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Home My WebLink AboutStrip and Re-Roof 2004 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 BUILDING PERMIT Permit Number: B2004-0732 Date: 09-Nov-04 Map/Lot: 096/088-000 Owner ID: 5337000 Project Location: 150 PARK AVENUE EXTENSION Unit: Job Description: Strip&Re-roof Owner Name: Phillip L and Suchomel Debra L Deschamps Tenant Name: N/A Careof: 150 Park Ave Ext Uncasville Cr 06382- Telephone: Contractor Name: A&J Builders Telephone: (860)376-5166 DBA: Lic/Reg Type: HIC Lic/Reg No: 500923 22 Edmund Road Exp Date: 30-Nov-05 Griswold _ Ct 06351- Construction Value Permit Fees - Construction Information Building Value: $6,900.00 Building Fee: $56.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code w/2004 Amendment Mechanical Value: $0.00 Mechanical Fee: $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $6,900.00 Penalty Fee: $0.00 Permit Code: R4 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $1.10 Total Fee: $57.10 It shall be the owners repsonsibility to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. ❑ Footing -Prior to pouring concrete ❑ R Plumbing and leak test ❑ Backfill-Footing drains and waterproofing ❑ R Electrical ❑ Concrete Slab-Prior to pouring concrete ❑ Elec Trench-with conduit installed ❑ Framing ❑ Electrical Service CRS No: 0 ❑ Fireplace Throat-One flue above throat ❑ R HVAC ❑ Chimney-One flue above thimble ❑ Gas Piping and leak test ❑ Firestop Draftstopping ❑d Final Inspection ❑ Insulation ❑ Certificate of Occupancy Building Official's Approval: _ j Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville,CT 06382 Fax. 848-7231 Residential Building Permit Application Form Permit "co D D 7L j_ ❑ New Construction [Addition 0 Alteration []Accessory Structure ❑Single Family 0 Two-Family[, Townhouse Job Address _ 53 c1 (ç fii/V— (Number) (Sweet) (Unit) Job Description '(1 l kt cA II c S I Owner - � l L ( ` e Cts c_`kravwt f 5 Mailing Address I-60 Paw k 4Ui E 4 C City tiY1 C CAS(, \ l State 1* Zip U'63 51 Tel k q / 77e/ / Contractor 6.-4-23 �b ^ ��. Mailing Address City G—VA-S(�c(/ State 61—_ Zip &3 5 Tel RI' /374' l 5l4 A Contractor's License/Registration Type&Number sob ela-> Exp. Date ,/ /30 / 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 ram a—utlorizec-to make application for a pernitTor such work as described above. Separate applications are re I 1/-d for electrical,plumbin l mechanical, etc. Owner/Agent Signature// Date / Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ $ (See 4verse side for additional-requirements) Revised Septem6er9,2004 t Town of Montville • Building Department 848-3030, Ext 382 CONSTRUCTION PERMIT APPROVAL h PC ,f C 4 Property Address vC Job Description The applicant is responsible for obtaining all of the required approvals checked off on this form. No building permit will be issued until all of the required signatures have been obtained. Required Approval Department Permit Issuance Approval Tax Collector C . is/ ,//P/o '-' Signature/date II Elk iWPCA I. _ cy _L.' Signatur ate ❑ Planning &Zoning Signature/date ❑ Health Department Signature/date ❑ Department of Public Works Signatures date ❑ State Dept. of Transportation Q!tmaturei date ❑ Fire Marshal Signature!date Comments/Conditions: W viseiSeptem6er9,2004 v State of Connecticut N 7A - 7B - 7C M v t � r Workers' Compensation Commission DIRECTIONS ' DIRECTIONS for FILING FORMS 7A,7B and 7C Ix Building Permit Requirements for Workers' Compensation Section 31-286b of the Workers'Compensation Act requires anyone who requests a building permit to first submit"proof of workers' compensation coverage for all of the employees who are engaged to perform services on the site of the construction project for which the permit was issued." The only exceptions to this law are the sole proprietor or property owner who will not be acting as general contractor or principal employer. What to give to the Building Official to obtain a Building Permit: 1. The General Contractor or Principal Employer must provide a written certificate of workers' compensation insurance for all of the employees on their project. This certificate may not be for liability, disability or any other type of insurance. 2. The Sole Proprietor or Property Owner who will not act as a general contractor or principal employer is not required to have workers'compensation coverage. In order to obtain the building permit, a FORM 7A should be completed and given to the building official. 