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Repair Damage from Fallen Tree 2017
Field Inspection Notice Town of Montville Building Department 860-848-6782, Ext. 782 2016 Building Code Address: 64 Polly's Lane Job Description: Rebuild Rear Deck Permit Number(s) B2017-0193 Permit Date: May 24,2017 Not Approved Approval INSPECTION Date: Comments Special Date Conditions Piers 06/01/17 W Final inspection for • certificate of occupancy **NOTE**: After one re-inspection additional inspection fees payable prior to re-inspection,are as follows: Residential inspections(except SFR C/O&SFR Additions C/O)-$10.00 SFR and Additions C/O re-inspections -$10.00 Commercial re-inspections(except Certificate of Occupancy- $25.00 Commercial Certificate of Occupancy- $50.00 Rev.Date: 1/18/06 Page 1 of 1 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 BUILDING PERMIT Permit Number: B2017-0193 Date: 24-May-17 Map/Lot: 103/051-000 Owner ID: 5625000 Project Location: 64 POLLYS LANE Unit: Job Description: Rebuild Rear Exterior Deck Owner Nam Raymond T.Hager Tenant Name N/A Careof: 64 Pollys Lane Uncasville CT 06382- Telephone: (860)639-0058 Applicant Name American General Building Services Telephone: (860)514-9565 DBA: Lic/Reg Type HIC Lic/Reg N 612994 P.O.Box 155 Exp Date: 30-Nov-17 Old Mystic CT 06372- Construction Value Permit Fees Construction Information Building Value: $6,297.00 Building Fee: $84.00 Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2016 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $6,297.00 Penalty Fee: $0.00 Permit Code: R10 C of 0 Fee: $10.00 Comment Plan Review Fe $8.40 State Ed Fee: $1.64 Total Fee Paid: $104.04 It shall be the owners repsonsibility 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. 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: n ▪ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑ Certificate of •.proval a - of Occupancy Building Official's Approval: .// '/2�i-"ii / • 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.: 6c96I7-Glia Type of Work Occupancy Type Permit Type ❑ New Construction ❑Single Family ❑Building ❑Addition ❑Two-Family ❑Plumbing 'Alteration ❑Townhouse ❑ Mechanical ❑Accessory Structure ❑Electrical CRS#: Property Address: 611 01,t7 S / / 110 ►( $,5dLt� (Number) (Street) (Unit) Job Description:___ 060(4 Owner: 21f- -mom /-hirItL Y Address: /���(9 t71- y Lw/ City: I,i 1UC45rrj9G State:C-( Zip Code:o&_.3k2-- Telephone(%())i37 vo s Applicant: 41'it,'i tcsW 'c;: L i?JJ Lcc,/c,s ( � DBA: C Address::/4-0 . /3/7) L &S 3 City:Qr o A✓vtsrr State: a— Zip Code:06 7 Z Telephone( Ot/ ) Contractors - Complete the Following: License Type: 14 l C License No.D&/2 .79 L/Expiration Date:1k D-47 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. rBy checking this box, I will follow the requirements of the 2014 NEC as the alternative compliance per section E3401.1 of the Residential Code, instead of the electrical requirements in chapters 34 through 43 of the Residential Code. Owner/Agent Signature: Date: 17_ )7 Constru tion Value Permit Fees Building Value: t, e (Q D 1 Building Fee: s'1-(x. Plumbing Value: Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: CofOFee: I0.0CD Plan Review Fee: O ,CIO State Ed Fee: I _&. Total Fee: I(.i-.