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Kitchen Remodel 2017 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 BUILDING PERMIT Permit Number: B2017-0269 Date: 06-Jul-17 Map/Lot: 016/029-T63 Owner ID: 5769000 Project Location: 63 RAINBOW DRIVE Unit: Job Description: Kitchen Remodel- Update Cabinets,Counter Tops,Sink, Faucet&Flooring Owner Nam Lisa Mongue Tenant Name N/A Careof: 63 Rainbow Drive Uncasville CT 06382- Telephone: (860)884-9030 Applicant Name Scribners Kitchen &Bath Designs Telephone: (860)444-7144 DBA: Lic/Reg Type HIC Lic/Reg N 500596 44 Route 32 Exp Date: 30-Nov-17 Quaker Hill CT 06375- Construction Value Permit Fees Construction Information Building Value: $3,500.00 Building Fee: $48.00 Use Group: IRC Plumbing Value: $1,000.00 Plumbing Fee: $30.00 Code: 2016 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $700.00 Electrical Fee: $30.00 Construction Type IRC Total Value: $5,200.00 Penalty Fee: $0.00 Permit Code: R4 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 State Ed Fee: $1.35 Total Fee Paid: $109.35 It shall be the owners repsonsibility to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING,MECHANICAL, ELECTRICAL PERMIT INSPECTIONS ❑ Footing-Prior to pouring concrete I R Plumbing and leak test ❑ Deck Piers R Electrical ❑ Backfill-Footing drains and waterproofing ❑ Elec Trench-with conduit installed ❑ Concrete Slab-Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor frami ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation Certificate of Approval � ❑ Certificate of Occupancy Building Official's Approval: aL) ,,./ //J ( , s Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.:60131— bath Type of Work u anc T e ermit T e ❑New Construction Single Family uilding ❑Addition Two-Family Plumbing ❑Alteration 0 Townhouse 0 Mechanical 0 Accessory Structure ❑Electrical CRS#: Property Address: to ga.,460a) DIiae, L Acca vIL He, Cr 0(off$ Z (Number) (Street) r(Unit) Job Description: (%� eel re's/Lode-1 _Luttadc CaYtetets, exu.4e/4-t,os, Si4t�., -Pa..0 -, -ciocviy Owner: Lisa, Wo•tgve. Address::' -- CP c,b0ol) E✓l tie City: LLA ea6 it l(,[- State: CA Zip Code: 0 b 8'L Telephone( 1 ) a a 1 - clo 30 Applicant: ce(i(An e6 6-4-641.--{-ek0.1.- ---- gDes+el H.S` DBA: p Address: Li L"{ ^v(4-le 3 D• City: 6,J....tof Ht« State: el Zip Code: 66 5 7`S Telephone( it(iV ) 4"`iq - 1047 Contractors- Complete the Following:' License Type: A(< License No.:0'-;-0.0`;`14, Expiration Date: i l (;v '( 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 permit for such work as described above. By checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Code, instead of the electrical requirements in chapters 33 through 42 of the Residential Code. r Att( Owner/Agent Signature: G�'1 Date: 7 i•h 7 Construction Value Permit Fees Building Value: .3 5 r'd.(JD Building Fee: 1. ,00 Plumbing Value: ( OOO Plumbing Fee: 3(..)-c-13 Mechanical Value: Mechanical Fee: Electrical Value: 7O() Electrical Fee: 30.CO Total Value: 5.200 Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: 1.35 Total Fee: IOci-S Revise&August 23,2007 Town of Montville Building Department File Receipt Date: 05-Jul-17 ReceiptNo: 12419 Received From: Scribners Kitchen&Bath Desianc Job Address: 63 Rainbow Drive Town Fees Collected State of Connecticut Fees Collected Bldg Cash: $0.00 State Cash: $0.00 Bldg Check: $109.35 State Check: 11 35 Bldg Credit: 0.00 State Credit: X0.00 Fire Cash: 0.00 Fire Check: 0.00 Fire Credit: gp 00 Construction Value: 15.700.00 Demolition Value: 10.00 CheckNo: 11733 Received By: Carmen Kneeland rn Gt_fy Address: 63 Rainbow Drive ITEM QTY $/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA Basement,Finished - SF $ 41.96 $ - $ Interior Renovations SF $ 36.09 $ - $ - $ _ AMENITIES Kitchen EA $ - $ Full Bathroom EA $ - $ - Half-Bathroom EA $ - $ GARAGE