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Home My WebLink AboutVinyl Siding 2000 Town of Montville Building DeOartment Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231 Building / Trades Permit Permit Number BP2000-639 Permit Date 12/20/00 Permit Type Building Permit Code R4 Job Street# 150 Job Location Park Avenue Extension Map/Block-Lot 096/088-000 Job Description vinyl siding, aluminum trim Owner Phillip Deschamps Mailing Address 150 Park Avenue Extension City Uncasville State Ct. Zip 06382 Telephone 848-7781 Contractor Yost Home Improvement *Mailing Address P. O. Box 263 *City Waterford *State Ct. *Zip 06385 *Telephone 442-8032 Lic/Reg Number 500250 Lic/Reg Type Home Improvement Expiration Date 11/30/01 Use Group R4 Size Type Construction 5B Building Value $13,000.00 Building Fee $76.00 Plumbing Value $0.00 Plumbing Fee $0.00 Heating Value $0.00 Heating Fee $0.00 Electrical Value $0.00 Electrical Fee $0.00 A/C Value $0.00 A/C Fee $0.00 Other Value $0.00 Other Fee $0.00 Total Values $13,000.00 State Ed Fee $2.08 C/O Fee $10.00 paid check Plan Review Fee $0.00 jotal Fees $78.08 II Building Official's Signature Ale . -- �---- Date /0L1oa)/O) Required Inspection ❑ Footings -Prior to pouring concrete ❑ Rough Heating and Air Conditioning • Footing Drains/Waterproofing - Prior to backfill ❑ Chimney-One flue above thimble ❑ Framing ❑ Fireplace-Throat ❑ Rough Electrical ❑ Fireplace-Final ❑ Electrical Service ❑ Firestopping/Draftstopping ❑ Rough Plumbing -Leak test required ❑ Insulation ❑ Pool Bonding and Electric ® Final Inspection for Certificate of Occupancy-PRIOR to Use or Occupancy Town of Montville Permit ta,&40,000-‘.3 Building Etapartment 310 Norwich-New London Tpke. Tel. 848-7166 Uncasville, Ct. 06382 Fax 848-7231 Application for Building or Trades Permit Building Permit Trades Permit ❑ New construction ❑ Accessory structure ❑ Plumbing ['Mechanical ❑ Addition ❑ Demolition ❑ Electrical Heating ❑ Alteration ❑ Other Air conditioning Gas piping Job Location /5---°' /4),41 R r 4 EXT Job Description/Materials ic, `l1r$ !JOWL S i D /,VG 04/ C A((' 7 " 6-446€4E i o c SPFCtT) F.1-5r/ wt-- /RAw/A/D ow Owner et-1( .L( P D CSCNA-,//)S Mailing Address /3-0 Pik/ ie AVE. EK/ City vNC,4SElf/ L& StateCQNN zip G3��Tel. - Rge' 7 -7a Contractor 0 g% E (''efrOaGYF4/7 ailing Address R 0 . X v26 3 City L,�J � f 7/ State C-/ Zip Og3kr Te160 $0 3 Z Contractors License/Registration Type&Number ,6-0 U - J)ST) Exp. Date // / 'O /0 / New Home Construction Contractors: Have you entered into a contract with the consumer for the proposed work ? ❑ 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 0 / Date //- / I / / O C� Construction Value Fee Building $ X3/DT�'� $ 7 Plumbing $ $ Heating $ $ Electrical $ $ Air Conditioning $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ /' State Education Fee $ / , 08' Total $ A3/ 6O( $ 76, 08' • if a 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: 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 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 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 /a / 9 / o o No. 00369 From: 11 } z1,641Z,C'Job Address: /4:5—Q /4z �/E' , X± 11:;) Amount $ t'8'0$` Cash Check Check # t. Received by i: ! r�,�_i � Permit # a04 jj--639