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HomeMy WebLinkAboutGas Heater and Line 2002 Town of Montville eijip Building Department Date f /ZZ / oZ Field Inspection Notice Permit # Job Location 77 POFz AVO... tpproved Type of Inspection 6(AS i r 4 cP(fl NCo 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 860-848-7166, Ex.t 81 Mechanical Permit Permit Number: M2002-010 Permit Date: 18-Jan-02 Permit Code R4 Job Location 177 PARK AVENUE EXTENSION UNIT: - MAP/LOT: 096/007-000 Job Description: gas line&gas heater Owner Contractor JOHN W JR+SUSAN L MAXON John Maxon 177 Park Avenue Extension 177 PARK AVE EXT Unit: - ,Uncasville,Ct.06382 UNCASVILLE CT 06382 Telephone: 848-9603 Use Group R4 Lic/Reg Type: Lic/Reg Number: 0 Code 1995 CABO Exp Date: Construction Type 55 Construction Values Permit Fees _ Building Value: $0.00 Building Fee: $0.00 Plumbing Value: $0.00 Plumbing Fee: $0.00 Mechanical Value: $300.00 Mechanical Fee: $10.00 Electrical Value: $0.00 Electrical Fee: $0.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $300.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.05 Total Fees: $10.05 It is the owners responsibility to schedule the following required inspections(minimum 48 hours notice requested): ❑ Footing-Prior to pouring concrete El 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 0 Final Inspection N Gas Piping and Pressure Test ❑ -•• . - . • c ':ncy-Prior to use or occupancy Building Official's Signature: Town of Montville Permit # /442D0 - O 1 d Building Department 310 Norwich-New London Tpke. Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231 Application for Building or Trades Permit Building Permit Trades Permit ❑New Construction 0 Accessory Structure ❑Action �rDemorstion ❑2'lum6ing LQafedianical ❑ ❑Alteration 0Other ` ectrtcal ?feating Air Conditioning 2- - Gas Piping Job Location 11 q P Aeg... 4VE ek 7-- UoC^,As V/LLE Job Description/Materials ap✓/A.)C-7 (,f S' L f#-3 4,_ j#Jsr4(jj, -, 62,4s' Owner JOnr/J 'I-/,d eco Mailing Address i el/Zic Avv E r- City IADC.4 Vf t.1.- State e_I Zip C' , Tel Box) / / qua 3 Contractor ' Mailing Address 5-41-le. City State Zip Tel / / Contractor's License/Registration Type&Number Exp. Date / / New Home Construction Contractors: Have you entered into a contract with a consumer for the proposed new home? ❑ Yes 0 No 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 ---Z=4,3- 21.A._ _ Date b/ / /S' i O';)'--- Cons ru. ion Value Fee ,� Building $ $ Plumbing $ $ Mechanical ,- Electrical $ C>$ Other $ $$ Certificate of Occupancy $ Plan Review Fee $ State Education Total $ © $. . ®� /'l1 rTj ,3--- STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at 619- PAeK Q L T In the town of i-It?1k-Y1 t/,, uC Name of building permit applicant: •Jo,-j-,�_3 I-4 A>CO3J Please check oge: 1. 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 to § 31-286b, "a property owner or sole proprietor[who] intends to act as a general contractor or principal employer"may provide either a certificate of workers'compensation insurance or a"sworn notarized 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. I do not intend to act as a general contractor or principal employer. [Sign a%I stop h• • _411i Si:nature of applican V 2. intend to act as a Tneral 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 proof of workers'compensation insurance for every contractor, subcontractor, or other worker before he/she 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 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) IfTown of Montville Building Department Receipt 4 16 Date / / /�' / a a No. 01419 IL From: ,.....4 o cv.____re„,t_x_p_ Job Address: 7 I (;) Amount $---/-4,-• -. Cash Check Check # (circle one) Received by /ice ',i' .�:.+►i j ,i Permit # �Yf a �,.�, 0/.