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Home My WebLink About2003 - 24x30 Garage - Electrical Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Electrical Permit Permit Number: E2003-0122 Date: 23-May-03 Map/Lot: 028/005-073 Owner ID 114514 Job Location: $4 PARTRID E Hn� i nw Unit Job Description: Electrical for garage addition Owner: Contractor: David and Michele Palmer Wayne R.Thompson Jr. 31 Lisbon Heights 34 Partridge Hollow Lisbon Ct. 06351- Oakdale CT 06370 Telephone: (860)376-3148 Lic/Reg Type/No. El 181667 Exp Date: 30-Sep-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 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: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $0.00 CO Fee: $0.00 Included on Building Permit Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fees: $0.00 It is the owners responsibility to schedule the following inspections(minimum 48 hours notice required): ❑ 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 0 Rough Electrical ❑ Insulation ❑ Electrical Service ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test 40)1111., Building Official's Signature: Town of Montville Building Department Permit#k-,0n -- 0 1 Z--z- 310 Norwich-New London Tpke. Tel. 848-3030,Ext 82 Uncasville,CT 06382 Fax. 848-7231 One &Two Family Trades Permit Application Form (]Plumbing ,electrical []Mechanical 5feating .Air Conditioning ❑Other Gas Piping Job Location 3 V Pc,.r+rij e 1(0 (3 Job Description/Materials /Ai ti-.T.C./5 <f)4- 6r0.-l'a c a cipf c`±.O 4 Owner Mailing Address City State Zip Tel / / Contractor iicJ(ie 4C✓)'� � 0-4-MailingAddress31 L,c' ,'t f-5 City 4;5 i. ,i'x State CT Zip aha 37 Tel e / 57q/ 3/L/c Contractor's License/Registration Type&Number l- f -/(ow 7 Exp. Date 2 1 30 / 6 3 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 1-B / -QK Et=gDate Slti/ l.1',3 Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ Electrical $ 512 Other $ $ $ Certificate of Occupancy Plan Review Fee $ •State Education $ $ Total $ STATE OF CONNECTICUT ` DEPARTMENT OF CONSUMER PROTECT!0\ ELECTRICAL UNLIMITED CONTRACTOR WAYNE R THOMPSON JR 31 LISBON HGTS LISBON,CT 06351 TYPE: El LIC./REG NO. EFFECTIVE EXPIRES 181667 10/01/2002 09/30/2003 SIGNED µyy C'�]/��yi • STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: 31 Pcr-1-r�` � L i (v ".. In the town of i'2 'rvfj�"/ 1 Name of building permit applicant: !Jae nC 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(FUN) 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 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 ch k one: 1. i I do not intend to act as a general contractor or principal employer. [Sign and stop 1195s]cy.A 44,h Signature gnatureo f 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) Town of Montville Building Department 848-3030,Ext 82 ONE&TWO FAMILY CERTIFICATE OF OCCUPANCY SIGN-OFF SHEET � lcb PVWO IJGc' Prop rty Address Job Description: &c:/, f L/2.-- The owner/agent shall be responsible for the completi of the form, no certificate of occupancy will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030-339 Approved ❑ Permit#: ❑ Not Applicable Septic System Date Approved O Permit#: 0 Not Applicable Private Well Date WPCA DEPARTMENT 848-3030,Ext.376 Approved ❑ Permit#: 0 Not Applicable Municipal Sewer Date House Trap 0 Outside 0 Inside Approved ❑ Permit# 0 Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 Approved Director Date ❑ Permit#: 0 Not Applicable PLANNING ONING DEPARTMENT 848-3030.Ext.379 • • ejc,a),24.--09In-Compliance 67�.3 2 Permit#: r� �) ? ❑ Not Applicable Zoning ate In-Compliance ❑ Permit#: 0 Not Applicable Inland-Wetlands Date 6/28/2002