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Home My WebLink AboutSFR - Gas Tanks/Lines for Fireplace f ~q Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Mechanical Permit Permit Number: M2063-0177 Date: 30-Sep-03 Map/Lot: 131/042-000 Owner ID 2509 lob Location: 20 Unit Job Description: Gas Tanks & Piping for fire[place Owner: Contractor: Hartens Pond LLC E. Osterman Propane P. 0. Box 310 183 Quarry Road New London, Ct. 06320- Milford CT 06460 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-ii s 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 ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany Gas piping and test Building Official's Signature:, a Town of Montville Building Department' ermit # 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 2 AKT~,_SOrJ 6637 Job Description/Materials /-Prg Owner . &)U I_ Mailing Address CAV State= Zip 00,,,TZC_-'Tel / / City Contractor,~:05 Y Mailing Address Q !t 15:><~ c 7 n City_ nV l -C -L T~ iOk) StateCT Zip a:~_I?o ExP Date ;l 3l Contractor's License/Registration Type & Number 6;/ l 5C 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 ap ation for a t for such work as described above. Own /Agent Signat e Date /c /0, Construction Value Fee Building $ $ Plumbing $ - $ Mechanical ,x~ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ T - - Building Departme-t Receipt Town of 1-*-,)ntville No.~ Date - From: f ~rl r fi Job Address: E Check # Cash z -heck F Amount -7~ Permit # ` Received by A Family` coed And Operated Business SINCE 1960 05terman Propane, Jnc. SPECIALISTS IN THE DISTRIBUTION OF PROPANE 410 Bank Street • P.O. Box 310 • New London, CT 06,320 (860) 447-0341 • (800) 680-7935• Fax: (860) 447-0395 www ~ostermangas.com Date: C1 2 ~ LO-3 C ity[Town of /V1 ONJ T" I Michael H. Farmer give my representative am Sugawara permission to sign and receive permits for the location below. Name: U &1~ -_SOt~J Address: ('DA 4DA a6 3 7 0 .l c. Plyric 95 Kf~WO$W-? WXD 41 "Z. J, Michael H. Farmer y' htt:1ldmvct.ora' LrC W0. SASS P7CPl&ES 216992838 B 09-21-2004 UGAWARA, I 7 ROYAL OA DR LEDYARD - CT 06339 os 09-21 1978.8 M xcT 5-03 suED .09-20 0 BRO ENDORS HN s . RESTR Bt 3 cam' 2 am Sugawara Client : 2427758 OSTERGAS ACOR~n CERTIFIC~E OF LIABILITY INSURANCE 10/`o4'~ 2 PRODUCER THIS CERTIFICATE .S 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:Utlca 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 CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LICYE FECTIVE POLICY EXPIRATION DATE ( INSR TYPE OF INSURANCE POLICY NUMBER PO LIMITS A GENERALLIABILITY CPP2347678 10/01/02 10/01/03 EACH OCCURRENCE $1 000, 000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone tire) s50 1 000 CLAIMSMADEI OCCUR ME D EXP (Any one person) $5 000 X PD Ded : 1, 0 0 0 PERSONAL & ADV INJURY $1 000,000 GENERAL AGGREGATE $2 000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 000,000 POLICY n PRO- F~j LOO A AUTOMOBILE LIABILITY BAC2347680 10/01/02 10/01/03 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1, 000, 000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY (Per accident) $ X NON-OWNED AUTOS X Drive Other Car PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTOONLY. EA ACCIDENT $ H ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS LIABILITY CULP2347686 10/01/02 10/01/03 EACH OCCURRENCE $10 000, 00 X OCCUR F CLAIMS MADE AGGREGATE $10, 000, 00 S DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND BINDER0149707 10/01/02 10/01/03 x WCSTATU- OTH, _ C EMPLOYERS' LIABILITY BINDER068041102273 10/01/02 10/01/03 E.L. EACH ACCIDENT $1, 000, 000 E.L.DISEASE-EA EMPLOYE $1 000,000 E.L. DISEASE-POLICY LIMIT $1 000, 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITTQNALINSURED; INSURER LETTER: CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBEDPOLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF,THEISSUING INSURER WILL ENDEAVORTOMAIL] 0 DAYSWRTTTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 6)63-70'- IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUT ORIZED REPRESENTATIVE ACORD 25•S (7/97)1 of 2 ##M45223 DLM 0 ACORD CORPORATION 1988