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HomeMy WebLinkAboutSFR - Gas Tank/Lines for Fireplace r Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Mechanical Permit Permit Number: M2003-0226 Date: 19-Nov-03 Map/Lot: 131/050-000 Owner ID 2510 Sob Location: 13 ANDERSEN LANE Unit Job Description: gas tank & Gas lines Owner: Contractor: David A and Jill Marchini Hendel's Inc. 35 Great Neck Road 23 Andersen Lane Waterford Ct. 06385- Oakdale CT 06370 Telephone: (860) 443-5337 Lic/Reg Type/No. GI 308397 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: $300.00 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: $300.00 CO Fee: _ $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.05 Total Fees: $10.05 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 ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany Gas piping and test Building Official's Signature Town of Montville Building Department 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 , Job Description/Materials Owner -111-L 4JOE CA IN I Mailing Address (S~ ~ City ~ 0 State 6~F Zip Tel ~~W/ Contractor f ~o-C Mailing Address W State Zip O3,5~ Tel ~613//32 City er -0 Contractor's License/Registration Type & Number1 0 ? 97 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 Signatur ~,J ® Date// 3 Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ IZ, { Town of "~ontville Building Departw--it Receipt No. C, '1 3, S Date f f From: r `fig F k Job Address: Amount F` Cash heck Check # _ ` = Circle one) Received by Permit Date: 9/25/03 Time: ll:`'__AM TO: @4918604431736 Page: OvZ- Client#: 11763 HENDINC ACORDW CERTIFICATE OF LIABILITY INSURANCE DATE (MMA)DIYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Webster Insurance - C/L ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 914 Hartford Turnpike HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Waterford, CT 06385 860 444-3900 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A. Zurich-American Insurance Hendel's Inc. INSURER B: American Home Assurance Co. P.O. Box 201 INSURER C. Crum & Forster 35 Great Neck Road INSURER D: Commerce Waterford, CT 06385 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH ADD* TYPE OFINSURANCE POUCYNUMBER POLICY EFFECTIVE POLICYEXPIRATION LIMITS -DAM (MMIDDAM A GENERALUABILITY GLO930366000 04/11/03 04/11/04 EACH OCCURRENCE x1000 X COMMERCIAL GENERAL LIABILITY OAMAGE TO RENTED 6300 00 CLAIMS MADE a OCCUR MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,0W400 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 2,000,000 POLICY PRO LOC B AUTOMOBILE LIABILITY CA5488241 04/11103 04/11/04 COMBINED SINGLE LIMIT X ANYAUTO (Eaaodderx) s1,000,000 s ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS Per person) $ X HIREDAUTOS P X NON-OJdNEDAUTOS BODILY INJURY $ (Per aoddent) X Drive Other Car PROPERTY DAMAGE $ per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY. AGG $ C EXCESSAIMBRELLAUABILTTY 5530832577 04/11/03 04/11/04 EACH OCCURRENCE $4,000,000 X OCCUR a CLAIMS MADE AGGREGATE s4.000.000 DEDUCTIBLE S n S X RETENTION $10000 S D WORKERS COMPENSATION AND WC7206709 04/11/03 04/11/04 X WC STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S5O0 000 OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE -EA EMPLOYE S500 ,OW SPECIALPROM SIONSbelow E.L. DISEASE-POLICY LIMIT 5500000 OTHER DESCRIPTION OF OPERATIONS /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 MAIL Rn DAYS WRITTEN NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED R RESE TIVE / ACORD 25 (2001/08) 1 of 2 #M27835 JJV © ACORD CORPORATION 1989 ' Town of Montville Building Department Field Inspection Notice Address: 23 Andersen Lane Job Description: Gas Permit Numbers: M2003-0226 Footing Not Approved: Approved: Comments: 1 Backfill Not Approved: Approved: Comments: i. Framing Not Approved: Approved: Comments: i. s Rough Electric Not Approved: Approved: Comments: i. Electrical Service Not Approved: Approved: Comments: i Rough HVAC Not Approved: Approved: Comments: i. Rough Plumbing Not Approved: Approved: Comments: i Gas Line Not Approved: Approved: 12/01/03 Burial & Pressure Comments: 1 Fireplace Throat / Not Approved: Approved: Chimney Comments: z. Fire/Draftstopping Not Approved: Approved: Comments: 1 Insulation Not Approved: Approved: Comments: 1 Certificate of Not Approved: Approved: Occupancy Comments: Not Approved: Approved: Comments: i Not Approved: Approved: Comments: 1 Not Approved: Approved: Comments: 1 Comments: Pagel of l