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Home My WebLink AboutGas Tank/Line - Relocate/Retest Town of Montville Building Department Field Inspection Notice Address: 23 Andersen Ln. Job Description: Gas Line Relocation Permit Numbers: M2004-0199 Date permit issued: 9-Dec-04 Not Approved: Approved: Trench Comments: 1 Not Approved: Approved: Pressure test Comments: 1 Certificate of Not Approved: 11/7/06 DJ Approved: completion Comments: No inspection ever called for. Page 1 of 1 Revised 9/20/04 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: M2004-0199 Date: 21-Sep-04 Map/Lot: 131/050-000 Owner ID: 81000 Project Location: 23 ANDERSEN LANE Unit: Job Description: re-locate tank-re-test gas line Owner Name: David A and Jill Marchini Tenant Name: N/A Careof: 23 Andersen Lane Oakdale CT 06370- Telephone: Contractor Name: Hendel's Telephone: (860)443-5337 DBA: Lic/Reg Type: G1 Lic/Reg No: 308397 35 Great Neck Rd. Exp Date: 31-Aug-05 Waterford Ct 06385- 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 w/2004 Amendment Mechanical Value: $100.00 Mechanical Fee: $8.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $100.00 Penalty Fee: $0.00 Permit Code: R5 C of O Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.02 Total Fee: $8.02 It shall be the owners repsonsibili`' 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. ❑ Footing - Prior to pouring concrete ❑ R Plumbing and leak test ❑ Backfill - Footing drains and waterproofing ❑ R Electrical ❑ Concrete Slab - Prior to pouring concrete ❑ Elec Trench - with conduit installed ❑ Framing ❑ Electrical Service CRS No: 0 ❑ Fireplace Throat - One flue above throat ❑ R HVAC ❑ Chimney - One flue above thimble W Gas Piping and leak test ❑ Firestop Draftstopping ❑ Final Inspection ❑ Insulation ❑ Certificate of Occupancy Building Official's Approval: Town of Montville w` Building Department Permit # 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT.06382 Fax. 848-7231 One & Two Family Trades Permit Applieatio ea M. RECEIVED ❑PfumdiV ❑Electrical ~cank4f S E P 2 0 2004 (eating ArConditlon BUILDING DEPT. Gas PipinB 6AX R501D Job Location Job Description/Materials k A-) Owner,l) j,' i c ~ 1/y/ Mailing Address S City a ~~A L State Zip i!!~O ~70 Teel j W/2- /7 Contractor Mailing Address 2 6- ~j P-ck 1 \ City State Cs ~ Zip 069f5 Tel Contractor's License/Registration Type & Number l?' ~5 3 7 Exp. Date/ c5 / d 5 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 Si ature ~.~_Date_7_j_/ Construction Value Fee CCU ~ Building Plumbing $ $ M. echanicalo.-' $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ 0, o ~ Total' r~~ o Z Montville Building Department Receipt No. Town of a 4- 2 k Date ~ ` From: Job Address: Check Check # ~ Amount - (circle ono Pernit 9 tl 0 i Received by f i I;IF_ATING, PIPING & CQOLIIN, G I.IMYED CONTRACTOR GI ROBERT 1k' IL2T~L 11 WOODLAM)DR ~ PO 13O 419 WATERFORD, CT 06M5 a LI / NQ 04 0.8 ~TIM ~ SIGNED - ~r-~ .r>"4 4 rw. ~ a5am '.sc - 4 ,I Date: 9/25/03 Time: 11:59 AM TO: @ 918604431736 Page: 002- Ciient#: 11763 HENDINC ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE ~$,~D/"'YY' 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 INSURERA: 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 ISSUEDTO THE INSURED NAMEDABOVE 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 BYTHE POLICIES DESCRIBEDHEREW IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSH .1 TYPE OF INSURANCE POLICY NUMBER POUCYEFFECTIVE POUCYEXPIRATION DATE (MMIDOMO DATE M LIMITS A GENERALLIABIUTY GLO930366000 04/11/03 04/11/04 EACH OCCURRENCE 51000000 PREM X COMMERgAL GENERAL LIABILITY DAMAGE TO RENTED S, N 000 CLAIMS MADE a OCCUR MED EXP (Any one person) $5.0w PERSONAL & ADV INJURY $1 000 GENERAL AGGREGATE $2,000.000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG S2 000 000 POLICY PRO LOC B AUTOMOBILE LIABILITY CA5488241 04/11/033 04/11/04 X ANY AUTO ~MBocidem'INGLELIMIT $1,000,000 ALL CANNED AUTOS BODILY INJURY S SCHEDULED AUTOS Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Drive Other Car PROPERTYDAMAGE $ (Per aocidm) GARAGE LIABIUTY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC $ 1 R OTHER THAN AUTO ONLY: AGG S C EXCESSNMBRELLALIABILITY 5530832577 04/11/03 04/11/04 EACH OCCURRENCE S4,000,OW X OCCUR F ]CLAIMS MADE AGGREGATE s4 000 000 DEDUCTIBLE g h S X RETENTION $ 10000 g 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 $500000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE -EA EMPLOYE $500 000 If ye& describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT S500,000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Sn DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR UABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED R RESE THE ACORD 26 (2001/08) 1 of 2 #M27835 JJV 0 ACORD CORPORATION 1988