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HomeMy WebLinkAboutGas Piping/LP Tank for Fireplace a Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Mechanical Permit Permit Number: M2003-0057 Date: 24-Apr-03 Map/Lot: 131/043-000 Owner ID 2507 Job Location: .16 ANDER~FN ! ANA Unit Job Description: _ gas piping,and LP tank for fireplace Owner: Contractor: Hartens Pond LLC E. Osterman Propane P. O. Box 310 183 Quarry Road New London Ct. 06320- Milford CT 06460 Telephone: (860) 447-0341 Lic/Reg Type/No. B1 307095 Exp Date: 31-Aug-03 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 ho me no i e rPnnirao)s ❑ 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 ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany Gas piping and test Building Official's Signature: 1 n Town of Montville a Building Department Permit # fj 310 Norwich New London Tpke. Tel. 848-7166, Ext 82 Uncasville, CT 06382 Fax. 848-723.1 One & Two Family LP-Gas Permit Application Form i CAA V-P41- ~'f CT Job Location / N Dr- /AJ 4=N e i , Job Description/Materials (O~S Q &I U- ~-P `rAAJk- Owner~t j MW50N 5 Mailing Address.? E7~/CCtZ) 4 Cih'_ Id~L~ State 9 9-r Zi Tel , 263 / A 10 ContractocrC, C)5TC` A& PkLPANC Mailing Address r~C F 1 Cg < Cm' State Zip Tei 960/o311 t/ Contractor's License/Registration Type & Number_ Q7 Exp. Date,-_4L/__U_/ 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. Date Construction Value Fee Building $ $ Plumbing $ $ - Mechanical Electrical $ zf Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education Total $ $ Z & 7 Town of."4ontville Building Departm--j Receipt No. f Date From: Job Address: Amount $ Cash cc k Check # (Circle one) Received by Pernut # h i ~ i Oilerinan i-o une, -)n.c. SPECIALISTS IN THE DISTRIBUTION OF PROPANE 410 BanK Street • PO 13cn 860) 311447 03-11 • 18001 58C 7S3`; 4L -Ili Lt:~5 Ci!~ JoS ph CapoCanc give my representative, Samuel I. Sugawara, pern?is~iol In :_~q sign and receive permits for the location hru Phone No. v2 ~1 l"~J~ 1 f//l/v~cSG~N 1~V oc~VT~fGc~ c~3~ 1 1 -,C f'PINC ti COOLING LIMITED CONTRACTOR O~EPf; A CAPOBIANCO PO BOX 36 ONECO, CT 06373 Y' E : B 1 = EFFECT;vE EXPIRES ~9,/^O~l/2C02 ~ 08/31/2003 'T zhftp,//dmovct.or LASS r... EkPTR?S 216992838 B 09 21 -2004 UGAWARA, I 7 ROYAL OA DR '4' LEDYARD CT 06339 "*i)uB 09-21 A 978 s M xcr 5-03 SUED 09-20 0 BRO ENDOxs HN " RESxx - B \ 3 ~~:n 2 , i Client : 2427758 OSTERGAS _ACORnr. CERTIFICA-rE OF LIABILITY INSU~a4NCE io/`04'~ 2 PRODUCER f r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gaudette Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE One Plummers Corner HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Whitinsville, MA 01588-2100 508 234-6333 INSURERS AFFORDING COVERAGE INSURED INSURERA:Utica Mutual Insurance Company E. Osterman Gas Service, Inc. INSURERB:Workers Compensation Rating & 1 Memorial Square INSURER c:Hart ford Underwriters Ins. Co. PO BOX 29 INSURER D: Whitinsville, MA 01588 INSURER E: COVERAGES 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CON DrrIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUOEO-BY PAID CLAIMS. INSR POLICYEFFECTIVE POLICYEXPIRATIONT TYPE OF INSURANCE POLICY NUMBER LIMITS A GENERAL LIABILITY CPP2347678 10/01/02 10/01/03 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire $5 0 0 0 0 CLAIMS MADE OCCUR MED EXP (Any one person) $5_`0 0 0 X PD Ded : 1, 0 0 0 PERSONAL & ADV INJURY $1 0 0 0 0 0 0 GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2 0 0 0 0 0 0 POLICYn PROC 71 - LOC A AUTOMOBILE LIABILITY BAC2347680 10/01/02 10/01/03 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1 , 0 0 0, 0 0 0 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS i BODILY INJURY X NON-OWNEDAUTOS (Per accident) $ X Drive Other Car PROPERTY DAMAGE (Per accident) $ GGAARAGE LIABILITY AUTOONLY- EA ACCIDENT $ ANY AUTO I OTHER THAN EA ACC $ R AUTO ONLY: AGG $ A EXCESSLIABILITY CULP2347686 10/01/02 10/01/03 EACH OCCURRENCE $10 000 00 X 11 OCCUR CLAIMS MADE AGGREGATE $1 0, 0 0 0, 0 0 DEDUCTIBLE $ X RETENTION $10 0 0 0 $ B WORKERS COMPENSATION AND BINDER0149707 10/01/02 10/01/03 X WCSTATU- OTH-MITSI EMPLOYERS' LIABILITY -+-ER C BINDER068041102273 10/01/02 10/01/03 E.L.EACHACCIDENT $1 000 000 E.L.DISEASE-EAEMPLOYE $1 0 0 0 0 0 0 E.L.DISEASE-POLICY LIMI $1 0 0 0, 0 0 0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDmQNaLINSURED-INSURERLETTER _ CANCELLATION SHOULD ANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRAMON JCJ ~ ~ t~~- ((u DATETHEREOF,THEISSUINGINSURERWILLENDEAVORTOMAILl O DAYSWRITTEN dw ip~ f b -1rjj I'vy L A0 NOTICETOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUTFAILURE'TO DOSOSHALL l t~ ~ ,r}~~j IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR f 1 / U '5j REPRESENTATIVES. AUT ORI2ED REPRESENTATIVE I ACORD 25-S (7/97)1 of 2 #M45223 DLM © ACORD CORPORATION 1988