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Bathroom Remodel 2016 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860)848-3030 X382 FAX. (860) 848-7231 ELECTRICAL PERMIT Permit Number: E2016-0167 Date: 17-Jun-16 Map/Lot: 016/029463 Owner ID: 5769000 Project Location: 63 RAINBOW DRIVE Unit: Job Description: Electrical for Bathroom Remodel Owner Nam Lisa Mongue Tenant Name N/A Careof: 63 Rainbow Drive Uncasville CT 06382- Telephone: (860)303-1166 Applicant Name Beaver Electric Telephone: (860)367-9157 DBA: Lic/Reg Type El Lic/Reg N 181770 8 Fielding Terrace Exp Date: 30-Sep-16 Uncasville CT 06382- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $0.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 Fees Included with Plumbing Permit State Ed Fee: $0.00 Total Fee Paid: $0.00 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 ❑d 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 frami ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation a Certificate of '•proval Certifi . e o .f. o.ncy Building Official's Approval: ------ • Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.: C i(p: 0it_o7 TArp e of Work u anc T e Permit Type 0 N e'Construction Single Family 0 Building ❑Adetion Two-Family 0 Plumbing ❑Alteration 0 Townhouse Mechanical 0 Accessory Structure1Electrical CRS#: Property Address: ect: ►So..J by ,...e bLiteao vie C Cb 8'Z__ (Number) (Street) (Unit) Job Description: Sok—pe,.— — aeviocc L.s t..45 i r*CLJ GCS:— Own er: Owner: �SG �VMws� Address: 6 'g3 a, n t.,J br t' City: Ace, in C le_ State: C T Zip Code: O(,3 Fr i Telephone( ° )303 - t 1.106 Applicant: (2• eat-le--r E Le GA-v.\c. DBA: ��^^- Address: ( i e(c n3 fi2i✓'sex-u City: lac✓tct, ✓tsit& State: Cr- Zip Code: V63e2.- Telephone(gbO ) 3 L7 - `j 1 Contractors-Complete the Following: License Type: £ LC License No.:64 117i"E( Expiration Date: 01130/14P I hereby certify that the proposed work mil conform to the State 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 ermitfor such work as described above. By checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.21 of the Residential Code, instead of the electrical requirements in chapters 33 through 42 of the Residential Code. Owner/Agent Signature: "(/1 s Ait-e/t Date: Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: .SDO,.po Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: •'Regud•.71zust23,2007 ,,, . .:,,,.',..?,,,,,,, BEAVER ELECTRIC ilif ■ RESIDENTIAL • COMMERCIAL ■ INDUSTRIAL Permission Slips for Electrical Permit Applications (0 - I - 2016 Permit Slip #1(0-01b -01b Att: Building Offices & Officials Re: Permit Applications Dear Sirs, This is to notify that, for the purpose of acquiring this bldg. permit Scribners Kitchen& Bath Design is authorized and acting as an agent for Robert M Thayer and Beaver Electric LLC and along with this letter please allow for the issuing of an electrical permit at the below location. Please see the attached information. Work Address: These Permission slips are only for use of Scribners to ease with the paperwork process of jobs and shall only be used for work in which Beaver Electric will be performing& is void otherwise. Thank you for your time and patience regarding this matter. ISIelyi ' TE". i _ON_ `'r r DEP.."1R/uE'V f OP'Ct31.st:41NR PRO`Il-ctJo\ ELECTRICAL UNLIMITED CONTRACTOR +--✓- ROBERT M THAYER Robert M Thayer 8 FIELDING TERRACE Beaver Electric LLC UNCASVILLE,CT 06382 8 Fielding Terrace Uncasville, Ct. 06382 LIC./REG NO. EFFECTIVE EXPIRES ELC.0181770-E1 10/01/2015 09/30/2016 Phone#= 860-367-9157 Please feel free to contact me (Robert Thayer) directly at Cell# (860)213-1546 with any questions or concerns regarding this matter. Thanks Again Only valid with original signature Phone (860) 367-9157 Fax (860) 848-3148 8 Fielding Terrace Uncasville, CT 06382 Lic#00181770 -----" tstAVt-4 OP 117:'IL '`" R� CERTIFICATE OF LIABILITY INSURANCE DATE(A1iNlpp/YYyr, 10/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES, BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). BRIO urance CON DUCER IA Me`� Jodi Guenther 80 Norwich New London Tpke PHONE "No,Exp:860-434-1611 l(NC No):860-561-877____ Uncasville,CT 06382 ADDRESS:jguenther@binsurance.com Jodi Guenther INSURER(s)AFFORDING COVERAGE NAic li, INSURER A:Selective Ins Co of America 12572 _ ' INSURED Beaver Electric,LLC INSURER B:The Hartford _ 8 Fielding Terrace _; Uncasville, CT 06382 C= INSURER D: INSURER E: ------� INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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 PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SUBS POUCY EFF POLICY EXP LTR i TYPE OF INSURANCE; ADOR Y vo POLICY NUMBER (MM/DD7YYY1) (MMlDD/YYYY) LIMITS __...