3. The Sole Proprietor or Property Owner who will act as a general contractor or a principal employer must provide a written certificate of workers' compensation insurance for all of the employees on their project and must file a FORM 7B with the building official—OR he will sign a sworn notarized affidavit on FORM 7B, stating that he will require proof of workers' compensation insurance for all those employed on the job site. 4. The General Contractor or Principal Employer who has properly excluded himself from coverage using the appropriate WCC form (see NOTE below)must file the FORM 7C with the building official.This form certifies that they have properly excluded themselves, and attests that they will require proof of workers' compensation insurance from every employee that works on the designated job site. NOTE: The general contractor or principal employer may exclude himself from workers'compensation coverage by filing one of the following forms with the appropriate Workers' Compensation Commission district office: Form 6B for employees who are Officers of a Corporation or Managers/ Members of an LLC Form 6B-1 for employees who are Members of a Partnership STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION HOME IMPROVEMENT CONTRACTOR PATRICIOACARIJSO 22 EDMONO„ JEWETT CITY, • 00351 A&J 13 laWEAS , LIC./REG NO. E IV EXPIRES 500923 114.60i/2040- 11/30/2005 SIGNED .„,.-4r411..,‘ 411.11111111.""-- mmoimmommmw DATE M ACORD :.. TIFI tT OF I I ITY I :, A :: 07/19/04 ;.:. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BYRNES AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 6 CONSUMERS AVE COMPANIES AFFORDING COVERAGE NORWICH CT 06360-7521 COMPANY A NATIONAL GRANGE MUTUAL INS CO INSURED COMPANY PATRICK JACARUSO DBA B THE HARTFORD A & J BUILDERS COMPANY 22 EDMUND ST C JEWETT CITY CT 06351 COMPANY D THIS IS TO ::::......................................................................................................................................................................................................................................................... CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) P GENERAL LIABILITY MPJ 7 5 4 5 7 1/01/04 1/01/05 GENERAL AGGREGATE $1, 000, 000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $1, 000, 000 CLAIMS MADE X OCCUR PERSONAL&ADV INJURY $ 500, 000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 500, 000 FIRE DAMAGE(Any one fire) $ 50, 000 MED EXP(Any one person) $ 5, 000 Ds. AUTOMOBILE LIABILITY B1J75457 4/01/04 4/01/05 500, 000 COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY • AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ B WORKERS COMPENSATION AND 0 2 WBCE F 3 5 6 3 7/18/04 7/18/05 X TSUA MITS Tr EMPLOYERS'LIABILITY EL EACH ACCIDENT _ $ 100, 000 THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ 500, 000 PARTNERS/EXECUTIVE — OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 1 0 0, 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERT ICM E HOL DER .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF MONTVILLE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 310 NORWICH NEW LONDON TPKE. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY UNCAS V I LLE, CT 06382 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV I...................................................................................... Sheri King........ I SK D ACOfiD ..... ......................................................................................................... Permit Fee Calculation Spreadsheet MISCELLANEOUS PERMIT CALCULATION Address: Pools & Spas Above Ground Round EA $ 3,200.00 $ - Above Ground Oval EA $ 6,000.00 $ - In-Ground EA $ 20,700.00 $ - Heater EA $ 3,465.00 $ - Hot Tub EA $ 5,250.00 $ - Roofing Strip & Reroof 23 SQ S 300.00 $ 6,900.00 Overlay SQ S 185.00 $ - Plywood SQ S 105.00 $ - Plumbing Full Bath EA S 4,230.00 $ - Half Bath EA S 2,690.00 $ - Garages Attached, 1 car EA S 8,885.00 $ - Attached, 2 car EA $ 15,114.00 $ - Attached, 3 car EA $ 20,914.00 $ Detached, 1 car EA $ 11,657.00 $ - Detached, 2 car EA $ 17,456.00 $ - Detached, 3 car EA $ 23,256.00 $ - Sheds SF $ 26.25 $ - Sheds with Electrical SF $ 26.25 $ - Electrical Service 100 Amp EA S 825.00 $ 200 Amp EA S 1,500.00 $ Siding $ - Windows & Doors S - Decks/Porches/Sunrooms Open SF $ 22.31 $ - Covered SF $ 62.69 $ - Enclosed SF $ 123.90 $ - TOTAL BUILDING CONSTRUCTION COST $ 6,900.00 PERMIT FEE CALCULATIONS Fee Building $ 6,900 $ 56.00 Plumbing $ - $ - Mechanical $ - $ - Electrical $ - $ Work Commenced before permit issuance $ - CO Fee $ - Plan Review $ - State Ed Fee $ 6,900 1.10 Total Fees S 57.10 Based on 2003 RS Means Residential Cost Data 11/8/04 Town of Montville Building Department Receipt Date // / ,- / No. 04445 P ‘ ' 1 / From: _.,/' _ J...,1.._�_.1' - _, �� '.�r9 ,, Job Address: _ • �; , Amount $ 57 Cash (� c-jr„-....--) Check # 77,.�' i..!„/ :-, Th i (circle one) Received by ` / /�. ,, .�` Permit # L�� o