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HomeMy WebLinkAboutRe-Roof 6sq 2001 Town of Montville Building Deparf'inent Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231 Building /Trades Permit Permit Number BP2001-501 Permit Date 8/27/01 Permit Type Building Permit Code R4 Job Street# 38Job Location PEQUOT ROAD Map/Lot 072/035 000 gyp_ Job Description Roofing Strip-6 Sq. Shingles > r ,, u: I E 1 Owner Contractor 1 David Waddington David Waddington Address 33 Pequot Road Address 33 Pequot Road 1 City Uncasville, State Ct. City Uncasville State Ct. IZip 06382 Telephone 848-1692 Zip 06382 Telephone 848-1692 I Lic/Reg Number I ^_ Lic/Reg Type Exp Date: Use Group R4 Code 1995 CABO Type Construction 5B Building Value $1,280.00 SC b Building Fee $10.00 4- 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 Values $1,280.00%6(. C/O Fee $10.00 Comments: Plan Review Fee $0.00 State Ed Fee $0.20 -. ` Total Fees $20.20 - Building Official's Signature Date -?"--/ Z,/ al It is the owners response• i• to, ed e the following required inspections (minimum 24 hours notice required): LjFootings-prior to po ri;/• concrete ❑ Backfill -footing drains and waterproofing ❑ Fireplace Throat ❑Concrete Slab, prior to pouring ❑ Fireplace Final LI Rough Framing ❑ Chimney -one flue above thimble ❑ Rough Electrical LI Firestopping/draftstopping ❑Electrical Service ❑ Insulation [Rough Plumbing and leak test ❑ Pool bonding [j] Gas piping -pressure test and installation © Final Inspection ❑ Rough HVAC ❑ Certificate of Occupancy-PRIOR to use or occupanc Town of Montville Permit#_____ _ 6/ 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 ❑Accessory Structure ['Plumbing 094feclianical Addition ❑Demolztion ❑Electrical [11 Alteration OtFier 7feating Air Comditioning "� Gas`J''Ping Job Location 3 Ise U0 (2a (AAAA 3 ✓1 1 k Job Description/Materials I.jwitiNffli; Ill - I IC U''{2 Owner A di LA-i U_Ot- 11,51( Mailing Address ,53Pe_ (/C) pet City ( ik ta,S V) l 'k_ State ( ( Zip cit, 3 - -Tel g.670 / --'-q---/ (Cv c( )-- Contractor Contractor ( Mailing Address City State Zip Tel / / Contractor's Li '` (� ( Number Exp. Date / / New Home Const, Have you entered in `- ner for the proposed new home? ❑ Yes ❑ No I hereby certify that t \\LIZ,. form to the Basic Building Code and all other codes as adopted by the State of Connecticut ai and further attest that the proposed work is authorized by the owner in fee and that I am author, -"" ii for a permit for such work as described above. di Owner/Agent Signature / e / Date g / a` - / Construction Value Fee Building $ / ? (79 ! $ /i2 Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ ,.-- Plan Review Fee $ State Education $ 0 Total $ / () ,i $---- '17C) '62 l-) STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (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) Town of Montville Buildiug Department Receipt i Date g--/tea / 0 / No. 01012 From: ` • ._ A ..0- — – Job Address: 33L (;) Amount $ 32 OA&C::# 1111110 Check Check # Circle onc) Received by ./•',_ -_ ,,��_ . '' /i.. Permit N a/–,6'‘)/ f Town of Montville Bui-ldipg Department Receipt is 2 Date 9 1 2 7 1_c( No. 01123 i_ vse '----- - - - From: Job Address: 3 8-- it...), r-7.,- l' Amount $ - i2_0_ Cash ( Check #; g 73) 7 490 Circle one) or At Received by , a Permit # / o/—f5