HomeMy WebLinkAboutRennovations/Bathroom Remodel 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: E21114:_0_023 Date: 28Llark.14 Map/Lot: 103/064_4)00 Owner ID: 5598000
Project Location: 3 POLLYS LANE Unit:
Job Description: _ElecfraacaLtar_Ren.o_vat o.ns&_Rentace_WateLlieater
Owner Nam _No_ts_sliaAe.eson Tenant Name N/A
Careof:
3 Pollvs I one
tlncnsville CT 05.389- Telephone:136()121.3-3484
Applicant Name Home Owner Telephone:
DBA: Lic/Reg Type
Lic/Reg N 0
Exp Date:
Constn i&ion
Pwrratieee C'onsfnic.fi4_n_Inform�i�n
Building Value: S.0,110_ Building Fee: S.a.QQ_ Use Group: IRC
Plumbing Value: 8_0.00 Plumbing Fee: S0 0Q Code: 2005 State Building Code
Mechanical Valu50.00 Mechanical Fe
Electrical Value: Si�QO Electrical Fee: S(1,00 Construction Type IRC
Total Value: WOO Penalty Fee: 50,0,0__ Permit Code: R5
C of 0 Fee: S0,Q0— Comment
Plan Review Fe SHOD Fees Included with Building Permit
State Ed Fee: $0,00
Total Fee Paid: S0.00
It shall be the owners repsonsibility to schedule the followinq 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 ❑ Gas Piping and leak test
❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION
❑ Insulation
Certificate of Approval
Ce 'i ate f'Occupancy
ituildina_Officiats_AoncovaL,_� ��/s��%L ,_ —
Town of Montville
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.: E3blll--L7 .43
Type of Work Occupancy Type Permit Type
0 New Construction ❑ Single Family ❑ Building
❑Addition ❑Two-Family ❑Plumbing
❑Alteration ❑Townhouse ❑Mechanical
❑Accessory Structure []Electrical CRS#:
Property Address: 3 C � y S LC 11
(Number) (Street) (Unit)
Job Description: 1 \ec +ric. LOU- ec_#-r-t.cck_J hof U
Owner: '1 io -J-a6/z. j � 6 11
Address: / (J (f/n K J I t f,V0`'r Dr.
.
City: (' arl- )V1 State: C I Zip Code: CI c2- 1 O Telephone 642,(I:O ) -
Applicant: /-101( ()(,O'((y t
DBA:
Address:
City: State: Zip Code: Telephone( )
Contractors - Complete the Following:
License Type: License No.: Expiration Date:
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 I 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 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Code,
instead of the electrical requirements/innc chapters 33 through 42 of the Residential Code.
Owner/Agent Signature: .Aid t, Date: / (9 7- /4/
Construction Value Permit Fees
Building Value: Building Fee:
Plumbing Value: Plumbing Fee:
Mechanical Value: Mechanical Fee:
Electrical Value: Electrical Fee:
Total Value: Penalty Fee:
C of O Fee:
Plan Review Fee:
State Ed Fee:
Total Fee:
Wrvised August 23,2007
�V,: f
State of Connecticut N
<<=�
Workers' Compensation Commission h; .r'
ezr_"��"��� Please TYPE or PRINT IN INK rr
z.
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 ) /�
Name ofAppliicantfor Bulding Permit k(Lt `�I Y✓,
Property located at ,D) 1 �J 1 L��` U I UY \\ `e ) (1.1 cc 9.3�
in the City!Town of A 1 c1.f)-\(\, '\l
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:
4
U/
t� 1 am the OWNER of the above-named property.I WILL NOT act as the general contractor or principal employer.
CASignature of OWNERAppbicant- 6 )`!�.`7
❑ 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
Federal Employer ID#(FEIN)
Signature of SOLE PROPRIh I OR Applicant
Town of Montville
Building Department
CONSTRUCTION PERMIT APPROVAL
Applicant is responsible for obtaining all of the required approvals. No permit will be issued until all the required signatures are obtained.
1
Propetty Address
CxA11 A1(0t� f E t eLi r-1 cc,( vi,' 1't-�q -�� f2er�v�- -t'ol'ls
Job Description J
Required
Department
Approval Permit Issuance Approval
Tax Collector 7// ,f
Signature/date
Comments: �J
Planning & Zoning .6.6.4 4. - �-�'- x> //Z 7/C
Si nature/date
Comments:
Fire Marshal � < <4
Signature/date
Comments:
Health Department
Required for properties with private septic or well
Comments:
•f WPCA, Administrative �i ( 1'1
Required for properties on sewer \ Si nature/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
Comments:
❑ Montville Police Department
Required for all permits EXCEPT one and two family residential Signature/date
Comments:
U State Dept. of Transportation
Required for Structures over 100,000 sq.ft.or with more than 200 parking spaces-Official copy of STC Certificate of Operation required-per
CGS 14-311
Signature/date
Building Department Review Complete
Signature/date
Revised May 23,2011