Detached - SF $ 71.53 $ - $ MECHANICAL Warm-Air n Y/N _ Hot Water n Y/N $$ Electric n Y/N Air Conditioning n Y/N $ _ ELECTRICAL SERVICE Upgrade Amps $ Subpanel EA $ 699.00 $ Gen Set EA $ 3,850.00 $ SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 6,497.70 $ - Masonry w/lfireplace EA $ 7,096.65 $ - Masonry w/2 fireplaces EA $ 11,095.70 $ - 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 $ - $ Above Ground Round EA $ 6,299.46 $ - $ _ Above Ground Oval EA $ 7,019.75 $ - $ Pool Heater EA $ 8,984.25 $ - $ Inflatable Type Pool EA $ 1,200.00 $ - $ _ SHEDS w/o electrical SF $ 25.55 $ - w/electrical SF $ 26.85 $ - $ _ RENOVATIONS Roofing,Overlay SF $ 3.50 $ - Roofing,Strip&reroof SF $ 4.50 $ - Roof Sheathing SF $ 1.51 $ - Siding SF $ 6.75 $ - Windows EA $ 550.00 $ - Skylights EA $ 1,051.10 $ - Doors,Exterior EA $ 601.50 $ - Oil Tank,275 Gallon EA $ - Oil Tank,550 Gallon EA $ - MISCELLANEOUS CALCULATIONS $ 3,500.00 $ 1,000.00 $ 700.00 Solar Install n TOTALS $ 3,500.00 $ 1,000.00 $ - $ 700.00 PERMIT FEE CALCULATIONS Construction Value Fee Building $ 3,500.00 $ 48.00 Plumbing y $ 1,000.00 $ 30.00 Mechanical y $ - $ _ Electrical y $ 700.00 $ 30.00 Plan Review Fee y $ _ Certificate of Occupancy Fee $ _ Plan Review Fee $ _ State Education Fee $ 1.35 TOTALS $ 5,200.00 $ 109.35 Figures are based on the 2006 RS Means Residential Cost Data 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: P2017-0064 Date: 06-Jul-17 Map/Lot: 016/029463 Owner ID: 5769000 Project Location: 63 RAINBOW DRIVE Unit: Job Description: Plumbing for Kitchen Remodel Owner Nam Lisa Mongue Tenant Name N/A Careof: 63 Rainbow Drive Uncasville CT 06382- Telephone: (860)884-9030 Applicant Name Bruning Plumbing&Heating Telephone: (860)848-0703 DBA: Lic/Reg Type P 1 Lic/Reg N 203634 t 40 Maple Avenue Ext. Exp Date: 31-Oct-17 Uncasville CT 06382- a, 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: 2016 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 Fees Included with Building Permit Plan Review Fe $0.00 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 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: ❑ 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 ❑ Certificate of Occupancy Building Official's Approval: V 1 c 1� ` , �� �_ v Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-723' RE SEDENTIAL PERMIT APPLICATION FORM Permit No.: Piz- 00Z/1' Typ a of Work ccu anc T e Permit Type ❑N e-Nr Construction Single Family Building El l Aviion Two-Family Plumbi ❑Alteration D Townhouse g Mechanical ❑Accessory Structure ❑Electrical CRS#: Property Address: i9 ga(nloow b(lk, ACa,,✓i1te, 06,3c--z, (Number) (Street) (Unit) Job Description: c i re- ck.a E— Ltrpda,k 2Q t4 .PK.f.uveo Owner: I--t5 . UV\n^-3-;,e- Address: (p 3 gay.Ab00a Di je � City: l.�CalkS✓ (� State: v� ZipCode: O(38-Z cat00 Telephone( ) IS/s4 - 30 Applicant: Brur.(3 DBA: Address: Ho V%-Aaf Afe, City: a'OVl State: ei Zip Code: 063Fr2 Telephone( cloo 0'703 Contractors -Complete the Following: License Type: f f!tvi i.. License No.:O ZO 3 0(f-df Expiration Date: t o 13(11 ? 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 ToH 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 • permit for such work as described above. NO By checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Cod instead of the electrical requirements in chapters 33 through 42 of the Residential Code. c/7 A4e4 6 Owner/Agent Signature: GL2 7 Date: 7 Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: 1000. • Plumbing Fee: • Mechanical Value: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review -: State ee: T•r I Fee: Revise&August 23,2007 i Bruning Plumbing & Heating 40 Maple Ave, Ext. Uncasville, CT 06382 860-848-0703 TO: Town/-E4ty of K.(akk✓., lle DATE: J4.