HomeMy WebLinkAboutElectrical 2001 Town of Montville
Building Department
Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231
,11110*
Building / Trades Permit
Permit Number EL2001-167 Permit Date 8/15/01 Permit Type Electrical Permit Code R5
Job Street# 72 Job Location PARK AVENUE EXTENSION Map/Lot 096/057-000
Job Description Electrical
Owner Contractor
F. C. HutchinsontIbne Hutchinson
Address 72 Park Avenue Ext. Address 72 Park Avenue Extension
City Uncasville State Ct. City Uncasville State Ct.
Zip 06382 Telephone 848-3119 Zip _06382 Telephone 848-3119
Lic/Reg Number
Lic/Reg Type Exp Date:
Use Group R4 Code 1995 CABO Type Construction 5B
I
Building Value $0.00 Building Fee $0.00
Plumbing Value $0.00 Plumbing Fee $0.00
Mechanical Value $100.00 Mechanical Fee $10.00
Electrical Value $200.00 Electrical Fee $10.00
Other Value $0.00 Other Fee $0.00
Total Values $300.00 C/O Fee $0.00
Comments: Plan Review Fee $0.00
State Ed Fee $0.05
otal Fees $20.05
Building Official's Signature /2/�l�j �, /�1� Date j----1 /J / /
It is the owners responsibility to schedule the following req ed inspections minimum 24 hours notice required):
d Footings -prior to pouring concrete
Backfill -footing drains and waterproofing ❑ Fireplace Throat
Concrete Slab, prior to pouring ❑ Fireplace Final
❑ 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 ❑ Final Inspection
❑ Rough HVAC 0 Certificate of Occupancy - PRIOR to use or occupanc
Town of Montville Permit#,6-/c®Uf, /e. 7
Building Department ,�y�
310 Norwich-New London Tpke. l `�6" r �I�
Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231
Application for Building or Trades Permit
Building Permit Trades Permit
❑ New Construction ❑Accessory Structure
Action ❑�DemoCztion ❑�Plum6in9 N9Vfec(ranicaC
Q Alteration ❑pts ®Elect'ual 7feating
Air Conditioning
}� Gas Piping
Job Location 7 2 P Asz x Av
Job Description/Materials I [; it ta� '� U b i niL— �) CT
Owner\\c,� ; y W ��'�� c NJ Mailing Address J Z. 1'ratik., (V( .
Cit'`Mori 1y��� c State c t, Zip 06 3 2 Tel 40 / s.iiSf / ?)
Contractor S {j l�. /s Mailing Address
City State Zip Tel
Contractor's License/Registration Type&Number — Exp. Date / /
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 Date / / /
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical
Electrical $ a e vh 00 $
Other $ $ /el
Certificate of Occupancy $
Plan Review Fee $
State Education $ 05--
Total $ 3030 , 0G $ 0iO5s
Town of Contville Building Departure-t Receipt
;Q Date c" I i 4/ /6 / No. 00966
k
From: b'� /
___igtx , PP Gf LC h 1A/ i O
Job Address: 7 /1 y4142c + h": .
43 Amount $ 0. 0• 0,5 Cash Check Check #
(C ircic one)
r
Received by � i.i �� , 4'2 a40/--/6'7
.. - Permit # /�j �6D / - //6
i
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at - Z Vika It A3
In the town of M d N 1 V1\1.L�,
Name of building permit applicant:
Please check one:
1. XI I am the owner of the above property.
2.—I am the sole proprietor of a business.
2A.Name of business
2B. Federal Employer Identification Number(FEIN)
Pursuant to § 31-2866, "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. I do not intend to act as a general contractor or principal employer.
[Sign and stop here]
Signature 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)