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Home My WebLink AboutRe-Roof Overlay 2003 • Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Building Permit Permit Number: B2003-0181 Date: 08-May-03 Map/Lot: 033/017-K00 Owner ID 118506 Job Location: 36 PLATOZ DRIVE Unit Job Description: Roofing Overlay-both 36&46 Platoz Owner: Contractor: • Artemis G Mandes Nelson Building&Construction 511 Fitch Hill Road 11 Devonshire Drive Uncasville Ct. 06382- Waterford CT 06385 Telephone: (860)848-1182 Lic/Reg Type/No. HIC 573264 Exp Date: 30-Nov-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $7,000.00 Building Fee: $40.00 Use Group: R2 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1996 BOCA Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: C4 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $7,000.00 CO Fee: $25.00 Plan Review Fee: $0.00 State Ed Fee: $1.12 Total Fees: $66.12 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 El Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: Town'of Montville Building Department Permit# 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231 One &Two Family Building Permit Application Form EJ Vw Canstruction 0 Addition. [J iteration Ei Accessory Structure El/Other Job Location -3C 7 P1 q i ZL -1)c_, Gicc .z-J . 32, • Job Description/Materials R -P O ex_ `rc1/4.\S.4-cn5 QE4j 6.0 s, 4 1-3. I -hAid bc.4; 0in5, Owner JoL-- Io.n ik F Mailing Address 1\ V On `n,R,"., �. f-„ . City U,.J r14 t rc. ? a State i• Zip 663 Vc Tel / Vi 3/ t W Y Contractor Gast3►--, Vx.,+•la\6, Mailing Address S---1 1 c.VCIA tk. 1 ` Pei • City tk n C Pir V c 1 Q State el-- Zip OC 32 Tel /Y?/ /(k l. Contractor's License/Registration Type&Number S-7 32 C: cil Exp.Date 1/ / 3° / C.)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 0 y��fZ� C- 3d 0 � —� / f"clz--- Date l / / Construction Value Fee Building $ -7066`- $ Plumbing $ $ Mechanical $ $ Electrical $ $ , Other $ $ Certificate of Occupancy $ Yy Plan Review Fee $ 4( State Education $ //7R- Total $ $___� ff (See*verse Birk for arational requirements) Town of Montville Building Department Receipt Date 5 / / / 03 No. 02706 From: IQ F44- , U/L Job Address: s - 96 P4-A7O_ Amount $ 6.6 ./Z Cash alaw Check (circle one) Received by ,, y�,\� Permit # _o g k STATE OF CONNECTICUT WORKERS' COMPENSATION COMIVIISSION 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 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 requir o have coverage unles a files his intent to accept coverage. C. v Signature of`applicant Subscribed and sworn to before me this L t al s' " day of p r Li __ 200'3 Ci.A-X-6--.4..alaaSd - — (Notary Public/Commissioner of the Superior Court) NOTARY PUBL% v t: OMISSION EXPIRES OCT.31,2007 4 Town of Montville 'T Building Department 848-3030,Ext 382 ONE&TWO FAMILY CONSTRUCTION PERMIT SIGN-OFF SHEET Property Address Job Description: The owner/agent shall be responsible for the completion of the form, no certificate of occupancy will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030-882 Approved ❑ Permit#: ❑ Not Applicable Septic System Date Approved ❑ Permit#: ❑ Not Applicable Private Well Date WPCA DEPARTMENT 848-3030,Ext.881 Approved ❑ Permit#: 0 Not Applicable Municipal Sewer Date House Trap ❑ Outside 0 Inside Approved ❑ Permit# ❑ Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 Approved ❑ Permit#: ❑ Not Applicable Director Date PLANNING &ZONING DEPARTMENT 848-3030.Ext.81 In-Compliance ❑ Permit#: ❑ Not Applicable Zoning Date In-Compliance ❑ Permit#: ❑ Not Applicable Inland-Wetlands Date • 4 Uncal Health Dist 372.W.Main Street-2"Floor Norwich,CT.06360-5450 Phone No. (860) 823-1189 791 FAX No. (860) 887-7898 E-Mail: office@uncashd.org finternet:http://www.uneashd.org Serving the People of Norwich and Montville �cashd.org APPLICATION TO CONSTRUCT AN ADDITION,DECK,POOL OR OR TO CHANGE THE USE OF A BUILDING GARAGE Owners Name: Phone Number. Property Address: Number of Bedrooms: Approval requested to: Construct an addition 0 Number of rooms: Sizeof addition: • Use of addition: Construct a deck❑ Size of deck: Construct a shed ❑ Size of shed: • Type of foundation? Install a pool Inground❑ Above ground❑ Size of pool: Install a garage 0 Size of garage: Other 0 Description and dimensions: Change the use of the building or rooms in the building ❑ Description of P change: Review Fee$25.00 Site Investigation Fee$50.00 Total Fee$ Fee Paid$ Cash Check# Receipt# *A plot plan showing the location of the existing building,any garages,pools, etc.,the septic system and the well must be submitted.additions,decks, *For an addition, a floor plan of the existing house and the proposed addition must also be . submitted. *If test hole and percolation test data is not available,then a test hole( )m percolation test performed. � ) be dug and a *If the exact location of the septic tank&leaching field are not available,the owner must have requirements are them located,if deemed necessary,to ensure that all separating distance m met. Owner or Agents Signature Date • e • . a G) r z (7 O cl tri o n0 r •tty 0 ell � rli n T `tea. �7d ►► co C" C y N r 1-411 Wri z : c � t-4 zy C) W