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HomeMy WebLinkAboutGarage and Bathroom Electrical Work 2001 do Town of Montville Ne_e ritu Building Department 6 ! C 'E' Date J/ /� � Field Inspection Not' e Permit#,9/0f4j/- 7/O Job Location a_f — i r 44 /� 0/1 Approved Type of Inspection /A - I - _ a-�, -e IP I' Not Approved - Please call for re-inspection when the following corrections have been completed: Building • ti cial Town of Montville Building Department Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231 Building /Trades Permit Permit Number BP2001-720 Permit Date 12/13/01 Permit Type Building Permit Code R4 Job Street# 14 Job Location PARTRIDGE HOLLOW Map/Lot 028/005-078 Job Description Alteration Owner Contractor John Keagan _ John Keagan Address 14 Partridge Hollow Address 14 Partridge Hollow City Oakdale State Ct. City Oakdale State Ct. Zip 06370 Telephone 848-3167 Zip 06370 Telephone 848-3167 Lic/Reg Number Lic/Reg Type Exp Date: Use Group R4 Code 1995 CABO Type Construction 5B Building Value $300.00 Building Fee $10.00 Plumbing Value $0.00 Plumbing Fee $0.00 Mechanical Value $0.00 Mechanical Fee $0.00 Electrical Value $1,000.00 Electrical Fee $10.00 Other Value $0.00 Other Fee $0.00 Total Values $1,300.00 CIO Fee $0.00 Comments: Plan Review Fee $0.00 State Ed Fee $0.21 ytal Fees $20.21 Building Official's Signature � ��? Date/a /A/ /0/ It is the owners responsibility to schedule the following require inspections (minimum 48 hours notice requested): Ei Footings-prior to pouring concrete ❑ 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 ❑ Pool bonding [ Gas piping -pressure test and installation © Final Inspection ❑ Rough HVAC ❑ Certificate of Occupancy - PRIOR to use or occupanc Town of Montville Building Department Receipt Date /1 / & / a) No. 01312 From: Job Address: /1/ �A jzyziT�C C ,- U-oc• Amount $ OC . Cash Check Check # (circle one) Received by g Permit # goo I— 720 Town of Montville Permit# 0 Pao0 I -7 ao 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 El Addition n�DemoGtion ❑�Plum6ing ��fecCranicaC ❑Alteration ❑Other �ilectricaC 51-eating Air Conditioning —Gas ung Job Location ' (/ Pa f r r d,e ,//a//e'ci Job Description/Materials O /9.4-,p C; rc---; r Rex a., d / o/,,67 a-r/. 7 f y / CC s•t,, /e, r eT"f..„../h-4../....„J-7_ cbn s -r v � b/yw4 1l Cry E Owner To 4„ k e c u.1 Mailing // Address /7 Ph/Tc, Jge_ /lc//Al,/ City O /Cd a/e State C % Zip 476-J /e Tel Il'60 / evil J/6 7 Contractor Se / F Mailing Address 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 ❑ 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,- (;7/. i // a Date / v2 g/ / Construction Value Fee Building $ s— $ /J_ Plumbing $ $ Mechanical $ $ Electrical $ /oou— $ /moi Other $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ a • Z_/ $ lam'«rte $ -,-70 •7.---j STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Buildin: Permit Affidavit for Prose Owners or Sole Pros rietors (Conn. Gen. Stat. § 31-286b) 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 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 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 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)