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Home My WebLink AboutGas Line/Tank Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Mechanical Permit Permit Number: M2003-0249 Date: 19-Dec-03 Map/Lot: 131/046-000 Owner ID 2502 Job Location: J ANDERSEN LANE Unit Job Description: Gas line and tank Owner: Contractor: Raymond T and Michele L Occhialini Suburban Propane PO Box 385 7 Andersen Lane Uncasville CT 06382- Oakdale CT 06370 Telephone: (860) 848-5510 Lic/Reg Type/No. G-1 390521 Exp Date: 31-Aug-04 Tenant: N/A Telephone: Construction Values 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: 1995 CABO Mechanical Value: $1,000.00 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: $1,000.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.16 Total Fees: $10.16 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 ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service CRS 0 Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany Gas piping and test Building Official's Signature c Town of Montville Building Department t 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 We-,,- s t , ~cL A-a~.~ 4•~!l T.e , r / r Job De's'cription/Materials .s"-4 3-6 Owner kft W 'Q. / •K Mailing Address 7 A*_ dg_.- sv -t Z,. 0 City Statel l Zip 4G3 7o Tel A46 / PVorZ Contractor C~ Mailing Address ~D ax City G s L llr StateC , Zip Ovl.?.~'Z Tel lv / -Pi / r`r-o Contractor's License/Registration Type & Number 37~d S 2 / lr - / 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 application for a permit for such work as described above. Owner /Agent Signature A', Date Z / 17 / G Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ e C-v-- $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total fG Town of ~ jntville Building Departme-t Receipt / Date / 7t- /_L______ From: a s^.-. Job Address: A30 mz S ~ 1 ~ t~ Amount 46 Cash ~ Check Check # _ - - (Circlc one) Permit Received by SUBURBAN PROPANE 262 GALLIVAN LANE1 P.O. BOX 385 UNCASVILLE, CT 06382 (800)-573-3757 - (860) 848-5510 FAX - (860)-848-5517 DATE: JOB NAME: JOB ADDRESS: '7 .~h c~c1- J G h STARTING DATE: f 2~~ 3 CONTRACTOR'S AGENT: Ste- ~kr ~4 H %r~4 ~z r. TO: CITY/TOWN OF PLEASE BE ADVISED THAT THE ABOVE REFERENCED AGENT HAS BEEN AUTHORIZED TO OBTAIN A PERMIT FROM YOUR BUILDING DEPARTMENT FOR THE SPECIFIED PROJECT IN THE NAME OF THE CONTRACTOR. NAME: LEO MARTIN STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION HEATING, PIPING & COOLING LIMITED CONTRACTOR SIGNED: LEO R MARTIN JR 91 SCOTLAND RD LICENSE # BALTIC, CT 06330 TYPE: G1 LIC./REG NO. EFFECTIVE EXPIRES 390521 09/011//j2003 08/31/2004 SIGNED MARSH CERTIFICATE C ^'N.SURANCE CERTIFICATE NUMBER NYC-000189428-06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS MARSH USA INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE 44 W HIPPANY ROAD POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE P.O. BOX 1966 - AFFORDED BY THE POLICIES DESCRIBED HEREIN. MORRISTOWN, NJ 07962-1966 COMPANIES AFFORDING COVERAGE COMPANY 08990-CORP--03-04 A ACE AMERICAN INSURANCE COMPANY INSURED COMPANY SUBURBAN PROPANE, L.P. B N/A 240 Route 10 West COMPANY P.O. BOX 206 C WHIPPANY, NJ 07981-0206 COMPANY D COVERAGES This,certificate super e s'and,replaces any previously Issued certificate. for. the policy. period'noted below. THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR EGENERAL F INSURANCE POLICY NUMBER DATE (MMIDDIYY) DATE (MMIDDIYY) A TY HDOG21691379 03/01/03 03/01/04 GENERAL AGGREGATE $ 2,000,000 AL GENERAL LIABILITY PRODUC TS -COMPIOP AGG S 1,000,000 OCCUR PERSONAL & ADV INJURY $ 1,000,000 S MADE 1,000,000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ X FIRE DAMAGE (Anyone fire $ 50,000 POLICY MED EXP (Anyone person) $ 5,000 A AUTOMOBILE LIABILITY ISA HO 794135 3 03/01/03 03/01/04 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO X ALL OWNED AUTOS BODILY INJURY $ (Per person) X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ (Per accident) X NON-OW NED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ $ OTHER THAN UMBRELLA FORM WC STATU- TH A WORKERS COMPENSATION AND WLR C4 351875-6 (AS) 03/01/03 03/01/04 X TORY LIMITS ER ' EMPLOYERS' LIABILITY A SCF C4 351871-9 (WI/MA) 03/01/03 03/01/04 EL EACH ACCIDENT $ 1,000,000 THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERSIEXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS _ EVIDENCE OF INSURANCE COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE INSURER AFFORDING COVERAGE WLL ENDEAVOR TO MAIL -30- DAYS WRITTEN NOTICE TO THE TO WHOM IT MAY CONCERN CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDNG COVERAGE, ITS AGENTS OR REPRESENTATNES, OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. Br: Lillian Campbell MM1(3102) VALID'AS OF: 02/27/03