. In order to obtain the building permit,a FORM 7A should be completed and given to the building official. 3. The Sole Proprietor or Property Owner who will act as a general contractor or a principal employer must provide a written certificate of workers'compensation insurance for all of the employees on their project and must file a FORM 7B with the building official—OR he will sign a sworn notarized affidavit on FORM 7B, stating that he will require proof of workers' compensation insurance for all those employed on the job site. 4. The General Contractor or Principal Employer who has properly excluded himself from coverage using the appropriate WCC form (see NOTE below)must file the FORM 7C with the building official.This form certifies that they have properly excluded themselves, and attests that they will require proof of workers' compensation insurance from every employee that works on the designated job site. NOTE: The general contractor or principal employer may exclude himself from workers'compensation coverage by filing one of the following forms with the appropriate Workers'Compensation Commission district office: Form 6B for employees who are Officers of a Corporation or Managers/Members of an LLC Form 6B-1 for employees who are Members of a Partnership STATE OF CONN r A, A , DEE tiRLMLA I Oi CONSUME.?i't<.' i.I` r` HEATING,PIPING&COOI:jNG LIMITED CONTRACTOR JAMESc SArQRITA I 6I t ,, 'OE, t•RD STOI Nfs 0'�, 06378 LIC./REG NO iF,FECYIVE '" EXPIRES HTG.0388986 G ; '09/,&1/x'7 .�" 08/31/2008 g�_> .... SIGNED t�/ _ �' r�L .- 1� t� `mss ' V/ �V A _ � VF 414Yret �:tr. 0, i+ Nr.i:&y sy,l' r� i� .{, ,} r r :=- , 44.v ,* F',� ' ; § �k ` , F STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION t Be it known that X. JAMES L SAPORITA 6 DEE .Z RIDGE RD7.-:::::-.;'.•:-.: 'V STONINGTO ` CT 06378 s has been certified by ti>r�+ I : tet ',of sumer Protection as a , - QA'',E G �,I %I HEATINGp , PIPING & � '. ."'>' L�k I � ITED CONTRACTOR Lic- T , 986--G1 \TRANSr1,t/ ' M l h Effective: 09/01/2007 . Expiration: '08/31/20084-4.-...",14% Jerry Farrell,Jr.,Commissioner �• ,.. ,+�► � -5.17-V.- � � �r'� ,1"� arm »If* $114:113: \ �,., .Ij .•e "1,...V.4'. k, •1:0:::::41:. ie } VS”''.; ��'I +..• /y ,.„ :�,•ti.tyi.,= r, tij / ,4r.Y 4'.1;;P:;',4, z. 1 0 N� :•_a %T� iT...' .• .r4..M1',.. T•sy'/4 T t�� , tiUrjj+=8 �.•y '\� • �•w.' ,1':`'''' -" L,,•• i/},yy`. ,;: 4�h• .,•;.• •�isst"l;, ri ,I 1 ,,I-I\ I L_u.J OOU tZIC.31J IO• I MAY-.21-'2UU I MUN Uy:4ti Fin CIVLKU T I NJ urctinuc drcuncrto FM ITv. :I t o s I J I c 1 < +r ACQRD1, CERTIFICATE OF LIABILITY INSURANCE DATE 1M41ADITYYYI notnicER -- RS/7 Si?007 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ZWzRGr INSURANCE SROFIRS, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P 0 SOX 2729 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES PEIOW_ ALSANY, NY 12207-1723 INSURERS AFFORDING COVERAGE NAICIf tNSUREO SPICER PLf1$, INC. BTAL INSURER A' TRAVILIR3 INDEMNITY CO OF CT P.O, SOX 103 INSURER a: TRAVELERS INDEMNITY CO OP AMER GROTON, CT 06340 INS4 En c: AMERICAN HOME ASSURANCE CO .