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HomeMy WebLinkAboutElectrical Work 2002 411, Town of Montville Building Department Date /6 7/ Field Inspection Notice Permit # Job Location I- A .. Approved Type of Inspection � C ��- ,tel c e Not Approved - Please call for re-inspection when the following corrections have been completed: Building Official 1 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ext. 82 Electrical Permit Permit Number: E2002-296 Permit Date: 26-Sep-2002 Permit Code R5 Job Location: 146 PARK AVENUE EXTENSION UNIT: MAP/LOT: 096/087-000 Job Description: Electric Service&clean up wiring in basement Owner Contractor MARY E ALBOT Charles A.Carroll,Jr. 379 South Burnham Highway 146 PARK AVE EXT Unit: Lisbon,Ct.06351 UNCASVILLE CT 06382 Telephone: 889-4733 Lic/Reg Type: El Use Group R4 Lic/Reg Number: 122124 Code 1995 CABO Exp Date: 9/30/2002 Construction Type 5B Construction Values Permit Fees Building Value: $0.00 Building Fee: $0.00 Plumbing Value: $0.00 Plumbing Fee: $0.00 Mechanical Value: $0.00 Mechanical Fee: $0.00 Electrical Value: $1,800.00 Electrical Fee: $10.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $1,800.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.29 Total Fees: $10.29 It is the owners responsibility to schedule the following required inspections(minimum 48 hours notice requested)1 ❑ 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 © Rough Electrical ❑ Firestopping/draftstopping J Electrical Service ❑ Insulation ❑ Rough Plumbing and Leak Test ❑ Final •spection ❑ Gas Piping and Pressure Test 1 'ertificat- . Occu.:• • or to use or occupancy Building Official's Signature: Al0 / ✓� 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 Trades Permit Application Form El cPfum6ing Electrical f 9Kecfianica1 .Jfeating Air Conditioning Gas taping pother Job Location /' ' Ji? ,' ig c`..-d., Job Description/Materials 502 Lao-- Ci-NAii6c-i/ ,72,0A1U��r � ,72,0A1 rD0.941� /Q oZl /Avio. CLcA' 11)0 /V 1izW6 /A} J,9.5. ( L:(1iOwner /1,9/e* j22/34 i Mailing Address ..g/6" / )9/2g Akz. 6-yr City 02)609Si//GL6- State Ci Zip O& ,) Tel 76 /x? / / Contractor Cb&1us /9, ,^ l//9/?/I,aLL Mailing Address .37`j SGS .//LAv�i9,t,, Aim, City L15/74 C/ State C Zip C 5/ Tel et<G0 /ee,/ ''3 Contractor's License/Registration Type&Number </ )L4C&4 Exp.Date 7 1.10 / c1,4 I hereby certify that the proposed work w* 1 con orm to the Basic Building Code and all other codes as adopted by the State of Connecticut and the Town of M. tville a i d further attest that the proposed work is authorized by the owner in fee and that I am authorized to make . ;. .:tion or . permit for such work as described above. Owner/Agent Signature / Date Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ J "OD,GO $ /a $ Other $ Certificate of Occupancy $ Plan Review Fee $ State Education $ 6 •Zc] .-- Total $ ,/7-00 $ /o ,z9 STATE OF CONNECTICUT WORKERS'COMPENSATION COMMISSION Buildin: Permit Affidavit for Pro'e Owners or Sole Pro s rietors (Conn. Gen. Stat. §31-286b) IMP Property located at 1/5 / t '� _ --- In the town of Ujt/C ♦ v/�,� ,_ ` Name of building permit applicant __ . C1577'24,644- Please check one: 1- I am the owner of the above property. I am the sole proprietor of a business. _2A.Name of business I • L t(r' O1/ ��✓L- L " -7 f2., 2B.Federal Employer Identification Number(FEIN) Pursuant to §3 1-286b,"a property owner or soleProprietor[who] intends to act- ---'--' as a gcneral •_- contractor or principal employer"may provide either a certificate of workers'compensation insurance or a"sworn notarized affidavit... stating that he will require compensation insurance for al .:.se employed on the job site inccordance with this chapter. Please ch IIe: 1 do n. ;o n, o act. a general contractor or principal employer. [Si: ' an. 'P 'e. S i 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'com contractor,subcontractor,or other worker before he/she enPe uon insurance for every accordance with the Workers'Compensation Act(Chapter 568) in work on the above property in I understand that pursuant to§31-275 C.G.S., officers of a co partnership may elect to be excluded from coverage by filinga porstrew and pare a District Office; and that a sole proprietor of a business is not waiver with the coverage unless files his intent to accept coverage. required to have unless he Signa of applicant Subscribed and sworn to before me this day of ,200_. (Notary Public/Commissioner of the Superior Court) STATE OF CONNECTICUT DEPARTIIIEN1 01;C ox.s( JER PROTECTION ELECTRICAL UNLIMITED CONTRACTOR • CHARLES A CARROLL JR 379 S BURNHAM HWy LISBON,CT 06351 TYPE: E1 / L /REO4,/� 09/30/2002 7. SIGNED .,IW f Town of Montville Building'Department Receipt Date 9 / 6 / oz. No. 02126 From: � 'I1 t.-c-..froLL Job Address: Amount $ / d Z9 Cash rCiieck Check # (Circle one Received by rr� Permit #