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Home My WebLink About27ft Above Ground Pool and 10x20 Deck Electrical Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ex.t 82 Electrical Permit Permit Number: E2002-106 Permit Date: 25-Apr-02 Permit Code R5 Job Location: 33 PARTRIDGE HOLLOW UNIT: MAP/LOT: 028/005-068 Job Description: wiring for pool Owner Contractor MATTHEW R+ LAURA A TRYON Matthew Tryon 33 Partridge Hollow 33 PARTRIDGE HOLLOW Unit: Oakdale,Ct. 06370 OAKDALE CT 06370 Telephone: Lic/Reg Type: Use Group R4 Lic/Reg Number: 0 Code 1995 CABO Exp Date: 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: $0.00 Electrical Fee: $0.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $0.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 Included on Building Permit State Ed Fee: $0.00 Total Fees: $0.00 jt is the owners resoonsibility to schedule the following required 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 O Rough Electrical ❑ Firestopping/draftstopping ❑ Electrical Service ❑ Insulation ❑ Rough Plumbing and Leak Test ❑ Fin. section ❑ Gas Piping and Pressure Test ■ -- icate of Occupancy-Prior to use or occupancy Building Official's Signature: Town of Montville Building Department Permit # d _/O6 310 Norwich-New London Tpke. Tel. 848-7166, Ext 81 Uncasville, CT 06382 Fax. 848-7231 One& Two Family Trades Permit Application Form Tfum6ing ]Electrical 1119Kechanicaf I .7feating Air Conditioning Other _gas Piping Job Location 33 Jlr'� l(i € , ! � Job Description/Materials Mailing Address City 06.V. k$1 State ( t Zip (Ace-TO Tel 9r) (4-11Qi trTh.p Contractor Mailing Address City State Zip Tel 1 / 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. Owner/Agent Signature Date Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education Total S 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 r ..iik r f 101 oar. In the town of '. AIM. 4 Name of building permit applicant: Please check one: 1- VI am the owner of the above property. 2. I am the sole proprietor of a business. -2A.Name of business E 2B.Federal Employer Identification Number(F .-•.•.----'•----'--' Property owner or ...o.-........ sole proprietor who intends........................... Pursuant to §31-286b,"a contractor or principal employe"may provide either a [ �of workeract ase general insurance or a"sworn notarized affrs compensation insurance for all those •' stating that he will require proof of workers' ose employed on the job site in accordce with this chapter." Please check one: 1. I do not intend to act as a general contractor or principal employer. [Sign and stop here] Signa of applicant 2. intend to act as a general contractor or principal provide a certificate of workers'compensationp � employer.Applicant must either I Vbelow. insurance or sign the affidavit Affidavit ..._.. ... l herby swear and attest that I will require proof of workers'corn ............... contractor,subcontractor,or other worker before he/she engages compensation insurance abo a for every accordance with the Workers'Compensation Act(Chapter 6 ) in work on the above property in I undersand that pursuant to§31-275 C.G.S.,officers partnershipfrom coverage may elect to be excluded of a corporation and partners in a District Office; cragc by filing a waiver with the appropriate and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. -;._, `L , . . L.IL l'1 Si.iaturtof applicant Subscribed and sworn to before me if l �� s day of /0- A , _ /...,_ , / ,2002-- (QX,- (Notary Public/Commissioner of the Superior Court)