� G–E NERAL LIABILITY EACH OCCURRENCE s 1,00 ,(}01} A X 1 COMMERCIAL GENERAL LIABILITY S2069198 08/24/2015 08/24/2016 DAMAGE TO RENTED '- PREMISES(Ea occurrence) $ 100,001 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,001 PERSONAL a ADV INJURY S 1,000,00()) GENERAL AGGREGATE $ 3,000,000 GEM_AGGREGATE UNIT APPUES PER PRODUCTS-COMP/OP AGG $ 3,000,00{) $ POLICY J LOC ANY AUTO S2069198 AUTOMOBILE UABU.JTY COMBINED SINGLE UMIT —. A' (Ea accident) $ 1,000,(IIAt 08/24/2015 08!24/2016 BODILY[INJURY(Per person) $ AU-OWNEDSCHEDULED –__._— AUTOS X AUTOS BODILY INJURY(Per accident) $ , X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (PER ACCIDENT) $ $ -- UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ �-- EXCESS LIAB CLAIMS-MADE ------..---�. AGGREGATE $ DED RETENTION$ $ ..---- WORKERS COMPENSATION WC STATU- 011H- -� AND EMPLOYERS'LIABILITY TORY LIMITS ER 13 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 02WECCN4809 08/24/2015 08/24/2016 OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 500,---' (Mandatory in NH) 0 4 If yes,descr be underE.L.DISEASE-EA EMPLOYEE S 500,0-- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY OMIT $ 500,00(1 I DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICI FS (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEF O R.:: THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I' ACCORDANCE WITH THE POLICY PROVISIONS. AL THOR BI)REPRESENTATIVE 91°4 ©1988-2010 ACORD CORPORATION. All rights reserved,,. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860)848-3030 X382 FAX. (860) 848-7231 PLUMBING PERMIT Permit Number: P2016-0070 Date: 17-Jun-16 Map/Lot: 016/029-163 Owner ID: 5769000 Project Location: 63 RAINBOW DRIVE Unit: Job Description: Remodel Bathroom-Replace Tub/Shower with Shower Owner Nam Lisa Mongue Tenant Name N/A Careof: 63 Rainbow Drive Uncasville _CT 06382- Telephone: (860)303-1166 Applicant Name Fred Bruning Telephone: DBA: Lic/Reg Type P1 Lic/Reg N 203634 40 Maple Avenue Ext. Exp Date: 31-Oct-16 Uncasville CT 06382- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: IRC Plumbing Value: $900.00 Plumbing Fee: $30.00 Code: 2005 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $500.00 Electrical Fee: $30.00 Construction Type IRC Total Value: $1,400.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 State Ed Fee: $0.36 Total Fee Paid: $60.36 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 0 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 frami ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation 0 Certificate of Approval ■ Ce a • of• cupancy Building Official's Approval: • I Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RE SIDENTIAL PERMIT APPLICATION FORM Permit No.: P.;1o((p—CCU Typ e of Work Qccupancy Type Permit Type ❑N el/Construction pi Single Family 0 Building ❑Addtion 0 Two-Family KPlumbing ❑Alteration ❑Townhouselifl Mechanical 0 Accessory Structure 0 Electrical CRS#: / Property Address: tQ 3 Qa%tiloo,3 t rl✓e l 1.31A Cek tit me Cu 6c,3 -z (Number) (Street) (Unit) Job Description: l 04f/,.oe, - (ace -641¢ 1-c-t.ec .. 1..v..1 .- Owner: Lia- &njtye_ Address: 6 3 ., bo> 11)it' ve City: ti../iCSet*✓(,(1Q State: GT- Zip Code: v G Telephone( Si6 v ) 3 6i - t(fib Applicant: e6( (,...✓1„...q DBA: r� JJ Address: 40 'MAC tc. ke 41-- City: UuVV!ao 4.'l U.f State: G Zip Code: 665Q-2 Telephone( ) - Contractors-Complete the Following: ly 3 t ?i tO (3tItc. License Type: f . O2.O- 39- License No.: Expiration Date: I hereby certify that the proposed work will conform to the State 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 ennitfor such work as described above. By checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E330121 of the Residential Code, instead of the electrical requiremen in c ters 33 through 42 of the Residential Code. Owner/Agent Signature: ..4 I11,b Date: 11/4 is Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Qoo.CO Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: $wiucC Auqust23,2W7 Bruning Plumbing & Heating 40 Maple Ave, Ext. Uncasville, CT 06382 860-848-0703 TO: Town of 0.64- L DATE: lo' (.