HomeMy WebLinkAboutStrip and Re-Roof 2001 Town of Montville
Building Depart,-ient
Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231
Building / Trades Permit
Permit Number BP2001-683 Permit Date 11/16/01 Permit Type Building Permit Code R4
Job Street# 142 Job Location PARK AVENUE EXTENSION Map/Lot 096/013-000
Job Description Roofing - Strip, Siding & Windows
Owner Contractor
Bruce& Nancy Gordon ThermalFit
Address 149 Park Avenue Extension Address 10 Laurier Lane
City Uncasville State Ct. City Lisbon State Ct.
Zip 06382 Telephone 848-9984 Zip 06351 Telephone 859-3893
Lic/Reg Number 553138
Lic/Reg Type HIC Exp Date: 11/30/01
Use Group R4 Code 1995 CABO Type Construction 5B
Building Value $10,000.00 Building Fee $58.00
Plumbing Value $0.00 Plumbing Fee $0.00
Mechanical Value $0.00 Mechanical Fee $0.00
Electrical Value $0.00 Electrical Fee $0.00
Other Value $0.00 Other Fee $0.00
Total Values $10,000.00 C/O Fee $0.00
Comments: Plan Review Fee $0.00
State Ed Fee $1.60
To;2, .aI Fees $59.60 II
Building Official's Signature �� `fir
9 ��, yJ rte. Date if l /6 /0/
It is the owners responsibility to schedule the following require spections (minimum 24 hours notice required):
❑Footings -prior to pouring concrete
❑ Backfill -footing drains and waterproofing L 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
LI Gas piping -pressure test and installation V Final Inspection
❑ Rough HVAC ❑ Certificate of Occupancy - PRIOR to use or occupanc
Town of Montville Permit#)i'z z I—43
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 ❑CPlumbing ❑Mechanical
❑Addition ❑fE1 ctrical 7feating
❑�DemoGtion
❑Alteration ['Other Air Conditioning
Gas(Piping
Job Location / [/ l spit / c,-c- • c /73
Job Description/Materials �-i-� /?o /` S Tn, ;0/ /-e I 307-1 5/-1,74-0
Owner /1-,4,-.5 t /5,7 u. G o.i c/o..) Mailing Address / /' [-yr
City C,-v, c . /< L State c %Zip • Tel $'Co / yam/ ?g -7
Contractor T l 7 •�.. �` 'i Mailing Address /0 L ,9 .. /N►'t L ,
City S /3 er,-v State c T Zip 3 S/ Tel S6o / Err 5/ 3 k-r7
Contractor's License/Registration Type&Number 5S 3/3 " Exp. Date // / 3 0 / a /
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 /' / / c
Construction Value Fee
Building $
Plumbing $ $
Mechanical $ $
Electrical $ $
Other $ $
Certificate of Occupancy $ ��
Plan Review Fee $
State Education $ /
Total $ /O, aul.> $ c-) �,
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at '/�j G��, <, r/1/<__
Inthetownof (- i C //e_ C
Name of building permit applicant:
Please check one:
1. I am the owner of the above property.
2. , I am the sole proprietor of a business.
2A.Name of business ry L I- j
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)
Town of Montville Building Department Receipt
Date // / 7 / 0/ No. 01265
From: . ...,F;
Job Address: G PZ s
.10.E
C Amount $ � . 6 d Cashdlift
Check # 27c
(circle Ore)
Received by , �1./kr.frr..-44_.
Permit #gpZoa J_ 673
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