+LY-4 Revised August 23,2007 Town of Montville Building Department File Receipt Date: 17-Mav-17 ReceiptNo: 12275 Received From: American General Building Services Job Address: 64 PoIlys Ln Town Fees Collected State of Connecticut Fees Collected Bldg Cash: 10.00 State Cash: X0.00 Bldg Check: 1104.04 State Check: Bldg Credit: 11 64 X0.00 State Credit: Fire Cash: X0.00 $0.00 Fire Check: $0.00 Construction Value: $6.247.00 Fire Credit: 10.00 CheckNo: r'Demolition 1820 .,/ � �� Received By: Vernon D Vesey II /�2! Y . 6efr -.� Address: 64 Pollys Ln ITEM QTY $/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA Basement,Finished SF $ 41.96 $ - $ - Interior Renovations SF $ 36.09 $ - $ - $ - AMENITIES Kitchen EA $ - $ - $ - Full Bathroom EA $ - $ - Half-Bathroom EA $ - $ - GARAGE Detached SF $ 71.53 $ - $ - MECHANICAL Warm-Air n Y/N $ - Hot Water n Y/N $ - Electric n Y/N $ - Air Conditioning n Y/N $ - ELECTRICAL SERVICE Upgrade Amps $ - Subpanel EA $ 699.00 $ - Gen Set EA $ 3,850.00 $ - SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 6,497.70 $ - Masonry w/lfireplace EA $ 7,096.65 $ - Masonry w/2 fireplaces EA $ 11,095.70 $ - Wood Stove,free standing EA $ 2,692.25 $ - Wood stove insert EA $ 1,859.77 $ - DECKS,PORCHES,SUNROOMS Deck 180 SF $ 34.98 $ 6,296.40 Porch SF $ 149.38 $ - Sunroom SF $ 176.90 $ - $ - POOLS&HOT TUBS Hot Tub EA $ 8,016.25 $ - $ - Inground Pool EA $ 31,550.00 $ - $ - Above Ground Round EA $ 6,299.46 $ - $ - Above Ground Oval EA $ 7,019.75 $ - $ - Pool Heater EA $ 8,984.25 $ - $ - Inflatable Type Pool EA $ 1,200.00 $ - $ - SHEDS w/o electrical SF $ 25.55 $ - w/electrical SF $ 26.85 $ - $ - RENOVATIONS Roofing,Overlay SF $ 3.50 $ - Roofing,Strip&reroof SF $ 4.50 $ - Roof Sheathing SF $ 1.51 $ - Siding - SF $ 6.75 $ - Windows EA $ 550.00 $ - Skylights EA $ 1,051.10 $ - Doors,Exterior EA $ 601.50 $ - Oil Tank,275 Gallon EA $ - Oil Tank,550 Gallon EA $ - MISCELLANEOUS CALCULATIONS Solar Install n TOTALS $ 6,296.40 $ - $ - $ - (f PERMIT FEE CALCULATIONS .Q I Construction Value Fee /U`� ' �G. Building $ 6,297.00 $ 84.00 !/ L/2 Plumbing y $ - $ l�D Mechanical y $ - $ - Electrical y $ - $ - ( Plan Review Fee y $ - l Certificate of Occupancy Fee $ 10.00 Plan Review Fee $ 8.40 State Education Fee $ 1.64 it ofc TOTALS $ 6,297.00 $ 104.04 r�"0 Figures are based on the 2006 RS Means Residential Cost Data t �v State of Connecticut N 7A C Workers' Compensation Commission Please TYPE or PRINT IN INK 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 ���j c Mb3 ^!() rNameofApplicantforBuildingPermit �' a t3S, LC cc0K / ,,C O&5 Property located at by PO'-^ 7 64- (j ,, , "9 6 32 in the City/Town of 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: ❑ I am the OWNER of the above-named property.I WILL NOT act as the general contractor or principal employer. Signature of OWNER Applicant-- . ----- ❑ 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[Oil(FEIN) Signature of SOLE PROPRIETOR Applicant Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL id 4, diVd-iic5S Cis 066 Z Property Address io)ao .1) -ce* ,f,cvnirktiAber Jo Description Required Department Approval ' Permit Issuance Approval Tax Collector �. -,.- ���,�,�.` //7/1 7 Signature/date Comments: Fire Marshal Signature/date Comments: ❑ Planning & Zoning Lt'. Q" (`,- S(i - ) I Required for all permits except Signature/date Plumbing, Electrical.Mechanical,Roofing,Siding,Windows&Doors +‘.0.