HomeMy WebLinkAboutFurnace 2001 _` Town of Montville -vitae
Field Inspection Notice
Permit #
Location: 4 y PAR-k_ A VE G XT- Type of Inspection: / v gZ h c P / Pe c-
Issued to: > Delivered to:
PPROVED/ NOT APPROVED
The following orders are hereby issued for their correction:
Please call for inspection when corrections have been corn• -ted 860-848-7166
Date: 6/z7, B •
Building Official
Town of Iriontville
Building Department
Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231
Building / Trades Permit
Permit Number M2001-45 Permit Date 3/28/01 Permit Type Mechanical Permit Code R5
Job Street# 64 Job Location PARK AVENUE EXTENSION Map/Lot 096/055-000
Job Description Furnace Replacement
Owner Contractor
G. E. Capitol Mtg. Norwich Plumbing
Address 4680 Hallmark Parkway Address 6 Thomas Avenue
City San Bernadino State Ca. City Norwich State Ct.
Zip 92427 Telephone Zip 06360 Telephone 88620 )e
Lic/Reg Number 385806
Lic/Reg Type S3 Exp Date: 8/31/01
Use Group R4 Code 1995 CABO Type Construction 5B
Building Value $0.00 Building Fee $0.00
Plumbing Value $0.00 Plumbing Fee $0.00
Mechanical Value $3,000.00 Mechanical Fee $16.00
Electrical Value Electrical Fee
Other Value $0.00 Other Fee $0.00
Total Values $3,000.00 C/O Fee $0.00
Comments: Plan Review Fee $0.00
State Ed Fee $0.48
Total Fees $16.48
Building Official's Signature
Date ) / ` / ‘' 1
It is the owners respons • • to schedule the following required inspections(minimum 24 hours notice required):
❑ Footings-prior to pouring concrete
❑ Backfill -footing drains and waterproofing ❑ Fireplace Throat
❑ Concrete Slab, prior to pouring ❑ Fireplace Final
Li Rough Framing ❑ Chimney-one flue above thimble
❑ Rough Electrical ❑ Firestopping/draftstopping
❑ Electrical Service ❑ Insulation
❑ Rough Plumbing and leak test ❑ Pool bonding
❑ Gas piping -pressure test and installation V Final Inspection
❑ Rough HVAC Certificate of Occupancy-PRIOR to use or occupancy
• * , ,
Town of Montville Norii Permit #"(0200/— K�
• Building Department
310 Norwich-New London Tpke.
Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231
Application for Building or Trades Permit
Building Permit Trades Permit
❑ New Construction ❑Accessory Structure ❑Flum6ing echanical
❑Addition ❑Demolition ❑Electrical Heating
[tfteration ❑Other Air Conditioning
Gas Wiping
Job Location (pH P zl` N.3 t. G;CT
Job Description/Materials G6,\ ; /- T �,,,a.-vf_n../ es ►sC ..n, / rs P:1—
'
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Owner , .ar i. y t Mailing Address •
Cityr Q,<_ /L/ ' " jre) State Cc( Zip 7 7Tel / /
Contractor NO c14,,,.r V i,tJ, ',.,,5 Mailing Address 6 ---1.1.3).0w,v- V -vE t
City ,&IO rk.\x'7,4 -, State CT" Zip (;,?(Q 3(00 Tel fix) / f. !r /?ri0 i
Contractor's License/Registration Type&Number S.5— s'`,>eO L Exp. Date
P e / 3 1 / a't;el
New Home Construction Contractors:
Have you entered into a contract with a consumer for the proposed new home?❑ Yes ❑ No
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 E �J 1 )
C � �' Date � / �' / �
U
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical $ 1 00) $ /6
Electrical $ $
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $ Ve
Total $ 3CArx) $ /�p if/V 8
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at (,09 y
In the town of U
Name of building permit applicant: t�-AV - -- O_ Q U 4
Please check one:
1. I am the owner of the above property.
2. the sole proprietor of a business.
2A. Name of business S -r).-� c;\
2B. Federal Employer Identification Number(FEIN)
Pursuant to § 31-286b, "a property owner or sole proprietor[who] intends to act as a general
contractor or principal employer"may provide either a certificate of workers'compensation
insurance or a"sworn notarized affidavit... stating that he will require proof of workers'
compensation insurance for all those employed on the job site in accordance with this chapter."
Please check one:
1. 1/I do not intend to act as a general contractor or principal employer.
[Sign and stop here]
k U f��
Signatur of applicant
2. I intend to act as a general contractor or principal employer. Applicant must either
provide a certificate of workers'compensation insurance or sign the affidavit
below.
Affidavit
I hereby swear and attest that I will require proof of workers' compensation insurance for every
contractor, subcontractor, or other worker before he/she engages in work on the above property in
accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to § 31-275 C.G.S., officers of a corporation and partners in a
partnership may elect to be excluded from coverage by filing a waiver with the appropriate
District Office; and that a sole proprietor of a business is not required to have coverage unless he
files his intent to accept coverage.
Signature of applicant
Subscribed and sworn to before me this day of 200
(Notary Public/Commissioner of the Superior Court)
Vey
Town of Montville Building Department Receipt
p
Date /07 7 / e / No. 00517
From: G'fdi
Job Address: '.. _____„............___. C i ,
,.......__ :.
Amount $ Cash heck Check #
Circle onc)
/ ori of
filor
Received by I'.:„, ; % 1 �� ! Permit 11,7 c10z) 7- vo
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