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Home My WebLink AboutSiding 2004 Vain Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Building Permit Permit Number: B2004-0277 Date: 08-Jun-04 Map/Lot: 103/055-000 Owner ID 120019 Job Location: 45 POLLYS LANE Unit Job Description: Siding Owner: Contractor: Jennie Lubszewicz 'J.T. Burke Associates,Inc. 254 Burnside Ave. 45 Pollys Ln East Hartford Ct. 06108- Uncasville CT 06382 Telephone: (860)289-9381 Lic/Reg Type/No. HIC 516729 Exp Date: 30-Nov-04 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $14,500.00 Building Fee: $88.00 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: $0.00 Electrical Fee: $0.00 Permit Code: R4 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $14,500.00 CO Fee: $10.00 Plan Review Fee: $0.00 State Ed Fee: $2.32 Total Fees: $100.32 ft is the owners responsibility to schedule the following inspections(minimum 48 hours notice reauired): ❑ 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 El Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: V Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential Building Permit Application Form Permit#XnGG q— 0, 77 ❑ New Construction 0 Addition 0 Alteration 0 Accessory Structure ❑Single Family 0 Two-"Family 0 'Townhouse Job Address 5/S` ?oily S LHN - (Number) JJ (Street) (Unit) Job Description -T„/S i✓t 1 t V j N�[ Si'd t lo licit, AN d 74 r rt ,p r "_ �'M-fr9-(l e�` ot,r ' V /t'eJh ,4%/ jf h .1-10'I j Owner jt vl 11 1 Ii'6 S 1,./i s Mailing Address '/c pO//y{j LN,v e City !//^/( i /it.v State / — Zip 16 ,.:-. ,a .aTel 940 / gyg/P4a q Contractor T.7'" /34(la 1.. Sp/V S Mailing Address 62-5-Lt fir"W5t d a 14 V-t City of ST /714/27fecb State Ct Zip G-0/0 G Tel al&/o9 !/ 936 Contractor's License/Registration Type&Number „PG 7,2? 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 permit for such work as described above. Separate applications . -quire. or e ec . . , - ii,.i 1 mech nical, etc. Owner/Agent Signa Date 6) / 02 / O q c Construction Value Fee Building $ /yi,roc; $ gQ p'� Plumbing $ $ Mechanical $ $ Electrical $ $ Certificate of Occupancy $ /c/ �,� Plan Review Fee $ State Education $ "2 Total $ /yi Coo (See 1 verse side for additional requirements) Town of Montville Building Department Receipt P Date 6 / / p y No. 03878 From: /, ZA- '`tt-- 5;)A) '_ Job Address: — 01 c - _ Amount $ 00 3,1N_ Cash Check Check # '70K.„, (Circle one) Received by Al / j — ,,„„mmile Permit # po V 77 Y .- „- ---- : (S• ' . 4 ,,. , ..,44,. .,,,:,9-40.,,,,iis„4- A-7, ,N• . C 4-;•41. ), ' • ••• te, 4 # As,v ,z- -- ..,-‘ • . if,., :p il,./ / 4SIZVI, * '1%t•I'' . :. . 4)., ,..1". . ' .° 4t • 0 i, ZZ/ \Q- C) Z // / Q , i , CY/ '\- . ' . , , • .� i From:Monica Bodea At:JRO Insurance Agency FaxID:860-224-1822 To:J.T Burke Assgciates,Inc. Date 8/14/03 12:25 PM Page 2 of 2 ACORD. CERTIFICATE OF LIABILITY INSURANCE PRODUCER OP ID Mil OP (MMIDD/YYYY) 08/1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 4/03 Jones Raphael & Oulundsen Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 33 Court Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR New Britain CT 06051 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone: 860-225-7721 INSUREDINSURERS AFFORDING COVERAGE INSURER A: NAIL# Zurich Coaunercial J.T. Burke Associates, Inc. INSURER Maryland John T Burke 254 Burnside Avenue INSURERC East Hartford CT 06108 INSURERO COVERAGES INSURER E. THE PCy-CIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE ANr, REOUIREMEM,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOICUMENT NAMEDNSURED H RESPECT TORWH CH THIS THE YCERTPERIOD IIFI TEICMAY BE ISSUED OR �DI"G MAY PERTH N,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND C POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS �'• CONDITIONS OF SUCH LTR INS • TYPE OF INSURANCE POLICY NUMBER -• • -• GENERAL LIABILITYDATE(MM/DD/YY) DATE(MM/DD/YY) LIMBS A I COMMERCAL GENERAL LABILITY SCP36801042 EACH OCCURRENC. $ 1,000,000 06/01/03 08/01/04 PREMISES(Eaoccurence) $ 300 00o CLAIMS MADE X OCCUR X Care/Custody/Coat MED EXP(MY one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,0 0 0,0 0 0 GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2 aoo,000 POLICr PRO- _ PRODUCTS-COMP/OP AGG / JECT LOC $2,000,000 ( AUTOMOBILE LIABILm 1111 ANY ANO ' COMBINED SINGLE LIMIT IIIALL OWNED AUTOS (Ea accident) $ 1111SCHEDLILEO AUTOS BODILY INJURY IIIHIRECAUTOS (Per person) $ IIINOr+OWNED AUTOS BODILY INJURY a (Per accident) $ PROPERTY DAMAGE GARAGE LIABILITYer accident) S I ^ldY ALTO AUTO(PONLY-EA ACCIDENT $ 11111 OTHER THAN EA ACC $ AUTO ONLY EXCESS/UMBRELLA LIABILITY AGG $ OCCUR _ CLAIMS MADE EACH OCCURRENCE $ AGGREGATE S n DEDUCTIBLE $ $ 1 RETENTION ; • WORKERS COMPENSATION AND EMPLOYERS'LIABILITY $ B ANY PROPRIETOR�pARTNE WC4999459403 X TORY LIMITS •ER OFF'CER/MEMBEREXCU.pEO', cuTlvE 08/01/03 08/01/04 E.L.EACHACCIDEM II yes,descnpe under $ 10 0,0 0 0 SPEC AL PROVISIONS oeaw E.L DISEASE-EA EMPLOYEE $ 100,000 OTHER E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERAnONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION JTBLTR-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 5 SHI J.T. Burke & AssociatesN IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Attn: John Burke, S r• 254 Burnside Ave REPRESENTATIVES. East Hartford CT 06108 A •iir •REPRESENTATIVE /� �GACORD 25(2001/08) J Imo..