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Home My WebLink AboutRoof Overlay 2004 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Building Permit Permit Number: B2004-0221 Date: 10-May-04 Map/Lot: 096/008-000 Owner ID 113565 Job Location: 173 PARK AVENUE EXTENSION Unit Job Description: Roof Overlay-second layer Owner: Contractor: Bernard H and Elizabeth G Martell Bernard Martell 173 Park Ave. Ext. 173 Park Ave Ext Uncasville Ct. 06382- Uncasville CT 06382 Telephone: (860)848-3317 Lic/Reg Type/No. 0 Exp Date: Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $2,922.00 Building Fee: $16.00 Use Group: R4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R4 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $2,922.00 CO Fee: $10.00 Plan Review Fee: $0.00 State Ed Fee: $0.47 Total Fees: $26.47 It is the owners responsibility to schedule the following inspections(minimum 48 hours notice reauired): ❑ Footing -Prior to pouring concrete ❑ Rough HVAC ❑ Backfill-Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab- Prior to pouring concrete ❑ Chimney-One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service CRS #: 0 ❑d Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test 44fBuilding Official's Signature: 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# ❑ New Construction ❑Addition ❑Alteration ❑Accessory Structure ❑ Single'Family ❑ Two-(Family ❑ Townhouse Job Address /173 P/412/‹' tej L Tr- (Number) (Street) (Unit) Job Description R O O F Owner /J G ,t A..4-120 Mailing Address /93 PAR/c AuF EX? City U/v t. ,4 J' / / z'r State CI Zip 0613/2 3/2 Tel 1c ) /pip /2 g/7 Contractor Mailing Address City State Zip Tel Contractor's License/Registration Type&Number Exp. Date 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. Separate applications are required for electrical,plumbing,mechanical, etc. Owner/Agent Signature a Date D 5" / JO / Q Y Construction Value Fee Building $ CP9 $ �� Plumbing $ $ Mechanical $ $ Electrical $ $ Certificate of Occupancy $ /6 Plan Review Fee $ State Education Total $ $ n7C t J (See Wcverse side for additional requirements) • STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: /? �• /� 4 vE' 5- (/ In the town of WV 0 44' j/ ii L-/ e 063 Name of building permit applicant: 13t-RA/fS R p M,¢ 2 7-4`L Please check one: 1. V 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 t o § 3 1-286b, "a property owner o r s ole proprietor [who] intends t o act as a general contractor or principal employer" may provide either a certificate of workers' compensation insurance or a "sworn 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. t/ I do not intend to act as a general contractor or principal employer. [Sign d stop here] a_ ee 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 t hat I w ill require p roof o f workers' c ompensation i nsurance for e very c ontractor, subcontractor, o r o ther worker b efore h e/she engages i n 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 / /e) / No. 0379 From: #60.,/,‘" 6�'/ L�t.f��. ? Job Address: Alia: I Amount $ y 7 (Cash Check Check # Circle one) Received by •dili, _ _ .. ../:<• Permit #/674,0/./ —0 Permit Fee Calculation Spreadsheet MISCELLANEOUS PERMIT CALCULATION Pools&Spas Above Ground Round EA $ 3.150.00 $ Above Ground Oval EA S 5,250.00 $ In-Ground EA $ 18,900.00 $ Heater EA $ 3.465.00 $ Hot Tub EA S 5,250.00 $ Roofing Strip&Reroof SQ $ 207.20 $ Overlay 23 SQ $ 127.05 $ 2,922.15 Plywood SQ $ 101.85 $ - Sheds SF $ 26.25 $ Electrical Service 100 Amp EA $ 816.43 $ 200 Amp EA S 1,519.19 $ 400 Amp EA $ 6,039.29 $ Breezeway/Decks Open SF S 22.31 $ Enclosed SF $ 94.76 $ Porches Open SF $ 62.69 $ Enclosed SF $ 123.90 $ TOTAL BUILDING CONSTRUCTION COST $ 2,922.15 PERMIT FEE Building 2.922 S 16.00 Electrical - S S - S - CO Fee S 10.00 Plan Review $ - State Ed Fee 2,922 $ 0.47 Total Fees $ 26.47 Based on 2003 RS Means Residential Cost Data 5/10/04