(0 - JOB Name: c., - t,s16_, ,t(L& GT- !,ct +�tx+w IU24a�e�ts Ia(S�.t2.1sQ� —1,1Sold:-2� (Job Description) START DATE: (Z71i I Fredrick Bruning give permission to Scribner's Kitchen & Bath Designs (Lori Merlo) to use plumbing license to obtain permits. Fred Bruning STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION PLUMBING&PIPING UNLI_MITED CONTRACTOR FREDERICK BRUNING 40 MAPLE AVENUE EXT UNCASVILLE,CT 06382-2418 LIC./REG NO. EFFECTIVE EXPIRES 613 PLM.02034-Pi 11/01/2015 10/31/2016 31GNED A`�o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/15/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Melissa Quinn Sumner & Sumner, Inc. PHONE (860)423-7733 FAX A/C No:(860)450-7240 757 Main Street E-MAIL ADDRESS:mcruinn@sumnerandsumner.com P. 0. Box 187 INSURER(S)AFFORDING COVERAGE NAIC# _ Willimantic CT 06226 _ INSURER AMain Street America Ins. Co. 29939 _ INSURED INSURER B:Hartford Underwriters Insuranc 30104 BRUNING PLUMBING AND HEATING INSURERC: 40 MAPLE AVENUE EXT INSURER D INSURER E: UNCASVILLE CT 06382-2418 INSURERF: COVERAGES CERTIFICATE NUMBER:15/16 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 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 PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBRI ! POLICY EFF ' POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER i IMM/DDIYYYYL(MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY ! EACH OCCURRENCE $ 500,000 A CLAIMS-MADE X OCCUR DAMAGE TO RENTED 500,000 PREMISES(Ea occurrence) $ MPF6112E 12/12/2015112/12/2016 MED EXP(Any one person) _ $ 10,000 PERSONAL&ADV INJURY $ 500,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: Individual Risk Mod Prem $ AUTOMOBILE LIABILITY EO aa MBCNdEDtSINGLE LIMIT $ 750,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED _ AUTOS X AUTOS 02UECIB8727 10/30/201510/30/2016 BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ .,Uninsured motorist combined $ 500,000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE I AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION lori@scribners.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scribners Kitchen & Bath Design THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 44 Route 32 ACCORDANCE WITH THE POLICY PROVISIONS. Quaker Hill, CT 06375 AUTHORIZED REPRESENTATIVE V Ebersole Jr./VIP2 V egtAtA0014gL, ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(70401) Town of Montville Building Department File Receipt Date: 16-Jun-16 ReceiptNo: 11423 Received From: Scrinbers Kitchen and bath Job Address: 63 Rainbow Dr. Town Fees Collected State of Connecticut Fees Collected Bldg Cash: $0.00 State Cash: $0.00 Bldg Check: $60.36 State Check: $360.00 Bldg Credit: $0.00 State Credit: $0.00 Fire Cash: $0.00 Fire Check: $0.00 Fire Credit: $0.00 Construction Value: $1.400.00 Demolition Value: $0.00 CheckNo: 104455 Received By: David Jensen 1 i Address: 63 Rainbow Dr. !t ITEM QTY $/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA / Basement,Finished SF $ 41.96 $ - $ - Interior Renovations SF $ 36.09 $ - $ - $ li - AMENITIES Kitchen EA $ - $ - $ - ' Full Bathroom EA $ - $ - f` Half-Bathroom EA $ - $ - a• GARAGE Detached SF $ 71.53 $ - $ - s MECHANICAL 1 Warm-Air n Y/N $ - Hot Water n Y/N $ - Electric n Y/N $ - Air Conditioning n Y/N $ - 1 i ELECTRICAL SERVICE Upgrade Amps $ - x Subpanel EA $ 699.00 $ - Gen Set EA $ 3,850.00 - SOLID FUEL BURNING APPLIANCES ¢ Prefab Metal Fireplace EA $ 6,497.70 $ - Masonryw/lfireplace EA $ 7,096.65 $ - , Masonry w/2 fireplaces EA $ 11,095.70 $ - f: Wood Stove,free standing EA $ 2,692.25 $ - Wood stove insert EA $ 1,859.77 $ - DECKS,PORCHES,SUNROOMS Deck SF $ 44.07 $ - Porch SF $ 149.38 $ - Sunroom SF $ 176.90 $ - $ - POOLS&HOT TUBS Hot Tub EA $ 8,016.25 $ - $ - Inground Pool EA $ 31,550.00 $ - $ - t Above Ground Round EA $ 6,299.46 $ - $ - Above Ground Oval EA $ 7,019.75 $ - $ - Pool Heater EA $ 8,984.25 $ - $ - Z. Inflatable Type Pool EA $ 1,200.00 $ - $ - t. SHEDS w/o electrical SF $ 25.55 $ 11 - w/electrical SF $ 26.85 $ - $ - i. RENOVATIONS s. Roofing,Overlay SF $ 3.50 $ t."