– INSURER 0: ADMIRAL SNBURRNCS COMPANY $PIC0; INSURER E: COVERAGES THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TiI INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, 'TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTApN,THE INSURANCE AFFORDED BY T E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF suCH POLICIES.AGGREGATE LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS. MIEI1 CI D'I LT!L POLICY NUMIFR l fNE pLIaI �PIp W LITf ~. 1 (p B OB1°'AL LIABKLTY cco-us1cnaAo7 04/30/2007104/30/2008 EACH OCCURRENCE r• 1,000,000 _Xi COMMERCIAL GENERAL LIABILITY "b'AMACC 10 RENTED "--` 111 PREMISES IEasccu(RRc•I ' 50,000 —•�-�I GLAIMSMAO[ ,OCCUR MED EXPIAnv on•Duwm • 5,000 PERSONAL 6 ROY INJURY $ 1,000,000 GENERAL AGGREGATE 1 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS•COMPrOP AGG • 2,099,00o POLICY —1 Ino- (-1 JEST l l LOC A TOMOMLELLANUTY 86-1121C0,2 - AU04/30/2007 04/30/2008 X ANY AUTO COM61N[O SINGLE LIMIT I IEAAOCIC•Ri) 2,000,000 ALL owNED AUTO E SC IEDULCD AUTOS UODILY INJURY 1 IF*,p•,wn1 HIRED AUTOS " — NON•OwNEO AUTns BODILY INJURY I IPOr ICCIJantI X NCB-90 PROPERTY DAMAGE I I X OUDDSM 4 ACCID, P¢ Iy,.cr dr„fl GARAGE LIAiR1TY AUTO ONLY•EA ACCIDENT I 1 ANY AUTO I –_' OTHER THAN [A ACC 0 AUTO ONLY: AGO I D EXDEsSIUWBR*11A IIAIII,TY sX0000OSS23-os 04/30/2007 04/30/2008 EACH OCCURRENCE • 5,000,000 OCCUR CLAIMS MADE AGGREGATE 1 $,000,000 DEDUCTIBLE �..- ._...��_._._._ .,- �. . I n RETENTION I • C YYORKEREcoNP[N6A7aNAND NCI 711721 0I/12/2007 02/21/2009 x lir/Ir.-11A_ to '' EMPIO AI'LIAIIUTY ANY PROPRIETORMAATNOVEAECUTIVE E.L-EACH ACCIDENT 0 100,BOO~ S CCR/MEMBER EXCLUORDP I I E.L.DISEASE-EA EMPLOYEE 1 100,000 If y44• O4 I SPECIALL PROVISIONS Wb.r E.L.DISEASE-POLICY LIMIT • 500,0001 A OTHER na4 24CO3.z 101/30/2007 04/30/2008 DSD PPT1S & LIGHTS $500 PHYSICAL DAMAGE COV. DSD ALL OTASR$/ACV $1,000 i DEEORIPTIONOE OKRATI0Ns/LOCATIONS 1 VEWC LES/EXCLUSIONS ADDED EY ENDORSEMENT I SPECLLL PROVtp0Ns CERTIFICATE HOLDER CANCELLATION $IROULO ANY OF THE ABOVE OEICRIREO POUCIES OE CANCELLUO IUQRE THE EXPIRATION DATE THEREOF.THE I6RWMN NG EURER WILL EAPERLATOR TO MAIL 30 DAPI WRITTEN 'qilly) I4 ( )N. NOTICE TO TIRE CERTIFICATE HOLDER NAMED TO THE LEFT.OUT FAILURE TO DO 60 SHALL IMPOSE NO OIYOATION OR IUIIUTY OF ANY KIND vrQN THE INSURER,ITS AGENTS 011 REPRESENTATIVES, AUTHORIZED RE►RE3 T C `j,�E� CC Da ._ACORD 26(2001108) 0 AGGRO CORPORATION 1988 AG r r OAS 36 Thames Street, Groton, Ct. 06340 (860) 445-2436 • (800) 448-2028 Fax - (860) 445-2313 Date: c43i /2cx-7- City/Town/Borough: (14014-iviL(.,2_, t Job Site Address: 53Rfinv i3ot (Dave_, /11 cM f in uc;-, cfr 616.3g?-- Project 638a=Project to start on or about the following date: 49 /o/z.�� This letter authorizes p,-----,.___,_e....______ _ to obtain a permit on my behalf for the following customer/project: Property Owner: , 1, k/7/-,1 Mailing Address: 6302Ak ,22iue_ flt ii4/1U e, a-,6‘38 IPames L. Saporita -Jr_.›.. .a as Technicn copy o Jicguee lite Division of Spicer Plus, Inc. • Ct. Lic. #388986 • R.I. Lic. #00007469