�) Si Zol-7 JOB Name: YAdtitv,e - lo3 e.G"Gu,,� -bone, ( L't(k , G 1 ..tielneli uPctaAc W cob , (Job Description) START DATE: 3(A-4,t 2q{ 2a 1 ? I Fredrick Bruning give permission to Scribner's Kitchen & Bath Designs (Lori Merlo) to use plumbing license to obtain permits. ,��! : ,--c.--A"- STATE . t he red Bruning STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION PLUMBING&PIPING UNLIMITED CONTRACTOR FREDERICK BRUNING 40 MAPLE AVENUE EXT I UNCASVILLE,CT 06382-2418 1 I LIC /REG NO. EFFECTIVE EXPIRES PLM.0203634-P1 11/01/2016 10/31/2017 SIGNED _ ✓L?H fr - - A�RD0 CERTIFICATE ®F LIABILITY INSURANCE I DATE(MM/DD/YYYY)- fII THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.OTHIS 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 Sumner & Sumner, Inc. NAME:__ Quinn PHONE (860)423-7733 1 FAX 757 Main Street No, ;(qK �)_(860)450-7240 P. O. Box 187 ADDRESS:mq,luinn@sutnnerand$Umner.com INSURER(S)AFFORDINGCOVERAGE NAIC s Willimantic CT 06226 INSURED ---.-._.."___.._____ _-_.."____ INSURER A Maln Street America Ins. CO. 29939 BRUNING PLUMING AND HEATING INSURER B:Hartford Underwriters Insuranc 30104 INSURER c: 40 MAPLE AVENUE EXT — -- —---- -----. - INSURER D: --- -"' tiNCASVILLECT 06382-2418 INSURER E: COVERAGES INSURER F: -- CERTIFICATE NUMBER:16/17 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 1 :/DDLISUBRI LTR TYPE OF INSURANCE INSD WVD I POLICY NUMBER I POLICY EFF POUCH i UMITS __._ X COMMERCIAL GENERAL LIABILITY ' (MM/DD/YYYY) (M 11 A I CLAIMS-MADE j X I OCCUR I EACH OCCURRENCE $ 500,000 TT— I DAMAGE TO RENTED I PREMISES(Ea ) S 500,000 ittPF6112E 12/12/201612/12/2017I MED --J_ (Any one person) I S 10,000 GEN'L AGGREGATE OMIT APPLIES PER: I I I PERSONAL&ADV INJURY S 500,000 ! il POLICYI I Q I I I 'GENERAL AGGREGATE j§ 1,000,000 J Loc I PRODUCTS-COMP/OP AGG I$ 1,000,000 OTHER: I r --i-- AUTOMOBILE I Individual Risk Mod Prem -- _ AUTOMOBILE LIABILITY -- .$ I COMBINED SINGLE LIMIT B I ANY AUTO I (Ea accident) $ 750,000 ALL OWNED SCHEDULED I I BODILY INJURY(Per person) I$ AUTOS AUTOS 021=1138727 i 10/30/2016 10/30/2017 I BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS I I I- I i I I PeroaERTY ccidentDAMAGE I§ I —�I UMBRELLA UAB OCCUR I I Uninsured motorist combined $ 500,000 EXCESS UAB I E I 1 EACH OCCURRENCE s l CLAIMS-MADE _ AGGREGATE DED I RETENTION SS WORKERS COMPENSATION j S AND EMPLOYERS'LIABILITY I II RP- I! ANY PROPRIETOR/PARTNER/EXECUTIVE Yr/N I j I'MUTE I I ER OFFICE JMEMBER n NH)EXCLUDED? L I N/A I ! I E.L.EACH ACCIDENT 1$ I(Mandatory I If yes,describe under I 1 E.L.DISEASE-EA EMPLOYE$ DESCRIPTION OF OPERATIONS below I I I i E.L.DISEASE-POLICY LIMIT I$ I I I 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 ANY OF Scribners Kitchen & Bath Design THE SHOULD EXPIRATIONHE DATE THEREOF, NO CEABOVE DESCRIEDIES WILL BECB CE DDEELBEFORE 44 Route 32 ACCORDANCE WITH THE POLICY PROVISIONS. LIVVERED IN 1 Quaker Hill, CT 06375 AUTHORIZED REPRESENTATIVE 1 V Ebersole Jr./VIP2 ACORD 25(2014/01) The ACORD name and logo are ®1988-2014 ACORD CORPORATION. Ail rights reserved. INSO25 r2n14n1, 9 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 ELECTRICAL PERMIT Permit Number: E2017-0154 Date: 06-Jul-17 Map/Lot: 016/029463 Owner ID: 5769000 Project Location: 63 RAINBOW DRIVE Unit: Job Description: Electrical for Kitchen Remodel Owner Nam Lisa Mongue Tenant Name N/A Careof: 63 Rainbow Drive Uncasville CT 06382- Telephone: (860)884-9030 Applicant Name Beaver Electric Telephone: (860)367-9157 DBA: Lic/Reg Type El Lic/Reg N 181770 8 Fielding Terrace Exp Date: 30-Sep-17 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: 2016 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $0.00 Electrical Fee: Total Value: $0.00 Construction Type IRC $0.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comment Fees Included with Building Permit Plan Review Fe $0.00 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 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 ❑d Certificate of Approval ❑ Certificate of Occupancy Building Official's Approval: Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-723' RE SIDENTIAL PERMIT APPLICATION FORM Permit No.:G9a?