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Home My WebLink AboutElectrical - Replace 100 AMP Service 2002 • Town of Montville Building Department Date/7 / 6.2 / 05? Field Inspection Notice Permit # Job Location /✓ /4& f I Approved Type of Inspection _'� 4,- v Not Approved - Please call for re-inspection when the following corrections have been completed: Building Official Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ext. 82 Electrical Permit Permit Number: E2002-378 Permit Date: 26-Nov-02 Permit Code R5 Job Location: 153 PARK AVENUE EXTENSION UNIT: MAP/LOT: 096/012-000 Job Description: Electric Service Upgrade Owner Contractor JAMES+ LORRAINE M UKRAINE Paul Sucholet 20 Pinecrest Court 153 PARK AVE EXT Unit: Norwich, Ct. 06360 UNCASVILLE CT 06382 Telephone: 887-7018 Lic/Reg Type: El Use Group R4 Lic/Reg Number: 121829 Code 1995 CABO Exp Date: 9/30/03 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: $850.00 Electrical Fee: $10.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $850.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.14 Total Fees: $10.14 It is the owners responsibility to schedule the following required inspections(minimum 48 hours notice reauested); ❑ 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 ❑d Electrical Service ❑ Insulation ❑ Rough Plumbing and Leak Test i►, Final Inspection ❑ Gas Piping and Pressure Test ❑I Ce icate • 0%.ncy-Prior to use or occupancy Building Official's Signature: ��`� • • 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 DPfumbing glEfectricaf OIbfechanica! 5ieating Air Conditioning Gas Piping ['Other Job Location I.53 P ,r-1'�J 1 Av Q e.xT. Job Description/Materials Up atA;n d � A-Ln .S er-v r) «/ 106 Owner Lor-r-farNe U K'main Mailing Address £S3 Pp,K A✓e_ �ICr• City Uh C►\sUi State I Zip 10/3Tel 0/ $yWW / `)01 g Contractor R ) Sri c-_Lo l Est Mailing Address e c r€S L v r * City 1) O(✓l c� State r.:r Zip 06 36 0 Tel g'60/ )/9 9 20 Contractor's License/Registration Type &Number E-1 I Exp. Date _/�Q/ 03 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. 6 nfip Owner/Agent Signature `%, Date / Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ €SD Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ O.fy Total $ SDG $ /0•/// STATE OF CONNECTICUT WORKERS'COMPENSATION COMMISSION Buildin: Permit Affidavit for Pro Owners or Sole Pro rietors (Conn.Gen. Stat.§31-286b) Property located at �,. e �-- In the town of „) J' Name of building permit applicant: P f\�; Please check one: 1. I am the owner of the above property. 2. am the sole proprietor of a business. _2A..Name of business Svc 11.01e L. e(L.-TIT-cc 211 Federal Employer Identification Number(FEIN) Pursuant to §31-286b,"a property owner or sole fin contractor or principal employe"may proprietor[who]of to act as a general insurance or a"sworn notarized affidavit..provide either a certificate of workers'compensation f of woricas' compensation insurance for all those employed on the job site iniac ire nce with this » 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. X,I intend to act as a general contractor or principal provide a certificate of workers'con nemployer.insurance oApplicant must either below. or sign the affidavit Affidavit I hereby swear and attest that I will require proof of workers'con contractor,subcontractor,or other worker before hefshe engages compensation in the abo a for every in work accordance with the Workers'Com ion above property in Compensation Act(Chapter 568 . I understand that pursuant to§31-275 C.G.S.,officers of a corporation and partnership may elect to-be excluded from coverer apartners in a District Office;and- that a sole g by filing a waiver with the appropriate files his intent to : : proprietor of a business is not required to have coverage unless he rw �'ip w liwihA1111 Signature-o-?applicant Subscribed and sworn to before me this day of ,200 (Notary Public/Commissioner of the Superior Court) Town of Montville Building Department Receipt 4 Date // / / (4;) Z 7 c No. L '-3-'62 From: Job Address: ,/31 P4,2h A ra -2cT Amount $ /p . �/ ash Check Check # f s 4: / f x ? \ (Circle one) Received by J c-7,11,,1-_, Permit # oZ ._377 1 STATE OF CONNECTICUT DEPARTMENT OF CONSUMERPROTECTION ELECTRICAL UNLIMITED CONTRACTOR PAUL J SUCHOLET 20 PINECREST CT NORWICH,CT 06360 TYPE: El LIC./REG NO. EFFECTIVE EXPIRES 121829 10/01/2002 09/30/2003 SIGNED 6