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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: 82016-0393 Date: 13-Oct-16 Map/Lot: 092/154-000 Owner ID: 5399000
Project Location: 29 PENNSYLVANIA AVENUE Unit:
Job Description: Closeout 1990 Addition Permit
Owner Nam Donna L and Roy E Shafer Tenant Name N/A
Careof:
29 Penn Ave
Oakdale CT 06370- Telephone:
Applicant Name Roy E Shafer Telephone:
DBA: Lic/Reg Type
Lic/Reg N 0
Exp Date:
Construction Value Permit Fees Construction Information
Building Value: $0.00 Building Fee: $0.00 Use Group: IRC
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code
Mechanical Valu $0.00 Mechanical Fe
$0.00
Electrical Value: $0.00 Electrical Fee:
$0.00 Construction Type IRC
Total Value: $0.00 Penalty Fee:
$0.00 Permit Code: C3
C of 0 Fee: $000 Comment
Plan Review Fe $0.00
State Ed Fee: $0.00
Total Fee Paid: $0.00
It shall be the owners repsonsibiiity 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.
BUILDING PERMIT INSPECTIONS PLUMBING.MECHANICAL,ELECTRICAL PERMIT INSPECTIONS
❑ Footing-Prior to pouring concrete _ R Plumbing and leak test
❑ Deck Piers R Electrical
❑ Backfill-Footing drains and waterproofing Elec Trench-with conduit installed
❑ Concrete Slab-Prior to pouring concrete Pool Bonding
❑ Anchor Bolts-with sill plate and prior to floor frami [ ; Electrical Service CRS No: 0
• Framing R HVAC
Masonry Fireplace Throat or Chimney Thimble Li Gas Piping and leak test
• Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION
Insulation ❑ -rtificate of Approval
icate of Occupancy
Building Official's Approval:
"or
Town of Montville
Building Department
310 Norwich-New London Tpke.
TeL 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231
RESIDENTIAL PERMIT APPLICATION FORM Permit No.: $26/6 -c9 3
Type of Work Occupancy Type ermit T e
*New Construction L Single Family
Addition ❑Two-Family Plumbing
Alteration 0 Townhouse 0 Mechanical
0 Accessory Structure • CRS#:
Property Address: 2 ?E-1\11\1Sy I l Pr N 111jk L'
(Number) (Street) 1 (Unit)
Job Description: oActs C /970 � �T/D� /-2t1Z /i
Owner: Re hrs(�
Address: P� n]v zilid i 4 !/) 6
City: / �� State: 7 Zip Code: le6S70 Telephone( ) 40J_IP7-
Applicant:
DBA:
Address:
City: State: Zip Code: Telephone( )
Contractors -Complete the Following:
License Type: License No.: Expiration Date:
I hereby certify that the proposed work will conform to the State 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.
❑ By checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Code,
instead of the electrical requirements in chapters 33 t rou h 42 of the Residential Code.
Owner/Agent Signature: Date: ///
Constructig Value Permit Fees
Building Value: Building Fee:
Plumbing Value: Plumbing Fee:
Mechanical Value: Mechanical Fee:
Electrical Value: Electrical Fee:
Total Value: Penalty Fee:
C of O Fee:
Plan Review Fee:
State Ed Fee:
Total Fee:
Revised August 23,2007
v�v State of Connecticut
T Workers' Compensation Commission
•
7A
•
•
:��% Please TYPE or PRINT IN INK ce
Proof of Workers' Compensation Coverage when Applying
for a Building Permit for the Sole Proprietor or Property Owner
who WILL NOT act as General Contractor or Principal Employer
APPLICANT FOR BUILDING PERMIT
/?01/ :5 W7/
Name of Applicant for Building Permit
Property located at /9 ��4/2 ,-AAri-e,
intheCity/Townof O A I ' 0/h4�/
ATTEST
If you are the owner of the above-named property or the sole proprietor of a business doing work on the site of the construction project at the above-named
property and you WILL NOT act as the general contractor or principal employer,you are not required to have workers'compensation insurance coverage.
CHECK ONE(1) BOX ONLY and complete the following:
LJI am the OWNER of the above-named property.I WILL NOT act as t neral contractor or principal employer.
/4111.°
Signature of OWNER Applicant
❑ I am the SOLE PROPRIETOR of a business doing work at the above-named property.I WILL NOT act as the general contractor or principal employer.
Name of Business
Federal Employer ID#(FEIN)
Signature of SOLE PROPRIETOR Applicant
Town of Montville
lk Building Department
CONSTRUCTION PERMIT APPROVAL
Ax,z9/1:4179 (1/6/ii4, g-6LF7d
Ae14041dress
Job Description
Required
Department
Approval ' Permit Issuance Approval
Tax Collector /
Signature/date
Comments:
Fire Marshal
Comments: Signature/date
❑ Planning &Zoning
Required for all permits except Signature/date
Plumbing,Electrical,Mechanical, Roofing,Siding,Windows&Doors
❑ Health Department
Required for properties with private septic or well Signature/date
Comments:
WPCA, Administrative f�(/1�.2. � W t 104
Required40
for properties on sewer l
Signature/date
Comments:
❑ WPCA, Operations
When Required by WPCA Signature/date
Comments:
❑ Department of Public Works
Required when project includes driveway work or certain drainage requirements Signature/date
Comments: -
❑ Montville Police Department
Required for all permits EXCEPT one and two family residential Signature/date
Comments:
❑ Copy of State Dept. of Transportation Certificate
Required for Structures over 100,000 sq.ft.or with more than 200 parking spaces-Official copy of STC Certificate of Operation required—per
CGS 14-311
Signature/date
Building Department Final Inspection
Revised5farch23,2015