HomeMy WebLinkAboutElectrical- Cable and Socket 2004 Town of Montville
Building Department
Field Inspection Notice
Address: 122 Park Avenue Ext.
Job Description: Electric Service
Permit Numbers:E2004-0083
Footing Not Approved: Approved:
Comments: 1.
Backfill Not Approved: Approved:
Comments: 1.
Framing Not Approved: Approved:
Comments: 1.
Rough Electric Not Approved: Approved:
Comments: 1.
Electrical Service Not Approved: Approved: 4/2/04 JS
Comments: 1.
Rough HVAC Not Approved: Approved;
Comments: 1.
Rough Plumbing Not Approved: Approved:
Comments: 1.
Gas Line Not Approved: Approved:
Comments: 1.
Fireplace Throat/ Not Approved: Approved:
Chimney Comments: 1.
Fire/Draftstopping Not Approved: Approved:
Comments: 1.
Insulation Not Approved: Approved:
Comments: 1.
Certificate of Not Approved: Approved:
Occupancy Comments: 1.
Not Approved: Approved:
Comments: 1.
Not Approved: Approved:
Comments: 1.
Not Approved: Approved:
Comments: 1.
Comments:
Page 1 of 1
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext. 382
Electrical Permit
Permit Number: E2004-0083 Date: 29-Mar-04 Map/Lot: 096/061-000 Owner ID 113547
Job Location: 122 PARK AVENUE EXTENSION Unit
Job Description: replace entrance cable&meter socket only(panel done by others)
Owner: Contractor:
Anthony S Ozga J. Riley
23 St.John Road
122 Park Ave Ext Jewett City Ct. 06351-
Uncasville CT 06382 Telephone: (860)376-8621
Lic/Reg Type/No. El 103486 Exp Date: 30-Sep-04
Tenant:
Self
Telephone:
Construction Values Permit Fees Construction Information
Building Value: $0.00 Building Fee: $0.00 Use Group: R4
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO
Mechanical Value: $500.00 Mechanical Fee: $10.00 Construction Type: 5B
Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5
Other Value: $500.00 Other Fee:
$0.00 Comments:
Total Value: $0.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $0.08
Total Fees: $10.08
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 ❑ Firesto m draftsto
PP� 9/ PPin9
❑ Rough Electrical ❑ Insulation
El Electrical Service CRS #: 328680 ❑ Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature• �� /
// i
Town of Montville
* Building Department Permit# `''06r- 063
�
310 Norwich-New London Tpke.
Tel. 848-3030,Ext 82 Uncasville, CT 06382
Fax. 848-7231
One &Two Family Trades Permit Application Form
DPlumding lectricad D9Kechattical
5-leafing C i .s....JZf-g Fd
Air Conditioning
0 Other
Job Location /Z Z-- ,,,z-L ,( ,c
Job Description/Materials / p(4-€.4- z . �J/G � �� S�1
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Owner JQ,E.,f IR tut( J7ti_CJ-725170 Mailing Address I/ZZ 4
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City kftgt. 64,C*-f a Stat Zip O6'17 Tel / /
Contractor �? / Mailing Address 2.3 ,S. (d 4,--) "co,'
City al-/ State_Zip c LT
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Contractor's License/Registration Type&Number �—( / 0-7P f 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 make application for a permit for such work as described above.
Owner/Agent Signature
Date ? / L 7 /. d
Con truction Value Fee
Building $ $
Plumbing $ $
Mechanical $ $
Electrical $ L5---V $ d
Other $ $
Certificate of Occupancy $
Plan Review Fee
State Education $
Total $ $
e-
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: ( Z2 Pik
In the town of ( 'C ½ ( C�
Name of building permit applicant: jE1
Please check one:
1• I the owner of the above property.
2. SC 1 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 check one
1. do not intend to act as a general contractor or principal employer.
[Sign and stop here]
Signature of applicor
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)
ST E OF
CO
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MECTICUT
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D,gPART Off'CoERPROTECTION:--
ELECTRICAL'UNLIMITED r°`l8,c rox �
JA14,S F Pi
;,,2$ 30351 \
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s ? 0913012004
ExPIR
LIG.I REG N r i 1,042/ „,,,- ....i,,,,-;”' ;
1034864-- i vut k : !
SIGNED_ _ _
Town of Montville Building Department Receipt
Date / �� No. 0 3 6 3
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From: j
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Job Address: — • ,f4119 _
• i / A. /r r
Amount $ j9 . Cas Check Check #
-40 Circle one)
Received buei,„ore, // `./ ei 1.•/- ' Permit #