HomeMy WebLinkAboutFrame Apartment Building Temporary Electric 0 Town of Montville 3
Building Department
Date__5_1/.,2_/_0_43 Field Inspection Notice Permit # i a640 5.- w
Job Loca :In 3‘ - 7 Pa..te . ?v— ,
/ Approved Type of Inspection / t /e. r/ 4
Not Approved - Please call for re-inspection when the following corrections have been completed:
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Building Offic alCr
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext. 382
Electrical Permit
Permit Number: E2003-0094 Date: 08-May-03 Map/Lot: 033/017-K00 Owner ID 118506
Job Location: 36 PLATOZ DRIVE Unit
Job Description: Temporary Electric Service
Owner: Contractor:
Artemis G Mandes Ray Szymanski
81 Bishop Road
11 Devonshire Drive Bozrah Ct. 06334-
Waterford CT 06385 Telephone: (860)889-7581
Lic/Reg Type/No. El 104212 Exp Date: 30-Sep-03
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 CABO
Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B
Electrical Value: $200.00 Electrical Fee: $10.00 Permit Code: C5
Other Value: $0.00 Other Fee:
$0.00 Comments:
Total Value: $200.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $0.03
Total Fees: $10.03
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 ❑ Final Inspection
• Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature: � ��� /
4s -
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
ElPfumding v fectrica! DMechanicaf
5leating
J it Condfitioning
Gas Piping
Other
Job Location 36 ?' a'f'o - r-•�,, l� c-R S ����-
Job Description/Materials I� .4 S��v; e
Owner _-- Q.��I, ���
= r Mailing Address_
Cit a f� '` �/ Sta 70 Tel
Contractorga Sly Min% �; Mailing Address
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City t 7 r-c - State G Zip G 33 `f Tel 8� ' /82'7 / 7 S3/
Contractor's License/Registration Type &Number I U y Z( Z �. ` Exp. Date ? /3 0 / a 3
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 Date -7 / G2 o
snstruction Value Fee
Building $ $
Plumbing $ $
Mechanical $ $
Electrical $ )v 0
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $ 4r--o
Total $ Zoo $ ,�
i
i STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: 31 P1' '2. ))r-In the town of b s v A\ C"-t
Name of building permit applicant: (--- ‘/ -32 C S lc'
y
Please check one:
1. I am the owner of the above property.
2. p/lam the sole proprietor of a business. l
2A. Name of business: y r•.t G-.cif t I.-c`-76,'c
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. ✓I do not intend to act as a eneral contractor or principal employer.
(Egnand`top he
Sig allure .4� ppl ci 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 n quired to have coverage unless he files his intent to accept coverage.
7
Signature of applicant
Subscribed and sworn to before me this day of 200_.
(Notary Public/Commissioner of the Superior Court)
ro
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
ELECTRICAL UNLIMITED CONTRACTOR I
RAYMOND F SZYMANSKI
81 BISHOP RD
BOZRAH,CT 06334
TYPE: El
LIC./REG NO. EFFECTIVE EXPIRES
104212 10/01/2002 09/30/2003
SIGNED
Town of Montville Building. Department Receipt
Date / zy / 03 No. 02668
From: /-?e2jz-t- YMoNJh)
Job Address: �s2/ ,P�.&jba 27121 vt
Amount $ /O .03- Cash4091° Check # 363`1
vc c one)
Received by ✓�`trie% Permit # z<2,,7- GQ1)-