HomeMy WebLinkAboutTemporary Electric Service 2003 Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext. 382
Electrical Permit
Permit Number: E2003-0159 Date: 18-Jun-03 Map/Lot: 039/092-000 Owner ID 118028
Job Location: 93 PIRES DRIVE Unit
Job Description: Temporary Electric Service
Owner: Contractor:
Scott G and Stacia S Miner Scott Miner
93 Pires Drive
93 Pires Drive Oakdale Ct. 06370-
Oakdale CT 06370 Telephone: (860)848-2413
Lic/Reg Type/No. 0 Exp Date:
Tenant:
Self
Telephone:
Construction Values Permit Fees Construction Information
Building Value: $0.00 Building Fee: $0.00 Use Group: R4
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO
Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B
Electrical Value: $750.00 Electrical Fee: $10.00 Permit Code: R5
Other Value: $0.00 Other Fee: $0.00 Comments:
Total Value: $750.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $0.12
Total Fees: $10.12
It is the owners responsibility to schedule the following 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
PP 9
❑ Rough Electrical ❑ Insulation
❑d Electrical Service ❑ Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature: /:'
Town of,Montville
Building Department Nof Permit#
310 Norwich-New London Tpke.
Tel. 848-3030,Ext 82 Uncasville, CT 06382
Fax. 848-7231
One &Two Family Trades Permit Application Form c k S #.
OPlumding aE�t, Datechanicaf aYa (R`l
5[eating
Air Conuaitioning
Other Gas piping
Job Location 73 V 1 RES Ur
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Job Description/Materials �4-relp Ce...)/V :c c r Ado', /,o-
Owner 1T YY) f, C� Rrtc Mailing Address / J? Dr
City 04<d AKo - State Cr Zip 0723'20 Tel WCO /iL /aY 3
Contractor S42—kc Mailing Address SA rte_ 1
City State Zip Tel / /
Contractor's License/Registration Type &Number Exp. Date / /
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 ••rmit for such work as described above.
Ar/.
Owner/Agent Signature r Date / f d.3
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical $
Electrical $ 77--(D $ /f)
Other
$
Certificate of Occupancy $
Plan Review Fee $
State Education $ 4/c
Total $ 7 7) $ /D i
r.r STATE OF CONNECTICUT 41
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: 1 3 Pres Or
In the town of ' ' /or iAi;71 ,
Name of building permit applicant:
Please check one:
1. x 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(FON)
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 c eck one:
1. 2K I do not intend to act as a gene-.��
jntr ctor or prin.,cipal employer.
[Sign and stop here]
//4
Signature of applic.
I in
tend 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. ,ffic of a corporation and partners in a partnership may elect
to be excluded from coverage by filing a w•a4r th te appropriate District Office; and that a sole proprietor
_t , .
of a business is not required to have covera nle e(ie s ntent to accept coverage.
g
Signature of applicant
Subscribed and sworn to before me this day of
200_.
(Notary Public/Commissioner of the Superior Court)
Town of!)ntville Building Departme--t Receipt
Date ‘ / 9 / 0 -a No. 02834
r
From: �,/ / ,
Job Address: • - .:11
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Amount $ / Cash CI( Check # ��j
/ ',Alp Circle one) ��
Received by t.�f/, . '/i.,_/ /„;”...,, Permit # G 60 3 ---1,-5-?
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