HomeMy WebLinkAboutElectrical - 100 AMP Service Replacement 2002 1 I ' a Town of Montville (;)
Building Department
Date 7 /02,/ 4 Field Inspection Notice Permit # &R6146?-c245
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4Approved Type of Inspection
II Not Approved - Please call for re-inspection when the following corrections have been completed:
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:uilding Official
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
860-848-3030,Ext.82
Electrical Permit
Permit Number: E2002-205 Permit Date: 31-3ul-02 Permit Code R5
Job Location 159 PARK AVENUE EXTENSION UNIT:
MAP/LOT: 096/011-000
Job Description: Electric Service
Owner Contractor
STEFANIE G CAPLET+REED SCOTT B William Robarge
94 Cow Hill Road
PO BOX 84 Unit: Mystic,CL 06340
UNCASVILLE CT 06382-0084 Telephone: 572-6072
Use Group R4
tc/Re9 Type: El
Lic/Reg Number: 123489
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: $500.00 Electrical Fee: $10.00
Other Value: $0.00 Other Fee: $0.00
Total Value: $500.00 C/O Fee: $0.00
Comments: Plan Review Fee: $0.00
State Ed Fee: $0.08
Total Fees: $10.08
It is the owners responsibility to schedule the following reguired 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 ❑ Final Ins
Gas Piping and Pressure Test ❑ icate of Occupancy-Prior to use or occupancy
Building Official's Signature: /
/
Town of Montville
o
r Building Department Permit#e2 p0 a � '
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231
One & Two Family Trades Permit Application Form
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Job Location I S ��2 k f� t L)ok_-/2s/Q IJ
Job Description/Materials /Q 0 T r-k y S''e ie U, G (F..pp)pg&
Owner U%U1+4-vi. Mailing Address f c 9 ?, ek Cxj' s-._
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State a ZipO 6 34/O Tel C/6 6 /S'?Z/68''?Z
Contractor's License/Registration Type&Number
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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
Date 7 / �2 / 2-
Construction
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical $ $
Electrical $ —0o
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $
Total $ sc'Oe, `' 0
$ /0.0 T
1
7
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 / / I 2i 4
In the town of
Name of building permit applicant 2c a.-yam
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Please check one:
I- 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(F
Pursuant to §31-286b,"a
Property owner or sole •a •-genes
contractor or principal employer" proprietor[who]intends •----'...
may provide either a work r act as a
insurance or a"sworn notarized affidavit... statieng �of workers'compensation
will '
compensation insurance for all those employed on the job site inac proof of worker
accordance with this chapter."
Please check gne:
1- V I do not intend to act as a general contractor or principal employer.
[Sign and sto here]
Sigdature of applicant
2. I intend to act as a general contractor or
principal employer.Applicant must either
provide a certificate of workers'compensation sation insurance or sign the affidavit
...............
Affidavit .....................
I hereby swear and attest that I will
contractor,subcontractor,or other workucr bcfonf of cngages
�compensation 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.
partnership may elect to be excluded , officers of a corporation and partners in a
District Office; and that a sole proprietor of business is notverage by a waiver with the appropriate
files his intent to accept coverage.prequired to have coverage 8 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 BuildingDepartment
Receipt
C> Date -_ / —
From: NO. {�
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Address: a
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4;) Amount $
' -d r Cash i C.:."--heck�
/ Check # �
(Circ c c
Received h .
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