HomeMy WebLinkAboutAbove Ground Pool 2002 Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
860-848-3030, Ex.t 82
Building Permit
Permit Number: B2002-172 Permit Date: 30-Apr-02 Permit Code R8
Job Location: 123 PARK AVENUE EXTENSION UNIT: MAP/LOT: 096/018-000
Job Description: Above Ground Pool
Owner Contractor
RUSSELL E+ LISA) DANIELS C B Construction,Inc.
22 Avery road
123 PARK AVE Unit: Uncasville,Ct.06382
UNCASVILLE CT 06382 Telephone: 848-1268
Lic/Reg Type: HIC
Use Group R4
Lic/Reg Number: 556544
Code 1995 CABO
Exp Date: 11/30/02
Construction Type 5B
Construction Values Permit Fees
Building Value: $3,000.00 Building Fee: $16.00
Plumbing Value: $0.00 Plumbing Fee: $0.00
Mechanical Value: $0.00 Mechanical Fee: $0.00
Electrical Value: $150.00 Electrical Fee: $10.00
Other Value: $0.00 Other Fee: $0.00
Total Value: $3,150.00 C/O Fee: $10.00
Comments: Plan Review Fee: $1.60
State Ed Fee: $0.50
Total Fees: $38.10
It is the owners responsibility to schedule the following required inspections(minimum 48 hours notice requested):
❑ Footing-Prior to pouring concrete ❑ Rough HVAC
❑ Backfill-Footing drains and waterproofing ❑ Fireplace Throat
❑ Concrete Slab-Prior to pouring ❑ Fireplace Final
❑ Rough Framing ❑ Chimney-One flue above thimble
0 Rough Electrical ❑ Firestopping/draftstopping
❑ Electrical Service ❑ Insulation
❑ Rough Plumbing and Leak Test ❑ Final Inspection
❑ Gas Piping and Pressure Test MI Ce. • e of OccGpancy- Prior to use or occupancy
Building Official's Signature:
Town of Montville
Building Department Permit#
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231
One & Two Family Building Permit Application Form
11 New Construction []Addition Alteration [I Accessory Structure
Other A ,e G►axx\ 1L -R90(
Job Location 1 c ik ATP-- , A- •
Job Description/Materials L( ' -r c
Owner , 1)6( Qf I -e (c Mailing Address k
City LkeaSki State CT' Zip CIL-3U- Tel aCC /( __
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Contractor ? 00(l '►' 1-6 1 ),� Mailing Address ) ! ,. I 1.111(e)
City 1\;a tLh StateZip3a Tel Y106 / / /off
Contractor's License/Registration Type&Number it`JP„I w a r - Exp.Date /1 13() /j--X49--
1 -
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 AI- Date U t{ / Z2--1 bZ
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical $ $
Electrical $ $
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $
Total $ $
Permit Fee Calculation Spreadsheet
MISCELLANEOUS PERMIT CALCULATION
Pools&Spas
Above Ground Round 1 EA S 3,000.00 $ 3,000.00
Above Ground Oval EA $ 5,000.00 $ -
In-Ground EA $ 18,000.00 $ -
Heater EA $ 3,300.00 $ -
Hot Tub EA $ 5,000.00 $ -
Roofing
Strip&Reroof SQ $ 210.00 $ -
Overlay SQ $ 175.00 $ -
Sheds
With Electric SF $ 25.00 $ -
No Electric SF $ 25.00 $ -
Deck SF $ 15.00 $ -
Porch SF $ 23.00 $ -
TOTAL BUILDING CONSTRUCTION COST $ 3,000.00
PERMIT FEE
Building S 3.000 $ 16.00
Mechanical $ - $ -
Electrical S 150 $ 10.00
$
$
CO Fee $ 10.00
Plan Review $ 1.60
State Ed Fee S 3,150 $ 0.50
Total Fees $ 38.10
Based on 2000 Average Construction Cost
4/22/02
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. §31-286b)
Property located at
In the town of
Name of building permit applicant
PIease check 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
Pursuant to § 3 I-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. I do not intend to act as a general contractor or principal employer.
[Sign and stop here]
Signature ofapplicant
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
contractor,subcontractor,or other worker before hefshe 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 ace this day of
200 .