�� ❑ Health Department Required for properties with private septic or well Signature/date Comments: ❑ WPCA, Administrative k Afu /` 7 Required for properties on sewer Signature/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: ❑ Copy of State Dept. of Transportation Certificate 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 Final Inspection r' RevisedMarcli23,2015 Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL /01- /4/d-ii(%tiGe.C-4.4 0// O 6 Ste__ Property Address /0)Q c j) -Cc-,k ivn iler147.,t.,er Jo Description Required Department Permit Issuance Approval Approval Tax Collector ��-w �b �-- 5/,7 f, 7 Signature/date Comments: (//lf/(Fire Marshal Signature/date Comments: ����QQQQ�� ❑ Planning & Zoning (tJ3Q. "' 51/1 ) I -1 Required for all permits except Signature/date Plumbing,Electrical.Mechanical, Roofing,Siding,Windows&Doors rlQ,O ^.-V (UN' ofx .v ❑ Health Department Required for properties with private septic or well Signature/date Comments: ❑ WPCA, Administrative a< "'a 4-N 5/0 /1 7 Required for properties on sewer Signature/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: ❑ Copy of State Dept. of Transportation Certificate 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 Final Inspection Revised March 23,2015 , % 7 . z = L+11 . - .'- r _ ' I ' D . v 4 k N 1! or _... 1 ; ! --) o ii - iz4 in..--5-- ........ s.,..), ......_ ,.. ,.. , ....) se 0 le I , maus•••• •••••••J Z: 12) ' ...7 ...... ,.... . ; ; i Z ' CO 2 41 , • -4 • ttli u) •--- -* ' ' , c c • :1 ..--- _,,„"sei*.• :-..c.j j i .. . 2 --2 •1 __)c- i . 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A4 - `UVJ ,..,- g cl -1:.. .cu - ;0'3 1-,- t I 1 e 2 z - tp , 0 (n (n A Ini Z 1 <- ' • ••• Ct ):" ‘1 9_1 . iN- o� ' i vv \ Iv '` V\ 4 ) \-- i 0 c_)( Vie z_ d + O a e , Field Inspection Notice Town of Montville Building Department June 5, 2017 2016 Ct Building Code Address: 64 Pollys Lane Job Description: Install Chimney Liner Permit Number(s) B2017-0192 Permit Date: May 24,2017 Not Approved Approval INSPECTION Date: Deficiencies Special Date Conditions Final inspection and •• certificate of approval 06/02/17 VV **NOTE**: After one re-inspection additional inspection fees payable prior to re-inspection,are as follows: Residential inspections(except SFR CIO&SFR Additions C/O)-$10.00 SFR and Additions CIO re-inspections -$10.00 Commercial re-inspections(except Certificate of Occupancy- $25.00 Commercial Certificate of Occupancy- $50.00 Rev.Date: 1/18/06 Page 1 of 1 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 BUILDING PERMIT Permit Number: B2017-0192 Date: 24-May-17 Map/Lot: 103/051-000 Owner ID: 5625000 Project Location: 64 POLLYS LANE Unit: 1 Job Description: Install Chimney Liner Owner Nam Raymond T.Hager Tenant Name N/A Careof: 64 Pollys Lane Uncasville CT 06382- Telephone: (860)639-005_8_ Applicant Name AGBS LLC Telephone: (860)514-9565 DBA: Lic/Reg Type HIC Lic/Reg N 612994 P.O.ox 155 Exp Date: 30-Nov-17 Old Mystic CT 06372- Construction Value Permit Fees Construction Information Building Value: $1,000.00 Building Fee: $30.00 Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2016 State Building Code Mechanical Valu $0.00 Mechanical Fe $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $1,000.00 Penalty Fee: $0.00 Permit Code: R4 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 State Ed Fee: $0.26 Total Fee Paid: $30.26 It shall be the owners repsonsibility 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. BUILDING PERMIT