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Home My WebLink AboutHeating/AC - SFR Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 860-848-3030, Ext. 82 Mechanical Permit Permit Number: M2002-195 Permit Date: 21-Oct-02 Permit Code R5. Job Location: 4 ANDERSEN LANE UNIT: MAP/LOT: 037/002-060 Job Description: Heating & Air Conditioning Owner Contractor Brian C Gebo William rheaume 1295 Route 32 PO Box 264 Unit: Uncasville, Ct. 06382 Jewett City, CT 06351 Telephone: 848-2647 Lic/Reg Type: S1 Use Group R4 Lic/Reg Number: 303367 Code 1995 CABO Exp Date: 8/31/03 Construction Type 5B Construction Values Permit Fees Building Value: $0.00 Building Fee: $0.00 Plumbing Value: $0.00 Plumbing Fee: $0.00 Mechanical Value: $0.00 Mechanical Fee: $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $0.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 Included on Building Permit State Ed Fee: $0.00 Total Fees: $0.00 1 It is the owners resnonsiibilitV to schedule the following required inspections (minimum 48 hours notice requested): ❑ Footing - Prior to pouring concrete W] Rough HVAC ❑ Backfill - Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab - Prior to pouring ❑ Fireplace Final ❑ Rough Framing ❑ Chimney - One flue above thimble ❑ Rough Electrical ❑ Firestopping/draftstopping ❑ Electrical Service ❑ Insulation ❑ Rough Plumbing and Leak Test ❑ Fin Inspection ❑ Gas Piping and Pressure Test Certifl of 0 pan rior to use or occupancy Building Official's Signature: r Town of Montville Building Department Permit J 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-723.1 One & Two Family Oil Tank Application Form Job Location Job Description/Materials r. 1~ t gt" It A t4b lG- Z1 <o aj C06 flAi Owner ZC % 14Mailing Address Ir CIO City State Of Zip 0 Tel Y 6./6R Contractor .U Mo of- Mailing Address ().q T City 2~~t Cry c State c zip 0 6,31a` Tel Contractor's License/Registration Type & Number Exp. Date_ r 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. o Owner /Agent Signature Cr vtr2 /z-~,°' Date j Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ $ r IBM All. s LIMITED SHEET METAL CONTRACTOR WIL,LIANI L RHEAtWE 119 MOXLEY ROAD UNCrASVILLE, CT 06382 TYPE: $11'I1 LIC. / REG NO. EFFECTIVE EXPIRES m~ r 5791 - 09/01/2I)02 48/31/2003 STATE OF CONNECTICUT HEATING, PIPING & COOLING UNLUMTED CONTRACTOR Wl~ELiAM L RHEAME 119 MQXLEY ROAD } UNCASVILLE, CT 06382 TYPE: Sl LIC. / REG.NO. EFFECTIVE EXPIRES 303676 09/01/2002 08/31/2003 k I Y Natrona! ItWemait), Co. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE RENEWAL AGREEMENT Coverage is provided in Agency: 96018 Pr#: l Evergreen National Indemnity Company The Pawson Group (Carries Code: 20362) 5 South Main Street Branford, CT 06405 Carrier Policy 00300000.1675100 Carrier Prior Policy 003000001675099 1. The Insured: Rheaume Heating LLC Dba Uncasville Oil Type of Business: Other Mailing Address: 65 Maple Avenue Fein: 061479106 Uncasville, CT 06382 Risk ID: Other workplaces not shown above: NO OTHER WORKPLACES FOR THIS POLICY 2. The policy period is from 12:01 a.m. on 6/02/2000 to 12:01 a.m. on 6/02/2001 at the insured's mailing address. 3. A. Wor_•cers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: CT E1, _oyer.s Liability Insurance: Part Two of the policy applies to work in each state 1i.sted in Item 3.A. The limits of our liability under Part Two are: Bodily :Injury by Accident $ 100.000 each accident policy limit Bodily Injury by Disease $ 500,000 Bodily Injury by Disease $ 100.000 each employee C. 0-t_-her States Insurance: Part 3 of the policy applies to all states, except ND, OH, WA, WV, WY and the states designated in 3A above. D, Thi:> policy includes these endorsements and schedules: `YJC000000A(04/92) W0000311A(08/91) WC000406(08/84) WC000414(07/90) WC060301(04/84) ,v1C0603033(04/96) WC060401(07/96) 4. The premium for this policy will be determined by our Manuals of Rules, Classification;, Rates and Rating Plans. All information required below is subject i:o ver.lficatio__i and change by audit, Classifications Code Premium Basis Rate Per Estimated No. Total Estimated $100 of Annual Annual Remuneration Remuneration Premium ,e SEE SCHEDULE OF OPERATIONS Total Estimated Annual Premium 7,154.00 1~Iinirium Premium $ 750.00 Expense Constant $ 180.00 Countersigned by