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Home My WebLink About8x10 Shed 2001 Town of Montville Building Department Phone: 848-7166 310 Norwich New•London Tpke Fax: 848-7231 Building / Trades Permit Permit Number BP2001-700 Permit Date 11/16/01 Permit Type Building Permit Code R9 Job Street# 40 Job Location PHEASANT RUN Map/Lot 028/005-056 Job Description Shed Owner Contractor David M. Berube David M. Berube Address 40 Pheasant Run Address 40 Pheasant Run City Oakdale State Ct. City Oakdale State Ct. Zip 06370 Telephone 367-0869 Zip 06370 Telephone 367-0869 Lic/Reg Number Lic/Reg Type Exp Date: Use Group R4 Code 1995 CABO Type Construction 5B Building Value $2,000.00 Building Fee $10.00 Plumbing Value $0.00 Plumbing Fee $0.00 Mechanical Value $0.00 Mechanical Fee $0.00 Electrical Value $0.00 Electrical Fee $0.00 Other Value $0.00 Other Fee $0.00 Total Values $2,000.00 C/O Fee $10.00 Comments: Plan Review Fee $1.00 .... ...... ... State Ed Fee $0.32 T• -1 Fees $21.32 BuildingOfficial's Signature 9 a2�� l�l�c� Date /1/ /6 / �/ It is the owners responsibility to schedule the following requir inspections (minimum 24 hours notice required): L,Footings-prior to pouring concrete ❑ Backfill -footing drains and waterproofing CI Fireplace Throat Concrete Slab, prior to pouring ❑ Fireplace Final ❑ Rough Framing ❑ Chimney -one flue above thimble ❑ Rough Electrical Cl Firestopping/draftstopping ❑Electrical Service El Insulation [Rough Plumbing and leak test CI Pool bonding ❑ Gas piping -pressure test and installation CI Final Inspection ❑ Rough HVAC d Certificate of Occupancy-PRIOR to use or occupanc tiir• IVO Town of Montville Permit # - 'z' Building Department 310 Norwich-New London Tpke. Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231 Application for Building or Trades Permit Building Permit Trades Permit New Construction 0 Accessory Structure ��fumbing []Mechanical Md tion El�Demol tion [1]Alteration ptf�, �`E��' f sfeating Air Cotioning Gas lcping Job Location LI d Pt)EA5f'kii QvN C)fl✓On r^E Cl Ob-.370 Job Description/Materials PRE - go 3715 s n E i) c x 1 b ( )M E U5 Owner Pkv,9 M SCRUi56 Mailing Address Hp Pt1r`{ I AJ; 120k) City ( Ki)flLE State Cr Zip 06330 Tel (b0 / 3&1 i c$6ci Contractor SEL r Mailing Address City State Zip Tel / / Contractor's License/Registration Type&Number Exp. Date / / New Home Construction Contractors: Have you entered into a contract with a consumer for the proposed new home?❑ Yes ❑ No 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 SignatureDO / fe Date // / / 15 / Cli Construction Value Fee Building $ .,,,; o�O — $Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ / D O G Plan Review Fee $ State Education $ D U Total $ .- ()Q r) $ 1 j a7 Permit Fee Calculatior Spreadsheet MISCELLANEOUS PERMIT CALCULATION Above Ground Round EA $ 3,000.00 Oval EA $ 5,000.00 In-Ground,including fence&patio EA $ 18,000.00 Roofing Strip&Reroof SQ $ 210.00 Overlay SQ $ 175.00 Siding Sheds With Electric SF $ 25.00 $ No Electric 80 SF $ 25.00 $ 2,(100.0L. Deck SF $ 15.00 $ TOTAL BUILDING CONSTRUCTION COST,LESS MEP $ 2,000.00 PERMIT FEE Building $ 10.00 Electrical $ - CO Fee $ 10.00 Plan Review $ 100 State Ed Fee 2,000 $ 0.32 Total Fees $ 21.32 Based on 2000 Average Construction Cost 11/15/01 Town ofontville Building Depart', Receipt f Date /1 / „/ /_�_ No. 01288 C From: ,di)a_4,-e.:d '')/1 /I:\ -sililal........,_ Job Address: 1 /;- , ; * /__ Amount $ 42/ • 32 as Check Check # X(')0 i (Circle one) r Received by. r,,. __ _. _ -17.• Permit # _ ,0 STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn.� Gen. Stat. § 31-2866) / Property located at I Y fI6,7s fiII J; k(rJ In the town of NTvjLLC, Name of building permit applicant: }/i 6 M key 66 Please check one: I. 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 notarized 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. [Sigp 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 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) 'S Town of Montville Building Department 848-7166 CONSTRUCTION PERMIT SIGN-OFF SHEET ONts,qSckkj2F Property Address Map/Lot Job Description: U x l U S tl The owner/agent shall be responsible for the completion of the form, no construction permit will be issued until all signatures below have been obtained. HEALTH DISTRICT 823-1189 ❑ ' #: ❑ Not Applicable Septic System Date ❑ Approved E, Not Applicable Plans for Food Service Establishment Date ❑ Permit#: ❑ Not Applicable Private Well Date WPCA DEPARTMENT 848-7094 ❑ Permit#: ❑ Not Applicable Municipal Sewer Date ❑ Permit# ❑ Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 ❑ Permit# ❑ Not Applicable Director Date POLICE DEPARTMENT 848-7510 ❑ Plan Reviewed ❑ Not pplicable Officer in Charge Date PLANNING & ZONIN DEPARTMENT 848-8549 /k746,1,} 1/ Permit#: / �5a (/ ❑ ,�o J- � Y ❑ Not Applicable Zoning Date 114 • ❑ Permit#: []-' Not Applicable Inland-Wetlands Date FIRE MARSHAL'S OFFICE 848-1175 Review ❑ APPrdwd ❑ Not App i ble Fire Marshal Date