HomeMy WebLinkAboutGas Line/Tank
Town of Montville
Building Department
Field Inspection Notice
Address: 36 Andersen Lane
Job Description: SFR
Permit Numbers: B2003-0674 - M2003-0204 - E2003-0250
Footing Not Approved: Approved:
Comments: 1
Backfill Not Approved: Approved:
Comments: 1
Framing Not Approved: Approved:
Comments: l S
Rough Electric Not Approved: Approved:
Comments:
Electrical Service Not Approved: Approved:
Comments: 1
Rough HVAC Not Approved: Approved:
Comments: 1
Rough Plumbing Not Approved: Approved:
Comments: 1
Gas Line Not Approved: Approved: 1/7/04
Comments: 1
Fireplace Throat / Not Approved: Approved:
Chimney Comments: 1
Fire/Draftstopping Not Approved: Approved:
Comments: i
Insulation Not Approved: Approved:
Comments: 1
Certificate of Not Approved: Approved:
Occupancy Comments: 1
Not Approved: Approved:
Comments: L
Not Approved: Approved:
Comments: 1
Not Approved: Approved:
Comments: 1
Comments:
Pagel of l
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville, CT 06382
(860) 848-3030, Ext. 382
Mechanical Permit
Permit Number: M2003-0251 Date: 24-Dec-03 Map/Lot: 131/038-000 Owner ID 2516
Job Location: 36 ANDERSEN LANE Unit
Job Description: Gas line and tank
Owner: Contractor:
Hartens Pond LLC E. Osterman Propane
PO Box 310
183 Quarry Road New London CT 06320-
Milford CT 06460 Telephone: (860) 447-0341
Lic/Reg Type/No. G-1 388504 Exp Date: 31-Aug-04
Tenant:
N/A
Telephone:
Construction Values 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: 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 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 CRS 0 ❑ Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
0 Gas piping and test
Building Official's Signatur
Town of Montville
r 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 Sr.
Job Description/Materials 12==g (-5-AL- :E LIk s P_1F 6 FbK ~m&
Owner, y Mailing Address
City State Zip Tel
Contractor L, (2571E; NNlf q°~ ailing Address
City / V W L- yN /7. c),V State-C7 Zip C65 Z0 Tel 6 e/#71
. o~~ f
Contractor's License/Registration Type & Number `-7 Exp. Date/J~L 2
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 app 'cation o a permit for such work as described above.
Own /Agent S gnature Date ,/Z/ 2 /
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical -'s Sy $
Electrical $ $
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $
Total $ FOR
_ ent c~cceipt ,
. n Departm
wn of ' u NO.
1
Date
From. iJ
_ Check #
fob Address=
Cash' Chee
~ ~ permit #
Amount
r
€ Received by
y ~1 A Family Owned And Operated Business
SINCE 1960
0itepman Ppoloane, Jnc.
SPECIALISTS IN THE DISTRIBUTION OF PROPANE
410 Bank Street • P.O. Box 310 • New London, CT 06320
(860) 447-0341 • (800) 680-7935 • Fax: (860) 447-0395
www.ostermangas.com
Date:
City/Town of
i Michael H. Farmer give my representative aW0,'V-CA,__,
Brian Swanhaus/Sam ugawara
permission to sign and receive permits for the location below.
Name:
Address:
CT _mgj
M~R
95 ti r
cuvq>~n o st- >
r , G!
~ 9 ice;
} w _/Milchael H. Farm&
r SE'
216992838 B 09121-2004
UGAWARA, I
7 ROYAL OA DR
LEDYARD - CT 06339
OB 09-21-1978 s~ `M HOT 5-03
SUED 09-20'0 BRO
ENDORS HNC
2
an S aus/Sam Sugawara
17/2.1 207:0: :L~t EF!:M: Ess:. TC: 7fi^04AIu395 PA,Eo,.3(}' t):..3
Client: i,__, 753 C- STS
ACORD,M CERTIFICATE OF LIABILITY INSURA
N CE - F DATE (MfY/OD/YY}'Y)
PRODUCER V 1.. 10121!03
Gaudette Insurance Agency, Inc THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
One Plummers Corner HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
iWhitinsville,MA 01588-2100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
508 234-6333 I _
INSURED INSURERS AFFORDING COVERAGE NAIC 11
E. Osterman Gas Service, Inc. INSURFRk Utica National Insurance Group UM1097
j 997 Church Street INSURER 13: Commerce & Industry CC&1003
Northbridge, MA 01534
i
I INSURER D.