INSPECTIONS PLUMBING,MECHANICAL, ELECTRICAL PERMIT INSPECTIONS Cl 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 El Certificate of Approval - ifi •te of Occupancy Building Official's Approval: Age • Town of Montville Building Department 310 Norwich-New London Tpke. 1 Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.: bob)7 -0141 Type of Work Occupancy Type Permit Type ❑New Construction ❑Single Family 0 Building ❑Addition 0 Two-Family ❑ Plumbing ❑Alteration 0 Townhouse 0 Mechanical 0�tAccessory Structure 0 Electrical CRS* Property Address: t-/ PI2 '-y /3 L-a. tAIC�,/cS,ry i LuC7 O6 ?_ (Number) (Street) l '7 (Unit) Job Description: �ll/5>p-GL [4/A'l iv Lcr 6 k t lL. Owner: RiApvi/0/00 6¢al4 te-- Address. 1 6 ( 9 L(�L0. City: Upicg�vtr c / State:C Zip Code:O 2? Telephone 0640 )()39 00 r5 Applicant: 4 6-6s I-6-c , DBA: `� TCityAddress: e-D•• #S >o I (S--5--- City: : 0043 /''V75 rt L State:CT- Zip Code: 063 7? Telephone(UD v sly__ 7,s 6 j Contractors - Complete the Following: (- License License Type: License Nc© i 2Ti V Expiration Date: LI-30-47 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 2014 NEC as the alternative compliance per section E3401.1 of the Residential Code, instead of the electrical requirements in chapters 34 through 43 of the Residential Code. '7.Owner/Agent Signature: ..�---c Date: 5 -17-17 Constru •on Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: `0 O 9 .44 Mechanical Fee: .V:0 •CXR Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: r)t,..e Total Fee: 30.rQCp Revised August 23,2007 Town of Montville Building Department File Receipt Date: 17-Mav-17 ReceiptNo: 12276 Received From: American General Buildina Services Job Address: 64 POIIys In Town Fees Collected State of Connecticut Fees Collected Bldg Cash: 10.00 State Cash: Bldg Check: 10.00 130.26 State Check: 10.26 Bldg Credit: 10.00 State Credit: 10.00 Fire Cash: 10.00 Fire Check: 10.00 Const uction Value: 11 000.00 Fire Credit: 10 00 Demoli •- -• 10 00 CheckNo: 1819 / Received By: Vernon D Vesey II --✓ Address: 64 Pollys Ln ITEM QTY $/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA Basement,Finished SF $ 41.96 $ - $ Interior Renovations SF $ 36.09 $ - $ - $ AMENITIES Kitchen EA $ - $ _ $ Full Bathroom EA $ - $ _ Half-Bathroom EA $ $ _ - GARAGE Detached SF $ 71.53 $ - $ _ MECHANICAL Warm-Ar n Y/N $ - Hot Water n Y/N $ - Electric n Y/N $ _ Air Conditioning n Y/N $ - ELECTRICAL SERVICE Upgrade Amps $ _ Subpanel EA $ 699.00 $ _ Gen Set EA $ 3,850.00 $ _ SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 6,497.70 $ - Masonry w/tfireplace EA $ 7,096.65 $ - Masonry w/2 fireplaces EA $ 11,095.70 $ - Wood Stove,free standing EA $ 2,692.25 $ - Wood stove insert EA $ 1,859.77 $ - DECKS,PORCHES,SUNROOMS Deck SF $ 44.07 $ - Porch SF $ 149.38 $ - Sunroom SF $ 176.90 $ - $ _ POOLS&HOT TUBS Hot Tub EA $ 8,016.25 $ - $ - Inground Pool EA $ 31,550.00 $ - $ - Above Ground Round EA $ 6,299.46 $ - $ _ Above Ground Oval EA $ 7,019.75 $ - $ _ Pool Heater EA $ 8,984.25 $ - $ _ Inflatable Type Pool EA $ 1,200.00 $ - $ _ SHEDS w/o electrical SF $ 25.55 $ - w/electrical SF $ 26.85 $ - $ _ RENOVATIONS Roofing,Overlay SF $ 3.50 $ - Roofing,Strip&reroof SF S 4.50 $ - Roof Sheathing SF $ 1.51 $ - Siding SF $ 6.75 $ - Windows EA S 550.00 $ - Skylights EA $ 1,051.10 $ - Doors,Exterior EA $ 601.50 $ - Oil Tank,275 Gallon EA $ - Oil Tank,550 Gallon EA $ - MISCELLANEOUS CALCULATIONS $ 1,000.00 Solar Install n TOTALS $ - $ - $ 1,000.00 $ - PERMIT FEE CALCULATIONS Construction Value Fee Building $ - $ _ Plumbing y $ - $ Mechanical y $ 1,000.00 $ 30.00 Electrical y $ _ $ _ Plan Review Fee y $ _ Certificate of Occupancy Fee $ _ Plan Review Fee $ _ State Education Fee $ 0.26 TOTALS $ 1,000.00 $ 30.26 Figures are based on the 2006 RS Means Residential Cost Data 1� itt/ Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL 6 '1 /9 I-i S /44-, lico-&sv; I� - 00k Property Address jivs 714k- al rel n C ixi EX. Job Description Required Department Permit Issuance Approval Approval ' • Tax Collector `d -0..„„vjA-t-v-4— ' 7// 7 Signature/date Comments: ® Fire Marshal _____(/WL � Signature/date Comments: ❑ Planning & Zoning Ntiv. Required for all permits except Signature/date Plumbing,Electrical,Mechanical,Roofing,Siding,Windows& Doors ❑ Health Department Required for properties with private septic or well Signature/date Comments: II WPCA, Administrative bk&1 pe-e Mr e-r‘ 511--1/-j VU Required for properties on sewer Signature/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: ❑ Copy of State Dept. of Transportation Certificate 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 Final Inspection Revised 23,2015 Field Inspection Notice Town of Montville Building Department May 19, 2017 2016 Ct Building Code Address: 64 Polly's Lane Job Description: Replace Oil Boiler Permit Number(s) M2017-0064 Permit Date: May 9,2017 Not Approved Approval INSPECTION Date: Deficiencies Special Date Conditions Flue connection 5/19/17 DJ Clearance to combustibles • 5/19/17 DJ Plumbing 5/19/17 DJ Low water cutoff • 5/19/17 DJ Backflow prevention 5/19/17 DJ Electric • 5/19/17 DJ Final inspection and • certificate of approval • 5/19/17 DJ Rev.Date: 1/18/06 Page 1 of 1 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 MECHANICAL PERMIT Permit Number: M2017-0064 Date: 09-May-17 Map/Lot: 103/051-000 Owner ID: 5625000 Project Location: 64 POLLYS LANE Unit: Job Description: Replace Oil Boiler Owner Nam Raymond T.Hager Tenant Name N/A Careof: 64 Pollys Lane Uncasville CT 06382- Telephone: Applicant Name Tom Buehler Telephone: (860)639-1290 DBA: Tom Buehler Plumbing &Heating LLC Lic/Reg Type S7 Lic/Reg N 307653 15 Chinigo Road Exp Date: 31-Aug-17 Griswold CT 06351- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2016 State Building Code Mechanical Valu $5,000.00 Mechanical Fe $60.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $5,000.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 State Ed Fee: $1.30 Total Fee Paid: $61.30 It shall be the owners repsonsibility 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. BUILDING PERMIT INSPECTIONS PLUMBING,MECHANICAL,ELECTRICAL PERMIT INSPECTIONS El 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: n ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation Certificate of ApprG al ■ Ce.' ate of .ccupancy ?-- Building Official's Approval: 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.: rn Oi7 -C c( Type of Work Ocyupancy Type Permit Type El New Construction [ Single Family ❑Building Addition ❑Two-Family ❑ lumbing Alteration ❑Townhouse UMechanical ❑Accessory Structure 0 Electrical CRS#: Property Address: 6 it /gyp II V _/J . (Number) I (Street)/� (Unit) Job Description: &d6 Y (fail e/0// 47:ei/e`r NeLv Jo,/g.- 3 L' 1 -+ T(0 k1 byeoil Owner: 16x and !