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HomeMy WebLinkAboutGas Line/Gas Logs Town of Montville Building Department Field Inspection Notice Address: 3 Andersen Lane Job Description: Gas Permit Numbers: M2004-0009 Footing Not Approved: Approved: Comments: 1. Backfill Not Approved: Approved: Comments: 1. Framing Not Approved: Approved: Comments: 1. s Rough Electric Not Approved: Approved: Comments: 1 Electrical Service Not Approved: Approved: Comments: 1. Rough HVAC Not Approved: Approved: Comments: 1. Rough Plumbing Not Approved: Approved: Comments: 1. Gas Line Not Approved: Approved: 1/14/04 Comments: 1. Gauge reads 8 1/2 psi& I am assuming it is due to the extremet cold Fireplace Throat / Not Approved: Approved: Chimney Comments: 1. Fire/Draftstopping Not Approved: Approved: Comments: 1. Insulation Not Approved: Approved: Comments: 1. Certificate of Not Approved: Approved: Occupancy Comments: 1. Not Approved: Approved: Comments: 1. Not Approved: Approved: Comments: 1. Not Approved: Approved: Comments: 1. Comments: Pagel of l Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Mechanical Permit Permit Number: M2004-0010 Date: 16-Jan-04 Map/Lot: 131/059-000 Owner ID 2500 Job Location: 110111 !EFI~j ENS, AME Unit Job Description: Gas for gas logs Owner: Contractor: David A and Jennifer L Carson E. Osterman Propane P. 0. Box 310 3 Andersen Lane New London Ct. 06320- Oakdale CT 06370 Telephone: (860),i47-0341 Lic/Reg Type/No. G1 388504 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: $450.00 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: $450.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.07 Total Fees: $10.07 It is the owners responsibility to schedule the following insuections (minimum 48 hours notice required): ❑ 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 CRS 0 ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑r/ Gas piping and test Building Official's Signature: Town of Montville Building Department Permit # 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 L?~ ~ ~f IV '_o ef:) 4 kZ~ A Job Description/Materials 124o L._~ G~ s Owner ,4y~ C4cc212 Mailing Address S~ f f L-A city ,jkState C Zip 7(DTe1 ContractoE Mailing Address _4pr CIL"3_~ - city 46 72 ~Stag- Zip Tel ~ 47 OS41 Contractor's License/Registration Type & Number q/ 7388 Exp. Date/ 3 l /_0_j 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. Owne /Agent nature a Date Z Construction Value Fee Building $ $ Plumbing _ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ 7 Total $ $ A940, i Town of Montville-Building Department Receipt Date No. From: C Comdr. Job Address: Amount $ G~`"? Cash Check Check # - Q-- C circle onc) a Permit # I j-,?-c7O -2, -06,)0 Received by A Family Owned And Operated Business SINCE 1960 t 0itei,pn an Prop.ane~ Jnc. SPECIALISTS IN THE DISTRIBUTION OF PROPANE 410 Bank Street • P.O. Box 310 • New London, CT 06320 (860) 447-0341 • (800) 680-7935 • Fax: (860) 447.0395 www.ostermangas com Date:` l City/Town of'-- I Michael H. Farmer give my representative BriS an S g wary permission to sign and receive permits for the location below, Name- Address: BSc $YA7ACrP[PING h Cam„ 0 t'r,.,*". ECTTVF , . - f~ f ,95 K;ZRRO~WAOAD 38$504 • i iael . F rme? . ` 218992838 B 09 Z1-2004 - uvAwARA, 7 ROYAL