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Home My WebLink About2003 - FP Gas Logs t Town of Montville Building Department Date: j 3- Field Inspection Notice Permit #:c ll~ Address: Not Comments/Corrections Required- re-inspection required: Inspection Approved A roved ❑ Footing ❑ ❑ Backfill ` ❑ ❑ F ❑ Concrete Slab. ❑ ❑ ( ❑ Framing ❑ ❑ E ❑ Rough Elec ❑ p ❑ Elec Service ❑ ❑ ❑ Rough`HVAC ❑ ❑ Rough Plumbing ❑ Gas Line ❑ € Fireplace Throat ❑ h ❑ Chimney ❑ ❑ ! ❑ Fire/Draftstopping ❑ ❑ ❑ Insulation ❑ ❑ E ❑ Final Inspection ❑ ❑ ❑ Cof0 ❑ ❑ ❑ ❑ - spector's Signature Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Mechanical Permit Permit Number: M2003-0196 Date: 20-Oct-03 Map/Lot: 131/027-000 Owner ID 501 Job Location: Unit Job Description: Se tank & run gas lines for fire log & range Owner: Contractor: Shawn M Shugrue an Gary L Branch Hendel's 35 Great Neck Road 4 Adamo Avenue Waterford Ct. 06385- Oakdale CT 06370 Telephone: (860) 443-5337 Lic/Reg Type/No. G1 308397 Exp Date: 31-Aug-04 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $250.00 Mechanical Fee: $10.00 Construction Type: 5B Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $250.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.04 Total Fees: $10.04 I i h owners tesnonsibility to schedule following inspections (minimum 4 hours notice ❑ Footing - Prior to pouring concrete ❑ Rough HVAC ❑ Backfill - Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab - Prior to pouring concrete ❑ Chimney - One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service ❑ Final Inspection ❑ Rough plumbing an leak test ❑ Certificate of Occupany 0 Gas piping and test Building Official's Signa re: Town of Montville Building Department _ Permit # e? 310 Norwich-New London Tpke. Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 One & Two Family LP-Gas Permit Application Form Job Location u ~n Job Description/Materials l-/Z® `fo Flr< Q e~ !5 1 Mailing Address Owner, ~Y LA city- 0 State CJ Zip 0 376 Tel 1.~/' Z / 0 5 Contractor Ale K 9 zfi Mailing Address City 'e State Zip a6 Tel Contractor's License/Regis ration Type & Number ,112 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. Owner /Agent Signature U") 'LO Date /0 Construction Value Fee Building $ $ a ~Cl Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ $ / ®Gj Date: 9/25/03 Tim : ll:`---AM TO: @ 918r604431736 - age: G-Z- Ciient#: 11763 HENDINC ACORD- CERTIFICATE OF LIABILITY INSURANCE 09%25/03°f"" PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Webster Insurance - C/L ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 914 Hartford Turnpike HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Waterford, CT 06385 860 444-3900 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Zurich-American Insurance Hendel's Inc. INSURER S: American Home Assurance Co. P.O. Box 201 INSURER Q. Crum & Forster 35 Great Neck Road INSURER D: Commerce Waterford, CT 06385 INSURER E: COVERAGES 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. AGGREGATE LIMITS OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPEOFINSURAN POUCYNUMBER POLICY M 0 VE POU DATE IMMID (M LIMITS - DATE A GENERAL LIABILITY GLO930366000 04/11/03 04/11/04 EACH OCCURRENCE $1,0M,000 X CRCIAL GENE RAL LIABILITY ~MAG~ FSO REFn oN= D $3OO OOO MADE X OCCUR MED EXP (Any one person) *low PERSONAL & ADV INJURY $1 O00 PE RAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT PLIES PER DUCTS - COMP/OP AGG s2,000,000 POLICY PRO LOC B AUTOMOBILE LIABILITY CA5488241 04/11/03 04/11/04 COMBINED SINGLE LIMIT X ANY AUTO LEaacddent) $1,000,000 ALL OMED AUTOS BODILY INJURY 5 SCHEDULED AUTOS F. person) X HIREDAUTOS BODILY INJURY X NON-O+VNEDAUTOS Per accident) $ Drive Other Ca X 5 PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S L ANYAUTO OTHER THAN EAACC S AUTO ONLY. AGG $ C EXCESSAIMBRELLAUABI 5530832577 04/11/03 04/11/04 EACH OCCURRENCE $4 000 000 X OCCUR ❑ C. J MS MADE AGGREGATE S4 000 000 DEDUCTIBLE S R S X RETENTION $10)00 $ D WORKERS COMPENSATION AND WC7206709 04/11103 04/11/04 X V✓C STATU OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $5001000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $500,000 If yes, describe under SPECIAL PROVISIONS Wow E.L. DISEASE -POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATI NS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Sn DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR UASIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES AUTHOR2ED R RESE TIVE gM& ACORD 2b (2001/08) 1 of 2 #M27835 Jiv © ACORD CORPORATION 1988