` E\t" Address: e:9 U 1 c,Q ' City: 141./CCt5(f/fe State: ZipCode:f' 6Telephone( ) Applicant: / 4:=:1't 5veA/ems !� fi���fiN9 //� DBA: Address: /5 C��'//✓� led City: Li rI S 14A- /d State:C-e Zip Code: Telephone(q' ,O )4"V -/290 Contractors - Complete the Following: License Type: ,; 7 License No.:30X63 Expiration Date: "//3/// 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 2014 NEC as the alternative compliance per section E3401.1 of the Residential Code, instead of the electrical requirements in chapters 34 through 43 of the Residential Code. Owner/Agent Signature: %�-�" 9 9 - A - Date: 'Ski -;2` Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: Je 00 0 Mechanical Fee: Le 0 — Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: `.p 1. Revised":August 23,2007 Town of Montville Building Department File Receipt Date: 03-Mav-17 ReceiptNo: 12236 Received From: Tom Buehler Plumbina&Heatina Job Address: 64 Polly's Lane Town Fees Collected State of Connecticut Fees Collected Bldg Cash: 10.00 State Cash: 10.00 Bldg Check: 161.30 State Check: 11 30 Bldg Credit: 10.00 State Credit: $0.00 Fire Cash: 10.00 Fire Check: $0.00 Fire Credit: 10.00 Construction Value: 15.000 00 Demolition Value: 10.00 CheckNo: 1104 Received By: Carmen Kneeland C16/11"14_.A.4"1 VP. k44, Address: 64 Polly's Lane ITEM QTY $/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA Basement,Finished SF $ 41.96 $ - $ - Interior Renovations SF $ 36.09 $ - $ - $ - AMENITIES Kitchen EA $ - $ - $ Full Bathroom EA $ - $ - Half-Bathroom EA $ $ - - GARAGE Detached SF $ 71.53 $ - $ - MECHANICAL Warm-Air n Y/N $ - Hot Water n Y/N $ - Electric n Y/N $ - Air Conditioning n Y/N $ - ELECTRICAL SERVICE Upgrade Amps $ - Subpanel EA $ 699.00 $ _ Gen Set EA $ 3,850.00 $ SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 6,497.70 $ - Masonry w/lfireplace EA $ 7,096.65 $ - Masonry w12 fireplaces EA $ 11,095.70 $ - Wood Stove,free standing EA $ 2,692.25 $ - Wood stove insert EA $ 1,859.77 $ - DECKS,PORCHES,SUNROOMS Deck SF $ 44.07 $ - Porch SF $ 149.38 $ - Sunroom SF $ 176.90 $ - $ - POOLS&HOT TUBS Hot Tub EA $ 8,016.25 $ - $ - Inground Pool EA $ 31,550.00 $ - $ Above Ground Round EA $ 6,299.46 $ - $ _ Above Ground Oval EA $ 7,019.75 $ - $ - Pool Heater EA $ 8,984.25 $ - $ - Inflatable Type Pool EA $ 1,200.00 $ - $ _ SHEDS w/o electrical SF $ 25.55 $ - w/electrical SF $ 26.85 $ - $ _ RENOVATIONS Roofing,Overlay SF $ 3.50 $ - Roofing,Strip&reroof SF $ 4.50 $ - Roof Sheathing SF $ 1.51 $ - Siding SF $ 6.75 $ - Windows EA $ 550.00 $ - Skylights EA $ 1,051.10 $ - Doors,Exterior EA $ 601.50 $ - Oil Tank,275 Gallon EA $ - Oil Tank,550 Gallon EA $ - MISCELLANEOUS CALCULATIONS $ 5,000.00 Solar Install n TOTALS $ - $ - $ 5,000.00 $ - PERMIT FEE CALCULATIONS Construction Value Fee Building $ _ $ _ Plumbing y $ _ $ Mechanical y $ 5,000.00 $ 60.00 Electrical y $ _ $ _ Plan Review Fee y $ _ Certificate of Occupancy Fee $ _ Plan Review Fee $ _ State Education Fee $ 1.30 TOTALS $ 5,000.00 $ 61.30 Figures are based on the 2006 RS Means Residential Cost Data STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION HEATING,PIPING&COOLING LIMITED CONTRACTOR THOMAS A BUEHLER 15 CHINIGO RI) GRISWOLD,CT 06351-1602 LIC./REG NO. EFFECTIVE EXPIRES HTG.0307653-S7 09/23/2016 08/31/2017 Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL (I `-{ QI Li 3 [_Y_k n-e— Propefty Address 0; 1 te:20_11-A