OA DR LEDYARD - CT 06339 oB 09-21-1878 s BRO "cT 5-03 suED 09-20*0 ENDORs HK~ RESTR B \ .2 Bri m Sugawara NM FROM: Fs,. TO: [8;,044 hG'86 PA E: JU..: F Client#:2427758 OSTERGAS GATE (NVVJ001YYYY)~ A CORD,N CERTIFICATE OF THIS C LIABILITY CERTIFICATE INSUISF~AN 10121103 PRODUCER , ~ ISSUED T AS A MATTER OF INFORMATION Gaudette Insurance Agency, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE One Plummers Corner HOLDER. THIS CERTIFICATE ODES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Whitinsville, MA 01588-2100 508 234-6333 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURFRA: Utica NaUonal Insurance GrOUP UM I097 E. Osterman Gas Service, Inc. INSURER B: Commerce & Industry C&1003 997 Church Street INSURER C: Northbridge, MA 01534 iNSl1RFRD^ - 'NSUP.ER E. I COVERAGES TAE POLICIES GF INSURANCE L ISTED BELO'VV -IAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FGRTHE POLICY PERIOD INDICATED. NOT'wITHSTA:NDING ANY REOU'REMENT TERM OR CONDITION 0= ANY CCNTRAC? OR OTHER DOCUMENT W17-1 RESPECT TO WHICH THIS CERTIFICATE mAY BE ISSUED O:~ ' tV..AY PERTAIN, THE INSURANCE A°FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT70 ALL THE TERNS. EXCLUSIONS AND CONDITIONS OF SUC'-I DOJCIES AGGREGATE. LIN'ITS SHOWN MAY HAVE BEEN REDUCED EY PAID CLArAS. n I POLICY EFFECTIVE POLICY EXPIRATION' I TR N SC L TYPE OF INSURANCE POLICY NUMBER T / GATE fMhl&om UN~Rs A _GENERAL unelLrrY CPP234767$ 10101/03 10101104 EACH occURRFrICE S1,000,000 _ X Ci;MP1ERC'?L GEIVERP.L UAB'l ?'I i PREM DAMAG,5L• T FRE ozNTECuxental iry,5Q,000 ~ES~ a C~ p:'u1S N.ACE I X'OCCUR teE~D> txP IAnq one !arson; I S5,000 X.- PO Ded:3,000 I !PERSONA! 6.4C N_URY 191,000,000 GENERAL aGOREGA?_ 1 52,000,00'0 _GEIIt AGGREGA'-E I.?NT APPUES PFR PRODl1CTS CNitCP A(--,G 52,000000 _ FCVC'.:`' pap. r i :EST I LCC I y : A I AUTOMOBILE LIABILITY BAC2347680 10/01/03 T _ 10/01104 CDP..slNEC s NILE L,M17 X ~.NVr.uro (EaacdLl m) x $1,000,000 rL.',?WNED AUTOS _ 8-D'LY 9V:JRY i 5 SCHFGI ILFD AUTOS (Per oersor) I X H RFD A~_TCS f aJD'L'r WJVRv ; $ X II:N=;t'vNEL`rUTCE (Per accloant: X Drive Other Car - PRCFE~ (Fee accm&:lt, GARAGE LIABILITY - ------'T- A:.:'TC ONLY - FA ACClDFNT $ ,141 kjTC OTHER THAN EA °_c'` 5 AUTO ONLY I AUG i 5 A ! ExcESSVMBRELLALIA80.1TY CULP2347686 110!01/03 10/01104 EACH OCCURRENCE :910 000 000 ! X OCC_R `-I C.i\IMSMADE I A,GR EGAT_ 1510000000 - 1 9 DEDUCT: BCE I X _H TE_n'T C=• 510000 _ r- $ 1. 5 - 41'C STAT~_• J-TI- B WORKERS COk1PENSA?tGNAND 9697544 i 10101103 10!01104 --_tX ~-Sg EMPLOYER T LIABIUT•I . ~ EL. EACH ACGICEY? $1 000,000 AM ROPRIETMPAF?NERfEYE:,UT'JE OF°GER'NIEM8ERExCLUDECi FL D,8EASF EA.FMPLCYEE 51 I,UUU,000 I - scri0e 0 u^:rr L------------ I SPEC: c e F~ 71J5 jEL DISEASE - POL C~ r T1i 51,000, 000 OTHER CESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES r EXCLUSIONS ADDEC BY ENDORSEMENT I SPECIAL PROVISIONS i •Y CERTIFICATE HOLDER CANCELLATION SHOULD ANY DF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CATE THEREOF THE ISSUING INSURER WILL ENDEAVOR TOMAL I_ DAYS WRITTEN. ~l ` NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 $0 SHAD `l N IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS JR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001108) 1 of 2 #S47901/M47710 Rpg © ACORD CORPORATION 1388 I