-01 Typ a of Work ccu anc T e Permit Type ❑N e-Construction Single Family 0 Building ❑A•detion Two-Family 0 Plumbing ❑Alteration 0 Townhouse Mechanical 0 Accessory Structure Electrical CRS#: Property Address: 63 kaiAboL Driie� an . v,Ile/ Cr OCn38-Z (Number) (Street) (Unit) Job Description: IL- (nevi (einAr,ek ( - Rey t.a-c,¢._ o LA,{-Pe. py,,.4 sL,C ez. Owner: L.1Sang11e_.- Address: l 3 tainbu�.r D , rt,`. City: L/10..dt*Vi II State: e-1 ZipCode: 06,3gZ /, Telephone( Bl� ) �7 ____10_,_______3() Applicant: 'acuter -16,e-t-tic DBA: Address:' Fe(cA A5 I-efface_ j. City: (,lneaS✓1 ltt State: Zi Code: C)lm 3' 2_ i. P Telephone(�loc9 ) 367 - 9 I� Contractors - Complete the Following: License Type: 6I (Z 70 YP : EL. _. License No.: Expiration Date: Obi l&'I l 7 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 Tom '` 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 permit for such work as described above. . y checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.21 of the Residential Cod instead of the electrical requirem nts in chapters 33 through hh42 of the Residential Code. Owner/Agent Signature: ark Atit,i6.-- / � Date: Construction Value Permit Fees Building Value: _ Building Fee: Plumbing Value: Plumbing Fee: _ • Mechanical Value: Mechanical Fee: Electrical Value: 700.00 Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: ?terizzEAugust 23,2037 n - oil c ., ' BEAVER ELECTRIC 1 • RESIDENTIAL • COMMERCIAL • INDUSTRIAL I Permission Slips for Electrical Permit Applications 31.A.<<{ - - 2017 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: (1^v,,j u e - (,3 14 4.�G,�101( ve, 11U�eaa A CLQ, Ci o(,3 -2__ Lei-C 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 Sincerely STATE OF CONNECTICUT Robert M Thayer DEP-RTVE.\T OF(O\.SF 11ER PROTECTION Beaver Electric LLC ELECTRICAL UNLIMITED CONTRACTOR 8 Fielding Terrace ROBERT M THAYER Uncasville, Ct. 06382 8 FIELDING TERRACE UNCASVILLE,CT 06382 Phone#= 860-367-9157 Cell #= 860-213-1546 LIC./REG NO. EFFECTIVE EXPIRES ELC.0181770- 1 10/01/2016 09/30/2017 SIGNED p d Phone (860) 367-9157 Fax (860) 848-3148 8 Fielding Terrace Uncasvilie, CT 06382 Lic#00181770 ,QC-ORCY BEAVE-3 OP ID: GM 4...„-- CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDD1VYYY) I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE H OLDER. 6 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLITHIS CIES 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 Bouvier Insurance NAME: Jodi Guenther PHONE 80 Norwich New London Tpke Uncasville,CT 06382 WC,No,Ext):860 859-9821 [AND): 860,561 8778 Jodi Guenther no Amoss:jguenther@binsurance.com — INSURER(S)AFFORDING COVERAGE NAIC II INSURER A:Selective Ins Co of America 12572 INSURED Beaver Electric, LLC 8 Fielding Terrace INSURER e:The Hartford Uncasville,CT 06382 INSURER C: INSURER 0: • INSURER E: COVERAGES INSURER F: 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 ADDL SUB LTR TYPE OF INSURANCE INSR WVDj POLICY NUMBER II POLICY EFF POLICY EXP GENERAL LIABILITY (MM/D0lYYYlr)1(MMfDDIYYYY) LIMBS EACHCCURRENCE B X COMMERCIAL GENERAL LIABILITY S2069198 III DAMAGE TO RENTED $ 1,000,000 08!24/2016 08/24/2017 PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,00-, GENERAL AGGREGATE 5 3,000,00 _GEN'/AGGREGATE LIMIT APPLIES PER. I POLICY ^JE LOC PRODUCTS-COMPIOP AGG s 3,000,00 AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT (Ea acddeng $ .1,000,00- A ANY AUTO BA8718706 ALL OWNED — SCHEDULED 08/24/2013 08/24/2013 BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED HIRED AUTOS PROPERTY DAMAGE AUTOS $ _PER ACCIDENT) r , UMBRELLA LIAR $ ---, OCCUR B X EXCESS/IAB CLAMS-MADE S2069198 