HomeMy WebLinkAboutSiding and Windows 2003 Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext. 382
Building Permit
Permit Number: B2003-0495 Date: 05-Sep-03 Map/Lot: 103/018-000 Owner ID
119010
Job Location: _43 PODURCIEL LANE Unit
Job Description: Siding&Windows
Owner: Contractor:
Joseph F Jr and Noreen R Ladyga Jeffrey Gibson
143 Black Point Road
43 Podurgiel Lane Niantic Ct. 06357-
Uncasville CT 06382 Telephone: (860)460-4669
Lic/Reg Type/No. HIC 576420 Exp Date: 30-Nov-03
Tenant:
Self
Telephone:
Construction Values Permit Fees Construction Information
Building Value: $12,000.00 Building Fee: $70.00 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: $0.00 Electrical Fee:
$0.00 Permit Code: R4
Other Value: $0.00 Other Fee:
$0.00 Comments:
Total Value: $12,000.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $1.92
Total Fees: $71.92
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 0 Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature: / //
I
! Town of Montville
' Building Department Permit#
310 Norwich-New London Tpke. e63— ��S
Tel. 848-3030, Ext 382 Uncasville, CT 06382
Fax. 848-7231
One & Two Family Building Permit Application Form
❑ New Construction [ }Addition 0 Alteration 0 Accessory Structure
`)Other e,...LIffe ( )'(\
Job Location 43 Pr-oit.wa j L
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Job Description/Materials V1"yl S.c1,1nt eintire ho..,,se.
Owner J 2 e L�(y50L- Mailing Address 13 Pc h ; ( Lh-
City farIcbis()Ale
I State C T Zip Tel / /
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Contractor 70(\. Mailing Address IR Wcs f- cam(
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City ia►�`t�
State C% Zip 06" > S'7 Tel P'/O / 1 / 5c-66 i
Contractor's License/Registration Type&Number _57 6 1J-0 Exp. Date / / / '3 p i •O-
:
140 en o --Tnigo/�0czc144,,vir
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 /r., i / 1 /
Date e`•3
Construction Value Fee
Building $ I a,,0 OD
Plumbing $ $ 767 r
Mechanical $ $
Electrical $ $
Other $
$ $
Certificate of Occupancy $ ^,
Plan Review Fee
State Education $ ).
Total $ 9 2
$ )Zoc t— $ 7l, 9 z,
(See Reverse side for additionafrequirements)
Town of Montville Building Department Receipt
Date �__
� �°— No. 03127
From: ,,
• Jr Toa► 11J
Job Address: 3 r
Amount $�_ Cash
4 ► Check
(Circle one)
Received by
Permit # ay.r._ o5
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: 4 3 Pr-0 ( L,h
In the town of (A,rve,64't) (le.
Name of building permit applicant: Teq ,lard,et_
Please check one:
1. �I am the owner of the above property.
7( I
2. am the sole proprietor of a business.
2A. Name of business: _ , I ,A, f e e",b r /,'
2B. Federal Employer Identification Number(FEIN) D 5 'D 4-/¢r
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 checone:
1. V I do not intend to act as a general contractor or principal employer.
[Sign and stop here/
Signature of _ li,ant
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)
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
HOME IMPRO. CONTRACTOR
S GSON
14143,111'A'I KP 1 'RD
DBA GIBBON Eh R REMODELING
LIC./REG NO. EFFECItIV 4: EXPIRES
576420 -7- ,t,?/0 tN£t 11/30/2003
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SIGNED r