HomeMy WebLinkAboutWindow Replacements 2003 Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext. 382
Building Permit
Permit Number: B2003-0067 Date: 19-Mar-03 Map/Lot: 096/030-000 Owner ID 113534
Job Location: 75 PARK AVENUE EXTENSION Unit
Job Description: replacement windows
Owner: Contractor:
Robert A and Dawn M Netter Robert A. Netter
75 Park Avenue Ext.
75 Park Ave Ext Uncasville Ct. 06382-
Uncasville CT 06382 Telephone: (860)848-6961
Lic/Reg Type/No. 0 Exp Date:
Tenant:
Self
Telephone:
Construction Values Permit Fees Construction Information
Building Value: $2,250.00 Building Fee: $16.00 Use Group: R4
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO
Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B
Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R4
Other Value: $0.00 Other Fee: $0.00 Comments:
Total Value: $2,250.00 CO Fee: $10.00
Plan Review Fee: $0.00
State Ed Fee: $0.36
Total Fees: $26.36
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 0 Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature: ..Zea2.0-1e41-5
ilsorTown of.,rlontville
Building Depaiitment Permit 7
310 Norwich-New Condon Tpke.
Tel. 848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231
One& Two Family Building Permit Application Form
0 J(ew Construction 0 AdditionE]Alteration [J Accessory Structure
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Owner 12010CY1-I 4 . N L E� Mailing Address 7 a'�A/t.�� ✓-�,/e—L-)C7-
City V N C-eiS V I'! I €_ �' /
State � Zip �� 3�z Tel �� / ��/ �j�lo/
Contractor S(CI 1= Mailing Address
City State Zip Tel / /
Contractor's License/Registration Type&Number 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 1 . e application for a permit for such work as described above.
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Owner/Agent Signature ' " Date 3 / 1 3 /63
Construction Value Fee
Building $ 3-6 '.‘-d $ J6.
Plumbing $ $
Mechanical $ $
Electrical $ $
Other $
Certificate of Occupancy $ /o
Plan Review Fee $
State Education $ 3
Total $ t 3-6 $ a 6 I
(See*verse side for additional requirements)
Town oVontville Building Departn. ott Receipt
Date 3 / / / 3 No.
From: i / /� r
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Job Address: 7 5 O
Amount $__4-. Cash eek Check # /8- (")
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Received by \
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%raw STATE OF C JNNECTICUT
WORKERS' COMPENSATION COMIVIISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: 7s L>cj c'ry ctA I
In the town of o
Name of building permit applicant:
Please the k one:
1. 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 § 31-286b, "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
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 chec ne:
1. I do not intend to act as a _e t al o tractor �, ,1 = • :yer.
[Sign and stop here] � now/4i
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)