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Home My WebLink AboutGas Line/Tank/Logs I I, Town of Montville Building Department Field Inspection Notice Address: 12 ANDERSEN LN. Job Description: Gas line & tank for logs Permit Numbers: M2005-0039 Not Approved Deficiencies Approved ELECTRICAL Special Conditions TRENCH Not Approved Deficiencies Approved ELECTRICAL Special Conditions SERVICE • Not Approved ♦ Deficiencies Approved 3130105 JS 3/22/05 JS No pressure on line Special Conditions GAS LINE Not Approved Deficiencies Approved BOILER/FURNACE Special Conditions REPLACEMENT Not Approved Deficiencies Approved WOOD STOVE Special Conditions Not A roved Deficiencies Approved Special Conditions . Page I of 1 Revised 3/17/05 Sheet Printed: 3/30/2005 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: 142005-0039 Date: 18-Mar-05 Map/Lot: 131/044-000 Owner ID: 76000 Project Location: 12 ANDERSEN LANE Unit: Job Description: Gas Line Wank for gas logs Owner Name: John E and Dawn M Plourde Tenant Name: N/A Careof: 12 Andersen Lane Oakdale CT 06370- Telephone: Contractor Name: E. Osterman Propane Telephone: (860)447-0341 DBA: Lic/Reg Type: G1 Lic/Reg No: 394019 3 Enterprise Lane Exp Date: 31-Aug-05 Oakdale Ct 06370- 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 Mechanical Value: $450.00 Mechanical Fee: $8,00 w/2004 Amendment 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: $8.07 It shall be the owners rensonsibility to schedule the following inspections a minimum of 2 business days in advance Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING, MECHANICAL, EL E TRICA PERMIT INSPECTIONS ❑ Footing - Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical ❑ Backfill - Footing drains and waterproofing ❑ Elec Trench - with conduit installed ❑ Concrete Slab - Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts - with sill plate and prior to floor framing ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble Gas Piping and leak test ❑ Fireblocking _Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑ Certificate of Approval Certificate of Occupancy Building Official's Approval: ~,Sr Town`of Montville Buil4=:g Department 310 NorwL11-New London Tpke. Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential LP-Gas Permit Application Form Singfe Fami6i Two-Eamily Townhouse ermit # Job Address `-~N,/~~ -1yE (Number) (Street) (Unit) Job Descriptions Owner ~ &ffi) ~ a Mailing Address / Z ,~j// ~$F/1/Z ZAVC- city, G State zip r7O Contractor .F-7, Ds~,40 R&PNE- Mailing Address SAaM -XL SUC-AWA-RQ State Zip Tel City,!=-k License Type & Number-Q~ X9L6 Exp. Date /_,V /_2CO45 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. Separate applications are required for ec cal J Owner/ gent Si ture Date //7/O _ZZ Construction Value Fee Mechanical $ j (J $ ^ Electrical $ $ Plan Review Fee $ State Education $ Total $ $ ftvisedseptem6er9, 2004 Town of Montville Building Department Receipt Date No. p ~c From: Job Address: I Cash Chcck Check # Amount (c(rrc e cm~y ,t Perm it # Received by r ' t 16; 27%2004 12:0F 2t9 FR074; Far: Gar3de-te LL,sucance TO; 786044711395 FAGE; 502 OF WI.; CI ie nt#: 2427758 OSTE RGAS YYYY' ATE r ACORD,~ CERTIFICATE OF LIABILITY INSURANCE T1110/21104(MM1QD PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gaudette Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA'NA, One Piummers Corner HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND UR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Whitinsville, MA 01588-2100 508 234-6333 INSURERS AFFORDING COVERAGE NAIC tl INSURED INSURER A: Liberty Mutual Insurance Company AI0003 E. Osterman Gas Service, Inc, INSURER E: American Home Assurance One Memorial Square IIJ%URERC Whitinsvifle, MA 01588 ,NSUPFR1) INSURER E: COVERAGES T-IE POLICIES OF INSURANCE LISTED BELOW iAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQU!REIMENT TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE A=FORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY SAVE BEEN REDUCED BY PAID CLAIMS. IN5R POLICY EXPIRATION TR NSR TYPE OF INSURANCE POLICY NUMBER DATE fM DQfYYE PDAT Y MMIDID"I LIMITS A GENERAL LIABILITY BINDER290468 10101/04 10101105 EACH OCCURRENCE s1,000,00Q X I CCMMERCIA,LGENERAL LABILTY I DAMAGE TO RENTED ) $50000 _ CLAIWS MACE a OCCUR MED EXP (Anti one person, S PERSONAL & ADV W„ URY 51,00 0000 GENERAL AGGREGATE s2,000,000 GENT E L I LIMIT rPPLIES PER: PRODUCTS - COMPIOP AGG S2 000 OOO I PCUCY 17 JJEECOT - LOC A IAUTOMOBILELIABILrTY BINDER285108 10101104 10101105 COMBINEDSINGLE LIMIT s1,000,000 F'ALL ANY AUTO (Ea ecclcient) OWNED AUTOS 80010' INJURY $ r I SCHEOLREDAUTOS I (Perpersor) l X H RED AUTOS BODILY INJURY 5 X NON-CWNED AUTOS (Per acddent,, IX 1 Drive Other Car - PROPERTYDAMAGE (Per acddent, GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 5 ANY AUTO OTHERTHAN EA ACC S AUTO ONLY. AGG S S B EXCE£S,VMBRELL(AALIIABILITY BINDER285109 10101/04 10101105 EACH OCCURRENCE 51 0 000 000 x OCCUR I , CLAIMS MADE AGGREGATE 0 O OOU OOQ I s DEDUCTIBLE $ X RETENTION $ 10000 - $ A wuwcERS COMPENSATION AND BINDER2$5107 10101104 10101105 ta'cY TA i- FF- EMPLOYERS` LIABILITY A."PROPF;IETORPARTNEPlEXECUTIVE E L. EACH ACCIDENT 51,000,000 OFF!CERlME1JBER EXCLUDED? F L. DISEASE FA EMPLOYEE 51 ,OOO~000 SP -BSaiDa bn9er EL. DISEASE - POL Cy uMIT 51,000,000 5lSECiAL PRUvI_!CNS bela~v OTHER t DESCRIPTION OF OPERATIONS t LOCATIONS /VEHICLES? EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAL --aQ_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILrY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001i08) 1 of 2 #8505391M50402 MDB O ACORD CORPORATION 1988 f r - Town of Montville ° Building Department 848-3030, Ext 382 RESIDENTIAL LP-GAS PERMIT CONSTRUCTION PERMIT APPROVAL Properfy Address L s L 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 Approval Department Permit Issuance Approval ® Tax Collector 0 ; L WPCA 1 Sign S.. aftlre/ d., ❑ Planning & Zoning ❑ Health Department ❑ Fire Marshal Comments/Conditions: &visedSeptem9er9, 2004