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HomeMy WebLinkAboutFireplace and Chimney 2011 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860)848-3030 X382 FAX. (860) 848-7231 BUILDING PERMIT Permit Number: 82011-0546 Date: 09-Nov-11 Map/Lot: 070/074-000 Owner ID: 5452000 Project Location: 27 PETER AVENUE Unit: Job Description: Prefab Metal Fireplace&Chimney Owner Nam Hormel R.&Ellen C.Bardales Tenant Name N/A Careof: 27 Peter Avenue Uncasville CT 06382- Telephone: Contractor Nam Home Owner Telephone: DBA: �_... ._.__ Lic/Reg Type _ Lic/Reg No 0 Exp Date: _Construction Value_ Permit Fees Construction Information Building Value: $1,000.00 Building Fee: $10.00 Use Group: IRC Plumbing Value: - $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code Mechanical Valu $0.00 Mechanical Fee $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: _ $1,00.0.00 Penalty Fee: $0.00 Permit Code: R4 C of O Fee: $0,00 Comment Plan Review Fe $0.00 State Ed Fee: $0.26 Total Fee Paid: $10.26 It shall be the owners repsonsibility to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING.MECHANICAL.ELECTRICAL PERMIT INSPECTIONS ❑ Footing-Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical ❑ Backfill-Footing drains and waterproofing ❑ Elec Trench-with conduit installed ❑ Concrete Slab-Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor framin ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation . © Certificat- .f Approval ■ I ert ate of Occupancy Building Official's Approval: / • Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.: e0611-0511(10 Type of Work Occupancy Type Permit Type ❑New Construction ,'Single Family "IA Building ['Addition ❑Two-Family El Plumbing g ❑Townhouse ❑Mechanical ❑Accessory Structure ❑ Electrical CRS#: Property Address: 1 1 —Pe+e r- Avg (Number) (Street) (Unit) Job Description: \ c y " ' \ r Owner: %-\o.— r-.e \ \ e.-a '� \�\42- Address: Address: e- City: L\ s \ \cz State: C—C Zip Code: 0 —. Telephone( 0 )%22 - !"3% .\ Applicant: c„w DBA: Address: City: State: Zip Code: Telephone( ) Contractors - Complete the Following: License Type: License No.: Expiration Date: I hereby certify that the proposed work will conform to the State 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. ❑ By checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E33012.1 of the Residential Code, instead of the electrical requirements in chapters 33 through 42 of the Residential Code. Owner/Agent Signature: 62U - .-. -e)c,—LAc � Date: ' \ LA % t Construction Value Permit Fees Building Value: `4 , - �" /d F d o Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: -ora Revrs'ecE August 23,2007 Town of Montville Building Department File Receipt Date: 04-Nov-11 Receipt No: 6945 Received From: Ellen Bardales Job Address: 27 Peter Avenue Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check/Card $10.26 Check/Card $0.26 Check No: 437 Short/Over: $0.00 Construction Value: $1,000.00 Demolition Value: $0.00 Received By Carmen Kneeland v1`v State of Connecticut E. 7A Workers' Compensation Commission „Virg% %ie Please TYPE or PRINT IN INK re Proof of Workers' Compensation Coverage when Applying for a Building Permit for the Sole Proprietor or Property Owner who WILL NOT act as General Contractor or Principal Employer APPLICANT FOR BUILDING PERMIT Name of Applicant for Building Permit Property located at L_ l �Q A- ¢r J.J P_ in the City/Town of L.\ O LS ATTEST If you are the owner of the above-named property or the sole proprietor of a business doing work on the site of the construction project at the above-named property and you WILL NOT act as the general contractor or principal employer,you are not required to have workers'compensation insurance coverage. CHECK ONE(1) BOX ONLY and complete the following: ❑ I am the OWNER of the above-named property.I WILL NOT act as the general contractor or principal employer. Signature of OWNER Applicant- �� �, 4.�___.—45 UI am the SOLE PROPRIETOR of a business doing work at the above-named property.I WILL NOT act as the general contractor or principal employer. Name of Business Federal Employer ID#(FEIN) Signature of SOLE PROPRIETOR Applicant