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Home My WebLink AboutLP Line to Stove 2017 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 MECHANICAL PERMIT Permit Number: M2017-0155 Date: 06-Sep-17 Map/Lot: 070/098-000 Owner ID: 1410000 Project Location: 29 DOCK ROAD Unit: Job Description: Install New Gas Line to Stove Owner Nam Elaine L Baciewski Tenant Name N/A Careof: 29 Dock Rd Uncasville c'T 06382- Telephone: (860)608-6064 Applicant Name Dan Pickett Plumbing &Heating Telephone: (860)460-5155 DBA: Lic/Reg Type P 1 Lic/Reg N 277667 11 Donald Avenue Exp Date: 31-Oct-17 Quaker Hill Ct 06375- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: IRC Plumbing Value: $200.00 Plumbing Fee: $30.00 Code: 2016 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $200.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 State Ed Fee: $0.05 Total Fee Paid: $30.05 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 frami ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble El Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑d Certificate o •proval ■ Ce i . e of Occupancy Building Official's Approval: �-1--- Iown orMontville 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.: ma0I7—o15& Type of Work Occupancy Type Permit Type ❑ New Construction C]Single Family ❑ Building ❑Addition ❑Two-Family Plumbing f4 Alteration ❑Townhouse Mechanical ❑Accessory Structure 0 Electrical CRS#: Property Address: 25 Dix k �"Ij mofi Jt LLQ (Number) (Street) (Unit) Job Description: NE-kJ isyts A Nis 7a I5 s73 Owner: Address: 028 'bock, z. City: j JL IJ/ State: Zip Code: 66,3 '2 Telephone( $(Da ) (ovi - 64 20 4 Applicant: DEA: TIN tPt Ci£( ?Lunt! WiReirr IlaA- Address: 11 46)•(Jt L�1 4� 755CoCity:t �'01`tk 61 /ILL State: Cr Zip Code: 063 75- Telephone( ) 4t) -3/55- Contractors ntractors - Complete the Following: License Type: ? I License No.:0Z-7744 7 Expiration Date: / 3 Vet'j 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 1 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 2014 NEC as the altemative compliance per section E3401.1 of the Residential Code, instead of the electrical requirements in chapters 34 through 43 of the Residential Code. al Owner/Agent Signature: / ./ 1/ Date: � S Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Zbt . Plumbing Fee: 37,"' Mechanical Value: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: 2_40b.60 Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: (DCj Total Fee: alp- 0 5 Revised August 2,2007 Town of Montville Building Department File Receipt Date: 05-Seo-17 ReceiptNo: 12619 Received From: Dan Pickett Job Address: 29 Dock Road Town Fees Collected State of Connecticut Fees Collected Bldg Cash: $30.05 State Cash: 10.05 Bldg Check: $0.00 State Check: X0.00 Bldg Credit: 10.00 State Credit: $0.00 Fire Cash: $0.00 Fire Check: 10.00 Fire Credit: 80 00 Construction Value: $200.00 Demolition Value: X0.00 CheckNo: 0 Received By: Carmen KneelandCc*.4 ne _ ki 1A LQ QCt® � State of Connecticut N 7A Workers' Compensation Commission ce p �•itocirli Please TYPE or PRINT IN INK 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^IT Name ofApplicant for Building Permit %i ,2. r C ` f Property located at 2F 26 C J D in the City/Town of n1'ps"T'V 4 L1,� e(— 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: U I am the OWNER of the above-named property.I WILL NOT act as the general contractor or principal employer. Signature of OWNERApplicant-.- ___._ I 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 T'l Tr c k r�`i[— PL uy►t p (y/fic_en-lhk- Federal Employer ID#(FEIN) Signature PROPRIETORA Applicant 9 PP I► Town of Montville ' Building Department CONSTRUCTION PERMIT APPROVAL d qk-Rod Property Address Nem Ct1 Gzs Lt(lc -t-6 ( S Simi ., Job Description Required Department Approval ' Permit Issuance Approval Ili Tax Collectori. 7/S/17 Signature/date Comments: ® ✓ Fire Marshalf -:-"P - 9 < tl Comments:)-1 1 7 -:-"P( Signature/date [ ` 1 ❑ Planning & Zoning Required for all permits except Signature/date Plumbing, Electrical,Mechanical, Roofing,Siding,Windows& Doors n Health Department Required for properties with private septic or well Signature/date I. Comments: III WPCA, Administrative OIco6 Pee- p icknL Ct 143 ------). ' Required for properties on sewer Signature/date Comments: ❑ WPCA, Operations When Required by WPCA Signature/date Comments: ❑ Department of Public Works Required when project includes driveway work or certain drainage requirements Signature/date 1 Comments: ❑ Montville Police Department ' Required for all permits EXCEPT one and two family residential Signature/date Comments: 1❑ Copy of State Dept. of Transportation Certificate , Required for Structures over 100,000 sq.ft.or with more than 200 parking spaces-Official copy of STC Certificate of Operation required-per 1`. CGS 14-311 Signature/date Building Department Final Inspection Revised March 23,2015 ,t k 3 r tt': t.