HomeMy WebLinkAboutElectrical Service Replacement 2003 Town of Montville 0
Building Department
Date 7 /'57 65 Field nspection Notice Permit #Le7DO 3 ^ iii ti 11
Job Location C2 6 Yi14 //y' ' Z /t)
0—Approved Type of Inspection /("c'' 3- r V / C e
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, Not Approved - Please call for re-inspection when the following ections have en completed:
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Building Official
Town of Montville
Building Department
Date -7 / / 03 Field Inspection Notice Permit #
Job Location Z.- Po Z-1--r:
Approved Type of Inspection ./...0."C
Not Approved - Please call for re-inspection when the following corrections have been completed:
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ceding Official
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0 Town,of Montville 0 ,
Building Department
Date 7 i/ Field Inspection Notice Permit # t-A.V -/g'p
Job Location p //? ,� a..../0 P,
Approved Type of Inspection Z/E'(' . 5-"e r a Ir P
of Approved - Please call for re-inspection when the following corrections have been completed:
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Building O cial
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext. 382
Electrical Permit
Permit Number: E2003-0189 Date: 30-Jun-03 Map/Lot: 103/041-000 Owner ID 120011
Job Location 28 POLLYS LANE Unit
Job Description: Service upgrade
Owner: Contractor:
Leland M Wildes Curtis J Stern
43 Senkow Avenue
28 Pollys Lane Groton CT 06340-
Uncasville CT 06382 Telephone: (860)445-5267
Lic/Reg Type/No. E-1 123469 Exp Date: 30-Sep-03
Tenant:
N/A
Telephone:
Construction Values 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 NEC
Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B
Electrical Value: $800.00 Electrical Fee: $10.00 Permit Code: R5
Other Value: $0.00 Other Fee: $0.00 Comments:
Total Value: $800.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $0.13
Total Fees: $10.13
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
❑ Rough Electrical ❑ Insulation
❑d Electrical Service 0 Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature: ^�
A'
�' Town of Montville
Building Department Permit# E 90 0 3 (P'?
310 Norwich-New London Tpke.
Tel. 848-3030,Ext 82 Uncasville, CT 06382 Fax. 848-7231
One & Two Family Trades Permit Application Form
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Air Conditioning
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Gas Piping
DOther
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Job Location cVS " l z A:5 !✓./1/r'
Job Description/Materials /Qt /-.-r' n 1/.‘ ".i,/,--',47-7 7 ..._.17,-:7--- a/.2-,.-, '
Owner 1,--76- ,e,,,, -,�,= S Mailing Address ,.-1.42,...--.7.e
City eh/i-,- 5 ,t rz i State /' Zip 0/4:5'/)) Tel / /
Contractor ___.,- .4/ .4---",/,', i�'C Mailing Address 9,3 .�r.✓.re9 w ✓.=
City ....-1;,-re,-..-"o"./ State CT Zip p6;�z/v Tel , 6o /�/�/.�1 .__'-.„ 6 7 `7
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Contractor's License/Registration Type&Number Z/ - 1,.g.3V6 9 Exp. Date c3 130 / 03
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.
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Owner/Agent Signature _ ..,....„,./ .- -V-- --.--
-- I*1') Date C- / 7 / o_j
onstruction-YFee
Building $ $
Plumbing $ $
Mechanical $ $
Electrical $$ �Op - $ le)
Other
Certificate of Occupancy $
Plan Review Fee $
State Education $ . 13
Total $ 3420 7) $ / 0
Town of Montville Building'Department Receipt
Date 6 I c2 —7/ ® No. 02906
From: ,.'
i.a
Job Address: , a-,y.-4._
Amount $ / . t- Cash .:,., / Check # I iii
1 - /-) (Circle one)
b 4/� f-i �,. ;� / : Permit# E� '� -- (-5'?fir- - i - •-.
Pen! roll
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: 2"zS y5
In the town of ✓rrz c
Name of building permit applicant:
Please check one:
1. I am the owner of the above property.
2. LA am the sole proprietor of a business.
2A. Name of business:
2B. Federal Employer Identification Number(FEIN)
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. I do not intend to act as a general contrac s e :ncipal employer.
[Sign and sto here]
Signature ofpp�a licant
2. I intend 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., 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)
STATE OF CONNECTICUT.
DEPARTMENT OF CONSUMER PROTECTION
ELECTRICAL UNLIMITED CONTRACTOR
CURTIS J STERN
43 SENKOW AVE
GROTON,CT 06340
TYPE: El
LIC./REG NO. EFFECTIVE EXPIRES
123469 I 10/02/2002 09/30/2003
SIGNED ,G,