cr Job Description Required Department Permit Issuance Approval Approval ' Il Tax Collector � ',cje —'�-- 51,3 f 7 Signature/date Comments: / ✓ Fire Marshal Signature/date Comments: ❑ Planning & Zoning Required for all permits except Signature/date Plumbing,Electrical,Mechanical,Roofing,Siding,Windows&Doors ❑ Health Department Required for properties with private septic or well Signature/date Comments: • WPCA, AdministrativeO(C.r~ l P� O;0.r�G 51117 190 Required for properties on sewer Signature/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: ❑ Copy of State Dept. of Transportation Certificate 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 Final Inspection Reviser Cvfarrh 23,2015 Field Inspection Notice Town of Montville Building Department 860-848-3030 Ext. 382 Address: 64 Polly's Lane Job Description: Repair Roof due to Tree Damage Permit Number(s) B2010-0454 Permit Date: November 9,2010 Not Approved Approval INSPECTION Date: Deficiencies Special Date Conditions Roof repair 1113111 DJ Roofing 1/13111 DJ Final inspection and • 1113111 DJ certificate of approval Rev.Date: 1/18/06 Page 1 of 1 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860)848-3030 X382 FAX, (860) 848-7231 BUILDING PERMIT Permit Number: B2010-0454 Date: 09-Nov-10 Map/Lot: 103/051-000 Owner ID: 5625000 Project Location: 64 POLLYS LANE Unit: Job Description: Repairs to Roof due to Tree Damage Owner Nam Irwin Rutchik Tenant Name N/A Careof: Nathan Rutchik Conserv 71 Dunham St Norwich CT 06360- Telephone: (860)848-2346 Contractor Nam First General Services of Hartford Telephone: (860)295-8790 DBA: Lic/Reg Type HIC Lic/Reg No 547230 P.O. Box 365 Exp Date: 30-Nov-10 Marlborough CT 06447- Construction Value Permit Fees Construction Information Building Value: $11,029.00 Building Fee: $120.00 Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code Mechanical Valu $0.00 Mechanical Fee $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $11,029.00 Penalty Fee: S0.00 Permit Code: R4 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 State Ed Fee: $2.87 Total Fee Paid: $122.87 It shall be the owners repsonsibility 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. BUILDING PERMIT INSPECTIONS PLUMBING,MECHANICAL,ELECTRICAL PERMIT INSPECTIONS ❑ Footing-Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical ❑ Backfill-Fooling 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 framin ❑ 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 . 'q --•icate • ••proval e fi . e of Occupancy Building Official's Ap•roval. 41111GLIP —.or �� . 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.: &UP" 00. Type of Work Occupancy Type Permit Type ❑New Construction ❑Single Family Building ❑Addition ❑Two-Family Plumbing Iteration 0 Townhouse 0 Mechanical 0 Accessory Structure 0 Electricals CRS#: Property Address: & ` 0(1(.5 L- 1 ON c.46 (Number) reet) (Unit) Job Description: Re p A' V T a Req 2 04/4;N Hcaoe Paz-- fo -e e- i`*lfi5' o940 ;71 . sro/J-e e f,Jo✓lC f✓o 0?6te Ref 14e/e- iZeof Riff-4-c-75 ede d iecr e e too 74 .141-7 lc.r •J q lee-ie-4=1 A145.