HomeMy WebLinkAboutSiding 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: B2004-0571 Date: 08-Sep-04 Map/Lot: 096/004-000 Owner ID: 5351000
Project Location: 189 PARK AVENUE EXTENSION Unit:
Job Description: Siding
Owner Name: Robert N and Barbara A Jean Tenant Name: N/A
Careof:
189 Park Ave Ext
Uncasville CT 06382- Telephone:
Contractor Name: Property Owner Telephone: (860)848-3777
DBA: Lic/Reg Type:
Lic/Reg No: 0
Exp Date:
Construction Value Permit Fees Construction Information
Building Value: $8,000.00 Building Fee: $64.00 Use Group: R-4
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code
Mechanical Value: $0.00 Mechanical Fee: $0.00 w/2000 Amendment
Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B
Total Value: $8,000.00 Penalty Fee: $0.00 Permit Code: R4
C of 0 Fee: $0.00 Comments:
Plan Review Fee: $0.00
State Ed Fee: $1.28
Total Fee: $65.28
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
0 Final Inspection
❑ Insulation ❑ Certificate of Occupancy
Building Official's Approval: �1.L✓
It i
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 0 Addition Alteration 0 Accessory Structure
Single Family 0 Two-'Family 0 Townhouse
Job Address / 3 7 N A k Pt V 6 Eys� qs 1 o-\,, _
(Number) (Street) (Unit)
Job Description \) 11191 411127 ttliA R.�-�
Owner /Rt,4 Cfl t.ti_ Mailing Address -
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City li-i f)k5 V i J I( State e,C) i%vk Zip D(o�,c, Tel V4, 0/ i
Contractor S.6�, Mailing Address ` al al ,- .- Pot -,,i-.±. ,
City U.NC►ft-Ski t I k'. State C WrinZip Dere.--- Tel 8 t6 / 3 y$/ 3 77 7
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 SignatureVirt--sigt - ' ti--- Date l / 7 / 0 y
Construction Value Fee
Building $ l' 0oci $ Z1/
Plumbing $
Mechanical $ $
Electrical $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $ /, 2v' •
Total $ Madam $ 65.2-Y
R
(See&verse side for additional requirements)
4
i
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STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
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Property located at:
In the town of
Name of building permit applicant:
Please check one:
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 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� I do not intend to act as a general contractor or principal employer.
[Sign and stop here
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 insurance for e very c ontractor,
subcontractor, o r o ther w orker 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
848-3030, Ext 382
RESIDENTIAL
CONSTRUCTION PERMIT
SIGN-OFF SHEET
Property Address
Job Description:
The applicant is responsible for the completion of the form,no permit will be issued until all signatures below have been
obtained.
HEALTH DISTRICT 848-3030,Ext.339
Approved No Permit
❑ Permit#: ❑ Required
Septic System Date
Approved No Permit
❑ Permit#: ❑ Required
Private Well Date
WPCA DEPARTMENT 848-3030,Ext 376
Approved No Permit
❑ Permit#: ❑ Required
Municipal Sewer Date
Building Trap ❑ Outside ❑ Inside
Approved No Permit
❑ Permit# ❑ Required
Municipal Water Date
DEPARTMENT OF PUBLIC WORKS 848-7473
Approved No Permit
❑ Permit#: ❑ Required
Director Date
PLANNING&ZONING DEPARTMENT 848-3030,Ext.379
Approved No Permit
❑ Permit#: ❑ Required
Zoning Date
Approved No Permit
❑ Permit#: ❑ Required
Inland-Wetlands Date
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Town of Montville Building Department Receipt
Date c, / 7 / Gc-/ No. 04255
From: 2OBl -T A icA N)
Job Address: /V A 1it=5- .0 xi--
Amount $ �jCj . 2� Cash iiISMIP Check # 2-3/ 7
circle one)
Received by J �—Cm cPermit #,_v 44 —cUr7/