EACH OCCURRENCE $ 2,000,000 08/24/2016 08/24/2017 AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION -- $ AND EMPLOYERS'LIABILITY WC STATU- IOTH- C ANY PROPRIETOR/PARTNER/EXECUTIVEY1 N 02W ECCN4809TORY LIMITS 1 ER_ OFFICER/MEMBER EXCLUDED? I I N I A 08/24/2016 08/24/2017 EL.EACH ACCIDENT 5 500,000 (Mandatory in NH) I yes,describe under I E L.DISEASE-EA EMPLOYEE $ 500,000 IDESCRIPTION 00 OPERATIONS below B Property Section E L.DISEASE-POLICY LIMIT $ 500,000 52069198 08/24/2016 08/24/2017 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHCLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) — CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scribners Kitchen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bath Design ACCORDANCE WITH THE POLICY PROVISIONS. 44 Rte 32 Quaker Hill,CT 06375 AUTHORIZED REPRESENTATIVE Co 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD MEMO SCRIBNERS KITCHEN & BATH DESIGN 44 RT. 32 • QUAKER HILL, CT. 06375 PHONE: 860-444-7144 • FAX: 860-443-7143 • EMAIL: SCRIBNERS@SNET.NET ATTN: Building Department, Lori Merlo has my permission to apply for this permit on behalf of Scribner's Kitchen & Bath Designs. 7/511 ames Moran Date STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION HOME IMPROVEMENT CONTRACTOR SCRIBNER BUILDERS INC d/b/a SCRIBNERS KITCHEN&BATH DSGN I 44 ROUTE 32 QUAR HILL,CT 06375 SCRIBNER'S KITCHEN&BATH DESIGNS LIC./REG NO. EFFECTIVE EXPIRES HIC.0500596 12/01/2016 11/30/2017 SIGNED .e......\ SCRIB-1 OP ID:JE A �RO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/30/2017 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 Brown&Brown of CT,Inc. NAME: Judy Kerrigan, Brown&Brown 55 Capital Blvd.,Ste.102 IAC.No.ExtI:860-447-3111 FAX No):860-676-8172 Rocky Hill,CT 06067 linEss:jkerrigan@bbhartford.com Brown&Brown of CT Inc. INSURER(S)AFFORDING COVERAGE NAIC a INSURER A:Sentinel Insurance Co.LTD 11000 INSURED Scribners Builders, Inc. INSURER B:Hartford Accident&Indemnity 22357 dba Scribners Kitchen& Bath INSURER c:Hartford Casualty Insurance 29424 Design 44 Route 32 Quaker Hill, CT 06375 INSURERD: 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 ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/Mir/VT) (MM/DDIYYYY) LIMITS C X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 02SBALX7227 10/24/2016 10/24/2017 PREM SES(EaEocarrence) $ 300,00_0 MED EXP(Any one person) _ $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: 8 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000, (Ea accident) A ANY AUTO 02UECRO5620 09/11/2016 09/11/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS — AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE — — AUTOS (Per accident) S S X UMBRELLA LIAB X OCCUR C ��UAB EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 02SBALX7227 10/24/2016 10/24/2017 AGGREGATE S 1,000,000 DED X RETENTION$ 10,000 S WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY X SER TATUTE ER H B ANY PROPRIETOR/PARTNER/EXECUTIVEY/N 02WECLD5836 10/24/2016 10/24/2017 E.L.EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 H 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) Jobsite: Mongue-63 Rainbow Drive, Uncasville, CT 06382 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 Tpke AUTHORIZED REPRESENTATIVE Uncasville, CT 06382 - _�` � ©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 (o3 Rat A d r � WriedAvi t t,c, Oti 3 Z VYIu Property, idress / /"</77//14' A/7/1100, 7 Job Description --Required_ De artment Approval p Permit Issuance Approval ■ ���s 7 Tax Collector • Signature/date Comments: Fre Marshal ? l /� 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 Required for properties on sewer Signature/date Comments: n WPCA, Operations When Required by WPCA Signature/date Commants: ❑ 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 Revise March23,2015