(Notary Public!Commissioner of the Superior Court)
Town of Montville
Building Department
848-3030, Ext 82
ONE & TWO FAMILY
CONSTRUCTION PERMIT
SIGN-OFF SHEET
(,),3 P6,-1 74, Tx
Property Address
Job Description: Abp rt_c—e14--
The owner/agent shall be responsible for the completion of the form, no construction permit will be issued until all
signatures below have been obtained.
HEALTH DISTRICT 848-3030-882
❑ 'Permit#: N. Applicable
Theptic System Datejar
j
❑ Permit#: 'j Not Applicable
Private Well Date
{WPCA DEPARTMENT 848-3030,Ext.881
(( a l- d. 0 Permit#: Not Applicable
Municipal Sewer Date
0 Permit# Not Applicable
Municipal Water Date
DEPARTME OF PUBLIC WORKS 848-7473
N ❑ Permit#: o cable
Director Date`
PL G&Z G DEPART NT 848-3030,Ext.81
❑ Permit#//(/ ' [Not Applicable
.ening Date
4 7 /2K- 0 Permit#:a/ficNot Applicable
Inland-Wetlands Date
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MODEL 2000 COMPLETE SAFETY STAIR SYSTEM WITH GATE
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GROUND TO DECK a 0('�„ ► IN-POOL STAIR
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ABOVE GROUND POOL ALARM
MADE IN THE USA roolguard.
iitr INDUSTRIES.INC.
MEMBER
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MODEL PGRM-AG ' o',
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• Detects Intruders Cnr
•. • N•TIONAI
SPA POOL
INSTITUTE
• Snaps On Top Rail
i • Battery Powered
<,,, .:-.,.. • Completely Portable
• Convenient Storage
• Easy To Use
II .`" ' REMOTE RECEIVER
• Automatic Reset
ABOVE GROUND POOL ALAR '' . Affordable Price
�t - '.- .- -_,-. _ • Important Safety Feature
POOLGUARD POOL ALARM
Entry into the pool by children, pets, or
intruders is detected by the unit's electronic
14
sensor, and sets off a loud pulsating alarm. •
Safe, simple, and easy to operate, the 9-volt It` °`
battery powered alarm snaps on to the top rail
of your above ground pool. To store yourt. ;
alarm while using the pool, snap it on the out- 1 .i
side of the pool. POOLGUARD comes with a
remote receiver which sounds an alarm inside .
the home when the unit is activated at the
pool. The POOLGUARD alarm system can be IN-POOL STORAGE
used with a solar blanket on the pool. ._ �.__
CALL TOLL FREE: 1 -800-242-7163
P.O. Box 658 • North Vernon, Indiana 47265 • www.poolspa.com/poolguard
INCREASES POOL SAFETY
Swimming Pool-Alarm Affidavit
Date U / 12—/ OZ.--
Owner l t_5.5e Ii fu`ei c
Waif:ngAddress pa/c1_ )4-e
Cloas
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Cloas U o !lam CT- 0C) 3 ??
Location of troperty Cca
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kik; �,i P . owner/owners agent of the above refirnc dpropert hereby
swear
and attest that I am aware of the requirement for a poofafann to 6e installed in the pool to 6e
constructed at the a6ove refereneced property. Further, I am aware that the alarm must 6e instalf'ed
andfunctioning at the time of thef tnal ertificate of Occupancy)inspection for the poor
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(siiinzd)
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(date)
(Notary,Commissioner of the Su - Court, 'Su6scri6Fd and sworn to Wore me
Justice of the Trace)this • '�relay of f?,. •
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Oat Cornrtiuion`F-xpirts_J_�
LISA TERRY
NOTARY PUBLIC
MY COMMISSION EXPIRES OCT.31,2002
0
Inspected and Operational / /
Budding Official'
E. OVAL POOL (ft)ADDITIONAL UPRIGHTS THAT
Pia ISANON' D/VINGPOOL AS DEFINED IN THE CURRENT - ARE ON 48'POOLS.
NA110NAL SPA AND POOL INS 71171 TE'STAWDARD FOR ABOkE GROUND
SAYING POOLS(NSPI-9J. (**) (")
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12 3,400 3,700 17-0' HiGH RATE INTAKE
15 5,300 5,750 15-0' RITER 4g,..2 s
18' 7,600 8,250 181-0' COPING
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21' 10,350 11,250 21'-0' WASTE UNE U
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24' 13,550 14,650 24'-0' PUMP&
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NOT All POOL SES AND OPTIONS BASE 11,12=1:1 �DQ�
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STRAP FC OWL '*SWn1Bu ' SSES SCRAP OYKAxYS'IIlIMECi/R1P1S
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12x18' 5,540 6,000 17-0' 16-0' 18'-0' I A ►,• !for PROFESSIONAL ENGINEER
12x21' 6,600 7,150 17-0' 21'-0' 18'-0' ;• • ' :o'•'�G DELAIR GROUP LLC.
