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Home My WebLink AboutGas Line, Set Tank, Gas Logs Town of Montville Building Department Date: Field Inspection Notice Permit ' , Address: Not Comments/Corrections Required - re-inspection required: E Inspection Approved Approved - G ❑ Footing ' ❑ ❑ ❑ Backfill ❑ ❑ ❑ 'Concrete Slab ❑ ❑ ❑ Framing ❑ ❑ ❑ Rough Elec ` ❑ . Elec Service ❑ ❑ ❑ Rough H V AC ❑ ❑ ❑ Rough Plumbing ❑ ❑ TAI Gas Line ❑ E ❑ 'Fireplace Throat ❑ ❑ Chimney ❑ ❑ ❑ Fire/Draftstopping ` ❑ ❑ ❑ Insulation ❑ ❑ ❑ Final Inspection ❑ ❑ ❑ CofO ❑ ❑ ❑ ❑ f~' ector's Siliat re i Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike . Uncasville, CT 06382 (860) 848-3030, Ext. 382 Mechanical Permit Permit Number: M2003-0205 Date: 27-Oct-03 Map/Lot: 131/060-000 Owner ID 2501 Sob Location: 4 ,A1Y1DE1&SEN_LANE._ Unit Job Description: gas line, set tank & gas logs Owner: contractor: Nick J and Diane L Padjen E. Osterman Propane P. O. Box 310 4 Andersen Lane New London Ct. 06320- Oakdale CT 06370 Telephone: (860) 447-0341 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 inspections (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 ❑ Firestoppi ng/draftstop ping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany 0 Gas piping and test Building Official's Signature: w Town of Montville Building Department Permit # gjgo 6g 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 LE---_ Job Description/Materials DAN, Mailing Address Owner ` v City State Z~ Zip Tel ~ Contractor Mailing Address / City Statzj Zip Z ~Z~Tel Contractor's License/Registration Type & Numbe ~ Exp. Date/ / 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 applicati n for a permit for such work as described above. e t Signatu Da/ Construction Value Fee Building $ $ Plumbing $ $ Mechanica $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ r Total $ $ ' ~ntville Building Departme" Receipt Town of N` No. Date 9 From: - Job Address: Cash Chcn _ k r.~ Amount ~ check one) ' I r1 ` Permit # G? Received by, A Fami"med And Operated Business SiNCE 1960 Oiterman Propane, 9nc. 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: U / D City/ Fown of 11 m ~11 C 1 Michael H. Farmer give my representative Sam Sugawara permission to sign and receive permits for the location below. Name: ) V- 2~EAJ Address: t $~TTTeC, PIP3NG ~ G+IG LpQi'fD 10(zq 03 9s 1~cQ r ' Michael H. r er tttt a/dNrDrt. vct oraT AS ma,=s 216992838 B 09-21-2004 3UGAWARA, I 7 ROYAL OA DR LEDYARD CT 06339 oB 09-21.197$ M xGT 5-03 SUED 09-20` 0 BRO ENDQRS HN.'y • RESTR B - 3 tV 2 lIIIIIIiIIIIIIIHIiI IIIIIII~IIIIIIIIIIIIIIIIIIIIIIIII~~~ =~i am Sugawara 10/21/2003 8:56 AM FROM: Fax TO: 18608487231 PAGE: 002 OF 003 ERGAS Client#- 2421 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYYI PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF tKFOR1i11.ATION Gaudette Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR One Plummers Comer ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Whitinsville, MA 01588-2100 508 234-6333 INSURERS ~FORDING COVERAGE NAIC # INSURED INSURER A. Utica National Insurance Group UM1097 E. Os#.evma►3 Ga3 SersvLa, Vr+c. INSURER B: Commerce $ Industry C$I003 997 CWrrb.B+E.t INSURER C: Northbridge, MA 01534 INSURERU. I ~,a~,54~aF~ I I c.4ueLx~.c,~a 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR A44YPERT4,@I, THG,l4lSdJ,RiSQR4~"4GF£~gR' 8?r T4fFAG1l.G~ LG~ GL RLR~ ,HER61M kSS lG4 LC7 FG ,41 TWE T- laMB, F,Y-S,1.S)CN S-,4VD CCALHITIDNS CIF SJCk POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECnVE POLICY EXPIRATION LIMITS LTR SR TYPE OF INSURANCE POLICY NUMBER DA MIO D MM A GENERAL LIABILITY CPP2347678 10101103 10101104 EACH OCCURRENCE 1$1,000,000 (hAWGI TC cfLA760 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occ., anc@~.,,,, $500010 CLAIMS MADE 11 OCCUR MED EXP (Any one person) $5 .000 X PDDed:3000 PERSONAL & AOV INJURY $1000000 csaL4atL As-SATE $'2 ~+6 00 -71 I r.F_RL'L PGGPF1 Qi}TELM.7. 41?PUFS 4FR:. PF.UiJ1fl S - crwpSOP Ara $2 QoA pan 4 I POLICY F--j PRO- F--~ LOC A I AUTOMOBILE LIABILITY I AC2347680 10101103 10101104 Ca'GORJMED SINCJ G OMIT $1 000,U00 (Ea accident) X ANY AUTO ALL OWNED AUTOS ` BODILY INJURY I $ I (Per person) SCHEDULED AUTOS X HIREDAUTOS BODILY INJURY I$ (P^.n 2r ; -,I) NON-OWNED AUTOS X D rim OL*er Cay- I PROPERTY DAMAGE I $ (Per accident) ALIT-0CINLY - 4,61L'C,U7EAIT ANY AUTO ©TYrc445HAT4 EA ACC $ AUTO ONLY: AGG $ A EXCESSNMBRELLALIABILITY CULP2347686 10101103 10101104 EACH OCCURRENCE 410,000 000 I X OCCUR FICLAIMS MADE I AGGREGATE $10 000 000 i4 I $ DEDUCTIBLE I $ l X RETENTION $'C(8 $ WCSTATU- OTH- g vaaRxfTC~cvmFEws~,starenwe, 9633x4 Y0'~1f43 i~741f04 X ro L IM IEMPLOYERS'LIABILITY E-1.LFROHAL'L'~-7 ANY PROPRIETOR]PARTNERIEXECUTIVE OFFICE JMEMBER EXCLUDED? E.L.FXSEASE- E.A FMPLQ` F $1,QQtI.pQO If yyes, describe under E.L. DISEASE -POLICY LIMlr $1,QQ4},000 SPECIAL PROVISIONS below OTHER I DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS II CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Montville I DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ I n DAYS WRITTEN Attn: Building Inspector (NOTICE TOTHECERTIFICATE HOLDER NAMED TOTHELEFr,BUTFAILURETODOSOSHALL 310 Norwich New London Turnpike I IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Uncasville, CT 06382 REPRESENTATIVES. , n V J2 0- 1. =R ACORD 25 (2BD1fDA1 $ of 2 #047901,441147710 R!?~ n ACORD CORPLI:RATION IM