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Home My WebLink AboutStrip and Re-Roof 2004 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Building Permit Permit Number: B2004-0347 Date: 23-Jun-04 Map/Lot: 103/022-000 Owner ID 119005 Job Location: 33 PODURGIEL LANE Unit Job Description: Strip&Re-roof Owner: Contractor: Todd A and Cheryl A Matthewson Todd Matthewson 33 Podurgiel Lane 33 Podurgiel Lane Uncasville Ct. 06382- Uncasville CT 06382 Telephone: (860)848-7844 L Lic/Reg Type/No. 0 Exp Date: Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $3,937.00 Building Fee: $22.00 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: R4 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $3,937.00 CO Fee: $10.00 Plan Review Fee: $0.00 State Ed Fee: $0.63 Total Fees: $32.63 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 ❑ Electrical Service CRS#: 0 0 Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signator-• Tow!of Montville Building Department 310 Norwich-New London Tpke. Tel.848-3030,Ext 382 Uncasville,CT 06382 Fax. 848-7231 Residential Building Permit Application Form Permit# ❑New Construction El Addition 0 Alteration []Accessory Structure Single Family ❑ Two-Family 0 Townhouse Job Address 3 PGCt/l),rt'e I (^u v Q (Number) (Street) (Unit) Job Description s ' O—CP e '''G o Owner 4 / � Mailing Address City (Jv Cc.Sv. /lp State CT Zip 06,3T 2 Tel d(a0 /J%i / �c., y Y Contractor Mailing Address City State Zip Tel / / 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. Separate applications are required for electrical,plumbing,mechanical,etc. Owner/Agent Signature (2.--r_c_41i Date / /G / G Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ $ (See Weverse side for additional requirements) Town of Montvit Building Department Receipt Date _(:24 L No. 0 3 9 17 From: ('`-------^ f ,/ I Job Address: r...:air: __ � . ._ ori • \ Amount $ — Z-' Cash Check #.,3 7 9' / Circle one) .0.! . ,,..- . Received � r'��; i ' Permit f '7o(j y-- o8(56 ,. N,. � / � � Permit Fee Calculation Spreadsheet MISCELLANEOUS PERMIT CALCULATION Pools&Spas Above Ground Round EA $ 3,150.00 Above Ground Oval EA $ 5,250.00 $ In-Ground EA $ 18,900.00 $ Heater EA $ 3,465.00 $ Hot Tub EA $ 5,250.00 Roofing Strip&Reroof 19 SQ $ 207.20 $ 3,936.80 Overlay SQ $ 127.05 $ Plywood SQ $ 101.85 $ Sheds SF $ 26.25 S Electrical Service 100 Amp EA $ 816.43 $ 200 Amp EA $ 1,519.19 $ 400 Amp EA $ 6,039.29 $ Breezeway/Decks Open SF $ 22.31 $ Enclosed SF $ 94.76 $ Porches Open SF $ 62.69 S Enclosed SF $ 123.90 S TOTAL BUILDING CONSTRUCTION COST $ 3,936.80 PERMIT FEE Building 3.937 S 22.00 Electrical $ CO Fee S 10.00 Plan Review $ - State Ed Fee S 3.937 $ 0.63 Total Fees $ 32.63 Based on 2003 RS Means Residential Cost Data 6/10/04 STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: `3 Po ;Q In the town of AfcA/11—v "i1 e Name of building permit applicant: / ( 'Cj ,/ # 0 S Please check one: 1. >e 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 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. ,K I do not intend to act as a general contractor or principal employer. [Sign 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 Building Department 848-3030, Ext 382 RESIDENTIAL CONSTRUCTION PERMIT SIGN-OFF SHEET Property Address Job Description: The applicant is responsible for the completion of the form,no permit will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030,Ext.339 Approved No Permit ❑ Permit#: ❑ Required Septic System Date Approved No Permit ❑ Permit#: ❑ Required Private Well Date WPCA DEPARTMENT 848-3030,Ext 376 Approved No Permit ❑ Permit#: ❑ Required Municipal Sewer Date Building Trap 0 Outside ❑ Inside Approved No Permit ❑ Permit# 0 Required Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 Approved No Permit ❑ Permit#: ❑ Required Director Date PLANNING&ZONING DEPARTMENT 848-3030,Ext.379 Approved No Permit ❑ Permit#: 0 Required Zoning Date Approved No Permit O Permit#: 0 Required Inland-Wetlands Date