HomeMy WebLinkAboutElectrical Upgrade 100 to 200 AMP 2003 Town of Montville
Building Department
Field Inspection Notice
Address: 29 Pennsylvania Avenue
Job Description: Electric Service
Permit Numbers:E2003-0317
Footing Not Approved: Approved:
Comments: 1.
Backfill Not Approved: Approved:
Comments: 1.
Framing Not Approved: Approved:
Comments: 1
Rough Electric Not Approved: Approved:
Comments: 1
Electrical Service Not Approved: Approved: 11/5/03
Comments: 1
Rough HVAC Not Approved: Approved:
Comments: 1.
Rough Plumbing Not Approved: Approved:
Comments: 1
Gas Line Not Approved: Approved:
Comments: 1
Fireplace Throat/ Not Approved: Approved:
Chimney Comments: 1.
Fire/Draftstopping Not Approved: Approved:
Comments: 1
Insulation Not Approved: Approved:
Comments: 1
Certificate of Not Approved: Approved:
Occupancy Comments: 1. t
Not Approved: Approved:
Comments: 1.
Not Approved: Approved:
Comments: 1
Not Approved: Approved:
Comments: 1
Comments:
Page 1 of 1
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext. 382
Electrical Permit
Permit Number: E2003-0317 Date: 16-Oct-03 Map/Lot: 092/154-000 Owner ID
115509
Job Location: 29 PENNSYLVANIA AVENUE
Unit
Job Description: Electric Service
Owner:
Contractor:
Donna L and Roy E Shafer John MacNeil
424 Cherry Lane
29 Penn Ave Oakdale
Ct. 06370-
Oakdale
CT 06370 Telephone: (860)848-1121
Lic/Reg Type/No. El 104051 Exp Date: 30-Sep-04
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 CABG
Mechanical Value: $0.00 Mechanical Fee:
$0.00 Construction Type: 5B
Electrical Value: $1,000.00 Electrical Fee:
$10.00 Permit Code: R5
Other Value: $0.00 Other Fee:
$0.00 Comments:
Total Value: $1,000.00 CO Fee:
$0.00
Plan Review Fee: $0.00
State Ed Fee: $0.16
Total Fees: $10.16
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
❑ Rough Electrical ❑ Insulation
0 Electrical Service ❑ Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature. �/
Town of Montville
Building Department Permit#
310 Norwich-New London Tpke.
Tel. 848-3030,Ext 82 Uncasville, CT 06382 Fax. 848-7231
One & Two Family Trades Permit Application Form
DPlumding EZ1 ctrical 091fechanicaf
.5feating
Air Conditioning
Gas Piping
DOther
Job Location Ci Pr it/sjL (C'
Job Description/Materials C)P G'Q f J F (b 0 A 76 .2-00 ,A I r Sre,-1a' (.i'7-
Ovn -t p)d _ 04 S ass T5-
Owner R O ` S 4 v F'F// Mailing Address ;9 Lva}r..-;1} A OF,
City t9/4 CDA/r State t!T Zip O13 Tel OC) / E57 / 3 Y(IC
Contractor7-::VOL 1 "1 f��-��' Mailing Address (0-
City
C ZCity 04 ("Cr Statee-/ Zip 0637° Tel 'O Ie? '
Contractor's License/Registration Type &Number (" l lO ((O)7 Exp. Date CI / 30 /0
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 . i her a est that the proposed work is authorized by the owner in fee
and that I am authorized to make application f• a permit for • ch work as described above.
wner/Agent S': a Date l0 / / /
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical $ $
Electrical $ f 6 D O-CO
Other
Certificate of Occupancy $
Plan Review Fee $
State Education $
Total
Town of Montville Building Department Receipt
Date /d I 2 I No. 0323 3
From: 11 ; \-7`
/,4._ .e..,...ei
Job Address: �', a-Z�G 1 .�
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Amount $ 41._. Cash Check Check # 7 9y
/ (Circle one) <
Received b ,% _;. Arm Permit # (------O74::),3— , 7
kit . '
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
PL V II rtisr 6
Property located at: D p ,,my _ ' - 4 t/ ' ' U
In the town of /4/osA" ) 0 : /4"
�
Name of building permit applicant: Q—bLA/ 1/11,4-` '
'�fL—
Please cvhe�kDne:
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(NEIN)
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 check one:
1. I do not intend to act as a :- - ,i contractor .r prin 'sal employer.
[Sign and st ere
Signature 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)