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12V4' 7,700 8,350 17-0' 24'-0' 18'-0' PR.–) a =i cr DELAIR, EW,EROSEY 08110
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15;40' 12,050 13,050 15-0' 30'-0' 211-0' ;7A`L 22
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STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION ;
i; , Be it known that 1\
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‘,,,4 i C B CONSTRUCTION INC
22 AVERY RD '
-
UNCASVILLE, CT 06382
has been certified by the Department of Consumer Protection as a registered •
HOME IMPROVEMENT CONTRACTOR
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Contractor of Record: EVAN D WYNN : l_:i NI,
_sk Registration # 556544
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ti i Effective: 12/01/2001 ';i
gr.."(. Expires: 11/301;,
. 20021\
- \ Ja T. Fleming, Commsioner �,i
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Client# : 9909
4CQRn_. CERTIFICATE OF LIABILITY INSURANCE DATE(MM;DDYY)03/07/02
PRO(N:CER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Levine / Webster Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
914 Hartford Turnpike ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Waterford, CT 06385 INSURERS AFFORDING COVERAGE
860 444-3900
INSURED INSURER A. American Casualty of Pennsylvania
C B Construction, Inc. INSURERS Westport Insurance
DBA Treat's Pools INSURER C:
P.O. Box 205 INSURER D.
Norwich,CT 06360
I INSURER e:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTTHSTANDINO
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 01
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDmONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I NSRPOLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDIYY1 DATE(MAVDD/YYl
A GENERAL LIABILITY C7001217953 03/01/02 03/01/03 EACHcnURRENCE 11,000.000
FIRE DAMAGE(Any one fire, $100,000
X ^V.V.ER�':r1L GE NE RAL:,IAB L'.TY —
.21.A:MS MADE
OCCUR
MED EXP(Any one perwn) $10,000
PERSONAL&ADV INJURY 51,000,000
—'—• GENERAL AGGREGATE $1,000.000
PRODUCTS •OMP/OPAGG S1,000,000
GEN--A:,:IRE:,A:?:,V,''A?P::ES PER.
A AUTOMOBILE LIABILITY 05001217954 03/01/02 03/01/03 COMBINED SINGLE LIMIT $1 ,000,000
_ (Ea eccIdent) 1
X AN'•A="=
AL_CWSE:A„T BODILY INJURY 1
X 4:RE J A._--S BODILY INJURY 1
(Pa,rcident
PROPERTY DAMAGE 1
�. (Per r,.ident..
AUTO ONLY•EAACODENT S
GARAGE LIABILITY i—
ANYAT_
OTHER THAN EA ACC S
AUTO ONLY AGO S
EXCESS LIABILITY EACH OCCURRENCE 1 I
—___R l , AIMS MADE AGGREGATE S
S
L
��::a7,1_27:5...2. L
REETE�—:TN I wC STATU Cl.'H
B IVORKERSCOMPENSATIONAND WCX000862500 03/01/02 03/01/03 1EORYI MRs PR
EMPLOYERS'LIABILITY E.L.EACH ACCIDENT S100,000
E L DISEASE •EA EMPLOYEE $100,000
EL.DISEASE .POLICY LIMIT $500,000
OTHER
DESCRIPT ION CF OPERATI ONS:L.CCATIONS'V EHICL ES'EXCLL'SIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDRIONALLNSURED;INS URERTETTER CANCELLATION
,I SHOULD ANY cum ABOVE DESCRIBED POLICIES BE CANCELLED BEFCRETHE EXPIRATION
Insured's Copy DATETHEREOP.THE ISSUING INSURER WILL ENDEAVOR TOMAILI n DAYSIVRHTEN
NOI10ETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUT FALURE TODOSO SHALL
IMPOSE N O OB LIGATION OR LIAB ILTTY OF ANY KIND UPON THE INS URE R ITS AGE NTS OR
REPRESENTATIVES.
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DATE: y/Zz�o il E v, Pf 00 NS
SIGNATUR • a 1.54 c
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2 Wire must be listed for4 c
this application and ha �,� ��
insulabd ground '"KOMI
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