INStJP,ER p: - -
COVERAGES - -
T-'E POLICIES OF INSURANCE LISTED BELO'N -!AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FCR THE POLICY PERIOD INDICATED. NOTAIT:HSTANCING
ANY REVREMENT TERIN1 OR CONDITION 0= ANY CONTRACT. OR OTHER DOCUMENT WITH RESPECT'TO''AIHICH THIS CERTIFICATE MAY BE ISSUED OJ
MAY P,RTANN, THE INSURANCE A=FORDEDBY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH
POt.ICIES. AGGREGATE. LIMITS SHOWN IMAY HAVE BEEN REDUCE D BY PAID CLAIMS.
IkSR .,1Cj
LTn N R • TYPE OF INSURANCE -iPOUC'f EF1=1eCTIYE POLICY EXPIRATION ~
_POLICY NUMBER ~aT
DATE uMas
----~-PO
A GENERAL LIABILITY CPP2347678
90/01J'03 10/01 04 EACH OCCUP,RENCE I $1 000 000 _
!X COPAMERCIA.L GENERAL LIA64 TY DAMAGE TO RENTEC
r--- CLAMS WEE X OCCUR I .L_~ qqD _
X PD Ded:3 00Q MED EXP (Any one parson) I $50000
1 . 1 II i PFRSONA7 & AD\ IN URY $1,000)000
_
~ GENERAL AG REGA $ 000000
I_G_=11- AGGRFCA E 17AIT APPL ES PER: _
0
POL'C'~ r! P[ T LOC i PRODUCTS ..OMPICPAGG_• S2,000,000
A LA
UTOMOBILE LIABILITY -I
BAC2347680 1~QlQy/p3- 10!01(04 I
X H.NYAUro I iGO10BINEDSINGLELld:- I
(Eaecd_ent) $1,000,000
ALL OWNED AUTOS
$
~~SCHFDI;LFCAUTOS (BParoerar persor) or)
X H RED NGTC5
Y
X fJ--N-AED AUTOS (Par ac Many.
I ; (Per acddenf•
X Drive Other Car i F
- I I
PROPERTYCAMAGE
f, , (Per awdent', $
GARAGE LIABILfrY - -7------
' I AUTO ONLY EA ACCIUFIJ r I $
I NY AUTO
IOTHER THAN ACt:
_ 'AUTO ONLY'
EEXXCESSNMBRELLALL461LlTY CULP2347686 10101/03 10101144 EACHDCCURRENCE
O=.'R ! CUUMS MADE .~,L1_01000 0_0
^Gat~ EG'ATE
00,000,000
c_DUCrIBLE
'X
HcTENT~Cti- 5 10000
B WORKERS COMPENSATION AND 9697544 10.+01/03 10109I04 LX I $
EMPLOYERS' LIABILr7"f - 1VC STfiT OTH T-
v I Q
_ S_ _
ANY-RCPRI'-TOWPARTNEWEY.ECUTIVE E, L. EACHAC,,IDENT QQQ Q(~
OFrICEWMEMBER EXCLUDED? 1'--
-
'+•Jes, cascribe under DISEASF - Ea. FWLCYEE $1,0gq,g00
SPECIAL P?CV!SI:1NS oelUUr _
OTHER E L. DISEASE - POL CY 'JtA~7 1,000,000
DESCRIPTION OP OPERATIONS/ LOCATIONS I VEHICLESI EXCLUSIONS ADDED SY ENDORSEVENT/ SPECIAL PROVISIONS
CERTIFICATE HOLDER _ CANCELLATION
SHGULDANYOFTHEABOVE DE5CRIBEDPOLICIES 6ECANCELLEDBEFORE 7'HEEXPIRATION
CATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL ~],Q_ DAYS WRI'•rEN
~~Q OY ~1~ ~`V\I NOTICE T0 THE
CCitTIfICATE HOLDER NAMED TO THE LEFT. BUTFAILURE TO DO $D SHAL
~'✓~Cj \ (}3~ IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
1.7t ~v~ REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
'N .
ACORD 25 (2001;08) 1 of 2 #S47901/M47710
ROB 91;ACARD CORPORATION 1988