- Roofing,Strip&reroof - SF $ 4.50 $ - Roof Sheathing SF $ 1.51 $ - Siding - SF $ 6.75 $ - Windows EA $ 550.00 $ - Skylights EA $ 1,051.10 $ - g. Doors,Exterior EA $ 601.50 $ - 63 Oil Tank,275 Gallon EA $ - Oil Tank,550 Gallon EA $ - MISCELLANEOUS CALCULATIONS $ 900.00 $ 500.00 TOTALS $ - $ 900.00 $ - $ 500.00 PERMIT FEE CALCULATIONS Construction Value Fee Building $ - $ - Plumbing y $ 900.00 $ 30.00 Mechanical y $ - $ - Electrical y $ 500.00 $ 30.00 Working before Permit Issuance $ Certificate of Occupancy Fee $ Plan Review Fee $ - State Education Fee $ 0.36 TOTALS $ 1,400.00 $ 60.36 Figures are based on the 2006 RS Means Residential Cost Data -�'...4) SCRIB-1 OP ID: JE AC"ORO CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD YYYY) �� 06/06/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject toiI the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Judy Kerrigan Brown&Brown of CT,Inc. - 55 Capital Blvd.,Ste.102 PHONE o,Ext):860-665-8427 FAX No): 203-639-0031 Rocky Hill,CT 06067 E-MAIL kern an bbhartford.com Brown&Brown of CT Inc. ADDRESS:) g INSURER(S)AFFORDING COVERAGE NAIC II INSURER A:Sentinel Insurance Co.LTD INSURED Scribners Builders,Inc.dba INSURER B:Hartford Accident&Indemnity 22357 Scribners Kitchen&Bath INSURER c:Hartford Casualty Insurance 29.424_ Design 44 Route 32 Quaker Hill, CT 06375 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE 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 PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DD/YYYY) LIMITS C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REWEEO_----- ------------ CLAIMS-MADE X OCCUR 02SBALX7227 10/24/2015 10/24/2016 PREMISES(Ea ofn,rrence) $ 300,000 MED EXP(Any one person) _ $ 10,000 PERSONAL&ADV INJURY_ $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY JET LOC PRODUCTS-COMP/OP AGG_ $ 2,000,000 OTHER: $ . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A ANY AUTO 02UECR05620 09/11/2015 09/11/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident $ AUTOS — AUTOS ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS UAB CLAIMS-MADE 02SBALX7227 10/24/2015 10/24/2016 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN B ANY PROPRIETORPARTNER/EXECUTIVE 02WECLD5836 10/24/2015 10/24/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A --_ ---- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under '-- - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Job: Mongue-Location:63 Rainbow Drive, Uncasville, CT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Montville THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Inspector 310 Norwich-New London Tpk AUTHORIZED REPRESENTATIVE Uncasville, CT 06382 —i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL z hocb �.r;✓e, �n e€04,A lfe� C--t- (l.la.,Sv-C ,) �Q Property Address Et:44 '064, - I�P �l.iLs f S � �a�� S Job Description Required Department Permit Issuance Approval Approval Tax Collector -.��4./`t�`�+-e— Co/1 b/1 to ignature/date Comments: /OP/ 111 Fire Marshal . / Signature/date Comments: ❑ Planning & Zoning Required for all permits except Signature/date Plumbing,Electrical,Mechanical,Roofing,Siding,Windows&Doors ❑ Health Department Required for properties with private septic or well Signature/date Comments: ❑ WPCA, Administrative NA. � t , 1 11, Required for properties on sewerSignature/date Comments: ❑ WPCA, Operations When Required by WPCA Signature/date Comments: ❑ Department of Public Works Required when project includes driveway work or certain drainage requirements Signature/date Comments: ❑ Montville Police Department Required for all permits EXCEPT one and two family residential Signature/date Comments: ❑ Copy of State Dept. of Transportation Certificate Required for Structures over 100.000 sq.ft.or with more than 200 parking spaces-Official copy of STC Certificate of Operation required—per CGS 14-311 Signature/date Building Department Final Inspection Reviser"March 23,2015