HomeMy WebLinkAbout2004 - Water Heater Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext. 382
Plumbing Permit
Permit Number: P2004-0054 Date: 19-May-04 Map/Lot: 039/081-000 Owner ID 118016
Job Location: 54 PIRES DRIVE Unit
Job Description: Replace hot water heater
Owner: Contractor:
Benito Toledo Paul LaJeunesse
20 Susie Ave.
54 Pires Drive Moosup Ct. 06354-
Oakdale CT 06370 Telephone: (860)564-3840
Lic/Reg Type/No. P1 279715 Exp Date: 31-Oct-04
Tenant:
Self
Telephone:
Construction Values Permit Fees Construction Information
Building Value: $0.00 Building Fee: $0.00 Use Group: R4
Plumbing Value: $442.00 Plumbing Fee: $10.00 Code: 1995 CABO
Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B
Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5
Other Value: $0.00 Other Fee: $0.00 Comments:
Total Value: $442.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $0.07
Total Fees: $10.07
It is the owners responsibility to schedule the followinu 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 CRS#: 0 k Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signatur:.
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' Town of Montville
Building Department Permit#P700#---OA"
310 Norwich-New London Tpke.
Tel. 848-3030,Ext 82 Uncasville,CT 06382 Fax. 848-7231
One &Two Family Trades Permit Application Form
yg:LPlumbing ❑Electrical ❑Mechanical
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Air Conditioning
Gas Piping
❑Other
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Contractor's License/Registration Type &Number ? 7 7/ P---1 Exp.Date /0/ 3j/ 0 T
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 SignatureC.:) --,...7-,7
i Date o ��tgv
Construction Value Fee
Building $ $
Plumbing $ yl.2 , CSC) $ / 0 , o()
Mechanical $ $
Electrical $ $
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $ 7
Total $ $ J C, 07
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STATE OF CONNECTICUT
WORKERS' COMPENSATION COMNIISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: ' y
In the town of tet' /i d67-12_
_
Name of building permit applicant:..
Please check one:
1• I am the owner of the above property.
2. am the sole proprietor of a business. /
2A. Name of business:
2B. Federal Employer Identification Number(FEIN) 0 V Y0.5
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. ntend to act as a general contracto or principal employer.
[Sign . . stop - -]
Signature of applicant
2. I intend to act as a gen ral 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)
Town of Montville Building Department Receipt
Date l 17 / No. 03816
From: mac /'4 PLV M p l 1J 6,
Job Address: ppz_a_s
Amount $ /o - 477 Cash �!`asSi Check # 63)
(circle one)
Received by ` cJh+-•� Permit #
. . . . _ . .
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
PLUMBING&PINGS DcNTRACTo
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