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Home My WebLink AboutElectrical Work - Exterior 2002 Town of Montville itik\ Building Department Date 7 /''/ Q Field Inspection Notice Permit #E,,700,,,? -- Job Location 152) Pa ( 21/P ,'Approved Type of Inspection Ele r Ot& Not Approved - Please call for re-inspection when the following corrections have been completed: ( 61'L 'A\ Building Official Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ext.82 Electrical Permit Permit Number: E2002-204 Permit Date: 29-Jul-02 Permit Code R5 Job Location 150 PARK AVENUE EXTENSION UNIT: MAP/LOT: 096/088-000 Job Description: Electrical Service-exterior only Owner Contractor PHILLIP L+SUCHOMEL DEBRA L DESCHAMPS Niantic Electric 35 Forest Road 150 PARK AVE EXT Unit: Niantic,Ct.06357 UNCASVILLE CT 06382 Telephone: 739-3797 Lic/Reg Type: El Use Group R4 Lic/Reg Number: 125286 Code 1995 CABO Exp Date: 9/30/02 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: $700.00 Electrical Fee: $10.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $700.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.11 Total Fees: $10.11 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 ❑ Rough Electrical ❑ Firestopping/draftstopping • Electrical Service ❑ Insulation Rough Plumbing and Leak Test in Final Ins.- 'on Gas Piping and Pressure Test - ificate of Occupancy-Prior to use or occupancy Building Official's Signature: Town of Montville 4 Building Depariment Permit#� OD c? — 02 O i 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form Ptum6ing ECectricat L9KecIianica( .11-eating Air Conditioning Gas Piping ❑Other /5 D /2nT f v £x Job Location 7T3 Job Description/Materials C,},AA.,43 . / C0B/C w rh H w • is Owner phe-j/,ri2 6 44—sc�j Mailing Address r5 "04_le K -V cocr ' City ri c f �/� State el Zip Telr T7 77 O ! Contractor,3//A,&/77c /�/f'c7 (' Mailing Address .3_5' F �-/2 L S� Y City J/ft./4 if State C,f Zip O‘3S 7 Tel g�/77 / 3 7 7 Contractor's License/Registration Type&Number '/ / � 2 17.< Exp. Date l J D l_ 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 Signatur -"A Date 7 12..T / c9 2 Co struction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical ✓ $ $ /7 Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ 0„1, Total $ 70-0' — $ /p. 1/ STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Buildin• Permit Affidavit for Pro.e Owners or Sole Pro.rietors (Conn. Gen. Stat. §31-286b) Property located at In the town of - • ' • Name of building permit applicant ` -( Please check one: I. I am the owner of the above property. I am the sole proprietor of a business. _2A.Name of business j 7 /C 67C �� 2B.Federal Employer Identification Number(FEIN) 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 insurance or a"sworn notarized affidavit... stating that hte of workerse will compf of knsation ers' compensation insurance for all those employed on the job site in require �ordance with this chapter." Please check one: 1. t-` I do not intend to act as a general contractor or principal employer. [Sign and stop here) c- A V Signature of a.plicant 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 befoof re he/she h she d compensation insurance for every contractor,subcontractor,or other worker 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 partnership may elect to be excluded from coverage by filing and the appropriate in a District Office; and that a sole proprietor of a business is not waiveredto haveith the files his intent to accept coverage. required coverage unless he 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 / Z . / oz No. U 1g7G From: X)/ /•)1"1 C. Job Address: 1-6° /1:714 lzh A V� �-�- - Amount $ /e9 . // Cash Check Check # Circle one) Received by Ch-Ntrv-cgPermit # Z-0O -- Z--c