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Home My WebLink AboutSFR Electrical TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 ELECTRICAL PERMIT Permit Number: E2004-0338 Date: 16-Nov-04 Map/Lot: 039/086-000 Owner ID: 5530000 Project Location: 82 PIRES DRIVE Unit: Job Description: Electrical&Electric Service Owner Name: Dannie J.Cholewa Tenant Name: N/A Careof: 36 Chestnut Hill Rd. Griswold CT 06351- Telephone: Contractor Name: TIG Electric Telephone: (860)535-2289 DBA: Lic/Reg Type: El Lic/Reg No: 183635 95 Yawbux Valley Rd. Exp Date: 30-Sep-04 North Stonington Ct 06359- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code Mechanical Value: $0.00 Mechanical Fee: $0.00 w/2004 Amendment Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $0.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 Included on Building Permit State Ed Fee: $0.00 Total Fee: $0.00 It shall be the owners reosonsibility 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. ❑ Footing-Prior to pouring concrete ❑ R Plumbing and leak test ❑ Backfill-Footing drains and waterproofing 0 R Electrical ❑ Concrete Slab-Prior to pouring concrete 0 Elec Trench-with conduit installed ❑ Framing ❑d Electrical Service CRS No: 385324 ❑ Fireplace Throat-One flue above throat ❑ R HVAC ❑ Chimney-One flue above thimble ❑ Gas Piping and leak test ❑ Firestop Draftstopping ❑ Final Inspection ❑ Insulation ❑ Certificate of Occupancy Building Official's Approval: /l Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville,CT 06382 Fax. 848-7231 Residential Trades Permit Application Form Permit# Ec=?a'd ,-- 33 35' ❑Flum6ing kElectrica( O�1ec1ianica1 � # ' _ .7feating Air Conditioning Gas Piping Single Family 0 Two-Family 0 Townhouse Job Address ? re Rd. (Number) (Street) � (Unit) Job Description 31;19 l.e_ -0' ;t_y 0-4-< Owner D/9A (iVoLewet- Mailing Address 78 CHe srNu L 1 f-fl� lam. State City G{(Sw0�-Q c( Zip 0(.035-1 Tel a O / no/ 9Q Z'Z Contractor -----C\� (�m('t L Mailing Address 95-- y 60 i (% ( R.& City IV) , S* V1 t rgW\ State C-( Zip 6635-5 Tel x(00 / p -/ p.,28,9 Contractor's License Type&Number ( (a30C. Exp. Date 6? / 30 / 2.005- 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. 4 c .A.A.."- ( ,- , Owner/Agent Signature ��c% Date // / (3— / z 07-A i Construction Value Fee Plumbing $ $ Mechanical $ $ Electrical $ $ Plan Review Fee $ State Education Total $ $ VMI,Ir i ijfit'l� (Complete reverse side) R,viseiSeptemfer9,2004 "r C N State of Connecticut 7A - 7B - 7C Workers' Compensation Commission o DIRECTIONS -n •/ SaE�� DIRECTIONS for FILING FORMS 7A,7B and 7C z tzlitts; Building Permit Requirements for Workers' Compensation Section 31-286b of the Workers'Compensation Act requires anyone who requests a building permit to first submit"proof of workers'compensation coverage for all of the employees who are engaged to perform services on the site of the construction project for which the permit was issued." The only exceptions to this law are the sole proprietor or property owner who will not be acting as general contractor or principal employer. What to give to the Building Official to obtain a Building Permit: 1. The General Contractor or Principal Employer must provide a written certificate of workers' compensation insurance for all of the employees on their project.This certificate may not be for liability, disability or any other type of insurance. 2. The Sole Proprietor or Property Owner who will not act as a general contractor or principal employer is not required to have workers'compensation coverage. In order to obtain the building permit, a FORM 7A should be completed and given to the building official. 3. The Sole Proprietor or Property Owner who will act as a general contractor or a principal employer must provide a written certificate of workers'compensation insurance for all of the employees on their project and must file a FORM 713 with the building official—OR he will sign a sworn notarized affidavit on FORM 7B, stating that he will require proof of workers' compensation insurance for all those employed on the job site. 4. The General Contractor or Principal Employer who has properly excluded himself from coverage using the appropriate WCC form (see NOTA,below)must file the FORM 7C with the building official.This form certifies that they have properly excluded themselves, and attests that they will require proof of workers' compensation insurance from every employee that works on the designated job site. NOTE: The general contractor or principal employer may exclude himself from workers'compensation coverage by filing one of the following forms with the appropriate Workers'Compensation Commission district office: Form 6B for employees who are Officers of a Corporation or Managers/ Members of an LLC Form 6B-1 for employees who are Members of a Partnership STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION ELECTRICAL.UNLIMITEP CONTRACTOR El GLENN TUM T;F,TT 95 YAWB NORTH :- � �� StONt` fled,41' 06359 LIC,( NO ,I l25 � � �� 09/ 5 RAN Ll se SIGNED �/ �� /� Town-of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030, Ext. 382 Fax. 860-848-7231 CONSTRUCTION PERMIT PROVAL r/32_ A"-f- Property Address Job Description The applicant is responsible for obtaining all of the required approvals checked off on this form. No building permit will be issued until all of the required signatures have been obtained. Required A royal Department Permit Issuance Approval pP ® Tax Collector r/< -�%i'� .,� Signature/date ❑ WPCA Sig=nature,date ❑ Planning& Zoning Signature/date ❑ Health Department Signature/date ❑ Department of Public Works Signature/date ❑ State Dept. of Transportation Signature/date ❑ Fire Marshal Signature/date Comments/Conditions: icviseiSeptem6er9,2004