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HomeMy WebLinkAboutGas Tank/Lines for SFR 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: M2004-0280 Date: 28-Dec-04 Map/Lot: 043/009-017 Owner ID: 52000 Project Location: 5 ALLISON'S WAY Unit: Job Description: gas tank & gas line Owner Name: Joseph and Holga Registre Tenant Name: N/A Careof: 5 Allison's Way Oakdale CT 06370- Telephone: Contractor Name: Advances Gas Telephone: (860)859-9070 DBA: Lic/Reg Type: G1 Lic/Reg No: 386875 183 East Haddam Rd. Exp Date: 31-Aug-05 Salem Ct 06420- 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/2004 Amendment Mechanical Value: $450.00 Mechanical Fee: $8.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $450.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.07 Total Fee: $8.07 It shall be the owners reosonsibility 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 Gas Piping and leak test ❑ Fireblocking _Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ertifl to of Approval ❑ ificate of Occupancy 77- Buildin Official's Approval: Vfr&Vr-6 tv. Vfi rnxi QVV(GVS OvALULNV vzrl WBJ V1 Town of Montville , Building Department Permit # !2 , 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form *urn6uw 0-E(ectrtio( ❑Wecfranicaf _Meating ~ _,~lrrCoruf:'tioning ~CJar ~'piteg [~i7tf~er Job Location ~ WW%n fl Oa q n o k Job Description/Materials_]inSq ,AX 100anlLffiU C{Q. ~ to (4-L U00 CF,1~ Owner tnSw oh , P,.eq 1.s4 i Mailing Address Ct) City State-CJ Zip Tel { Contractor I`I0 lAS, Mailing Address 191 E t`CN U C~ City ,~-Ia I e YY1 State zip Tely Contractor's License/Registration Type & Number t-1 Exp. Date l~l C d_ e-H-6 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 /Agom Signature Datelg- //10 / Construction Value Fee Building $ _ _ $ Plumbing S 4!5n. o o s s© D Mechanical $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ i State Education i $ a Total S $ I 0 0 7 Town of AOntville Building Department Receipt No. 04 F%'S, `l-12 Date From: _ Job Address: Cash °'Check Check Amount Permit # Received by - r 1- ~'IL'VJI IV. YO?WlI L/1.?' LIl•ti IIJV ZvI YI Hp • OOV 11J ILL" N I/ State of Connecticut Department of Consumer .Protect Ion LICENSE VERIFICATION This Is to certify that the Connecticut Deportment of Consumer Protectio Indicate the following Information regarding: n s records MARK MARTIN 67 FORSYTH RD SALEM, CT 06420 a~- t ~A OP 'CON I TEC' l UT + DEPAR'TN~ENT ©F ONNS MER P$OTECTION Be itknown that 67.FORSYTE Im } SALEM, A6420 l rig. f xy wv " has been certified by the Ike} of C er. Frotectrori:as:;a licensed HEATING, PIPING & G. 010- ' _ D =C(NTRAeTOR !4 .v, ,4 3 ~ i Effective: 09/01/2004 1 Expiration: 08/31/2005 i -.._..Edw*iti.Ttl2odti'guc~y,Cofnmiccionet_....._ 1 ~ VVV--U- IVVV OnILCI nVGV~.rICJ Irvl. [1nGLt1 HUtIVI~ItJ IIVL UJ:'14:U1 p.m. IU-U/-LUU4 21'L A ORD„ CERTIFICATE OF LIABILITY INSURANCE OP ID P DATE(MM/DD/YYYY PRODUCER ADVAN-6 10/07 04 FLD S CERTIFICA TE IS ISSUED AS A MATTER OF INFQRMATION Bailey Agencies, Inc . Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE 17 8 Bri$ge Street ER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Groton CT 06340 Phone:860-446-8255 Fax:860-448-1608 INSURERS AFFORDING COVERAGE NAIC # INSURED nUF Ranger Insurance Advanced Gap Sales & Service : American Rome Assurance aces Mar3~, : 133 $ast Haddam Road Salem CT 06420 : COVERAGES : THE POLICIES OF INSURANCE LISTED BELOW HAVE B EEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, r4v] WFFHSTANDING 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY DATE MM+D DATE (MM/0 LIMITS A X COMMERCIAL GENERAL LIABILITY R/ENGO 2 3 7S 3 2 O O EACH OCCURRENCE $ 10 0 0 0 0 0 10/01/04 10/01/05 PREMISES Eaoocu.. $ 100000 CLAIMS MADE a OCCVA MEO EXP (Any one Penon) x 5 0 0 0 PERSONAL 3 ADV INJURY 5 1000000 OWL AGGREGATE LIILUT APPLIES PER: GENERAL AGGREGATE S 2 0 0 0 0 0 O POLICY OR LOC PRODUCTS. COMP/OP AGO s2000000 AUTOMOBILE LIABILITY A X ANY AUTO R/SBA0364746 10/01/04 10/01/05 (Ea COMBINED aoctident)INGLELIMIT $1000000 ALL OWNED AUTOS SCHEDULED AUTOS (BPODILYINJURY $ HIRED AUTO$ person) NON-OWNED AUTOS BODILY INJURY (Per accident) § PROPERTY DAMAGE GARAGE LIABILITY (Per accident) $ ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ EXCESSIUMBRELLA LIABILITY AUTO ONLY: AGG 5 A. X OCCUR CLAIMS MADE R/CUP0421934 EACH OCCURRENCE s 1000000 10/01/04 10/01/05 AGGREGATE $ 1000000 DEDUCTIBLE $ X RETENTION 510 0 0 0 $ WORKERS COMPENSATION AND S B EMPLOYERS' LIABILITY X RY LI ITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE 776x588 10/01/04 10/01/05 E.LEACH ACCIDENT OFFICER/MEMBER EXCLUDED? 5 5 0 0 0 0 0 It yes, describe under E.L. DISEASE • EA EMPLOYE $ 500000 SPECIAL PROVISIONS below OTHER E.L. DISEASE -POLICY LIMIT 5 5 0 0 0 0 0 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Proof of insurance with regards to the named insured. Original Issue Date 10/07/04 CERTIFICATE HOLDER CANCELLATION ADVANCI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL. ENDEAVOR TO MAIL 10 DAYS WRITTEN Advanced Gas Sales & Service NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Stacy Martin IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 183 East Haddam Road REPRE ENTATIVES. Salem, CT 06420 AU OR¢ED EPRESENTATIVE 2 ACORD 25 (2001/08) ®ACORD CORPORATION 1986 ADVANCED GAS 183 E. HADDAM ROAD SALEM, CT 06420 9070 860-859 -3627 SALES & SERVICE FoxTelephone 860-889 TOWN OF WATERFORD BUILDING DEPARTMENT RE: BUILDING PERMIT APPLICATIONS PROPERTY ADDRESS: 4 1 I so r~ LU A 0 A `K CO LG OWNER: J GSE RIA "Re C-- i 5T E-L DESCRIPTION OF JOB: _..1--1154o-U i o o C(1 1c7'u c~o-s T(~~n V-) C S STARTING DATE: I A' -~L-2-j o LICENSED CONTRACTOR: MARK MARTIN HTG.386875 LICENSED CONTRACTOR'S AGENT: ~b V In CE D u" S _ r. - PLEASE ALLOW MY EMPLOYEE TO PULL OR DELIVER THIS PEA Sincerely, STATE OF CONNECTICUT DEPARTMENT i CONSUMER PROTECTION L HEATING, PIPING & CgOI.iI+IG~LTMITED CONTRACTOR Gi MARK MARTIN ' MAR A MAR'T'EN PRESIDENT 67 VOASYTH-RD SALEM, CT 06420 L / NQ, FF V SIGNED r , Town of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030, Ext. 382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL t ~3'tic / operty Address 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 Department Permit Issuance Approval Approval ® Tax Collector - 6 + '12 I.aztu'l-c/ matte ❑ WPCA A daL ❑ Planning & Zoning q igiiatu e' crate ❑ Health Department Sigy.-tatw-e/ dale ❑ Department of Public Works ❑ State Dept, of Transportation ❑ Fire Marshal gilatt. Comments/Conditions: 2svisedSeptem6er 9, 2004