• Owner: T Address: 6 pD lly S v,+ . VA) City: ON C4 54(k State: C • Zip Code: D G 3 8-2- Telephone(s D L/ V )g'' - c2 3'C Applicant: (7i 5 l� ctrlC - i4 ( c e✓V!'C e..I flT lleMv ,o i d DBA: Address: p• 0• t3Ox _3Cv5 City: /4/Ia✓ (/oro State: C-'1% Zip Code:06 I1 tfTelephone(0 ° )?5 _ 0'77 O Contractors - Complete the Following: (� r �J License Type: !1 / C- License No.:°5..C1112 Expiration11-' 30—Date: 02.0(0 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• chapters .,throug,2 of the Residential Code. Owner/Agent Signature: / - Date: t'l' 8 l0 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 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: Revise&August 23,2007 Town of Montville Building Department File Receipt Date: 08-Nov-10 Receipt No: 5943 Received From: First General Services of Hartford Job Address: 64 Pollys Lane Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check/Card $122.87 Check/Card $2.87 Check No: 6692 Short/Over: $0.00 Construction Value: $11,029.00 Demolition Value: $0.00 Received By Carmen Kneeland CO WL.5„V1 fli 1 . kvvtdccrid , 1 1 , SI E Address: 64 Pollys Lane I ITEM QTY SNNtT TOTAL a Building Plumbing Mechanical Electrical C BUILDING AREA New Construction SF $ 113.03 $ - $ - s - Basement,Finished SF $ 22.96 $ - $ - k - Basement,Unfinished SF $ 12.40 $ - $ - - Crawl Sapce SF $ 930 $ - - Interior Renovations SF $ 35.09 $ - $ - $ - , MANUFACTURED HOMES Ground Anchors SF $ 6.45 $ - $ - $ - - Basement SF $ 12.41 $ - $ $ -- . Crawl Space SF $ 9.31 $ - $ - $ - li AMENITIES Kitchen EA $ - $ - $ - Full Bathroom EA $ - $ Half-Bathroom EA S - $ - t GARAGE Attached SF S 54.35 $ - $ - Detached SF $ 69.53 $ - $ - - Under SF 5 10.03 $ - $ - - Carport SF $ 19.89 $ -- MECHANICAL Warm-Air YIN $ - Hot Water n Y/N $ - Electric n Y/N $ _ - Air Conditioning n Y/N $ - 0 ELECTRICAL SERVICE a Upgrade Amps $ .. Overhead,new Amps $ - Underground,new Amps $ - q` - Subpanel EA $ 599.50 $ - „: - Gen Set EA $ 3,850.00 $ - ', SOLID FUEL BURNING APPLIANCES , Prefab Metal Fireplace EA $ 6,497.70 $ - - Masonryw/lfireplace EA $ 7,096.65 $ - Masonry w/2 fireplaces EA 5 11,095.70 $ - WoodStove,freestanding EA $ 2,692.25 $ -- Wood stove insert EA $ 1,859.77 $ - DECKS,PORCHES,SUNROOMS Deck SF $ 43.07 $ - Porch SF $ 149.38 $ - Sunroom SF $ 176.90 $ - $ - POOLS&HOT TUBS i Hot Tub EA $ 8,016.25 $ - $ - ?., Inground Pool EA $ 21,373.44 $ - $ - Above Ground Round EA $ 5.099.46 $ - $ - - Above Ground Oval EA $ 6,019.75 $ - $ - Pool Heater EA $ 8,984.25 $ - - InflatableTypePool EA $ 1,550.00 $ - SHEDS w/o electrical SF $ 20.35 $ - - ndelectrical SF $ 20.35 $ - $ - RENOVATIONS Roofing,Overlay SF $ 3.00 $ - k-' Roofing,Strip&reroof 2600 SF $ 4.00 $ 10,400.00 Roof Sheathing 480 SF $ 1.31 $ 628.80 Siding SF $ 5.50 $ - Windows EA $ 500.00 $ - Skylights EA $ 1,051.10 $ - Doors,Exterior EA $ 601.50 $ - - Oil Tank,275 Gallon EA $ - - Oil Tank,550 Gallon EA $ -- �.. MISCELLANEOUS CALCULATIONS TOTALS $ 11,028.80 S - S - S - PERMIT FEE CALCULATIONS Construction Value Fee Building $ 11,029.00 $ 120.00 Plumbing y $ - $ _ ' Mechanical y $ - $ _ Electrical y $ - $ _ Working before Permit Issuance $ Certificate of Occupancy Fee $ - Plan Review Fee $ State Education Fee $ 2.87 s TOTALS $ 11,029.00 $ 122.87 Figures are based on the 2006 RS Means Residential Cost Data PL-02 Rev 09/03 STATE OF CONNECTICUT 186767 DEPARTMENT OF CONSUMER PROTECTION 165 Capitol Avenue + Hartford Connecticut 06106 • Attached is your Home Improvement Contractor Registration. This registration is not transferable. For questions,contact the Trade Practices Division at(86o)713-6110 or email trade.practices@ct.gov. 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'"`��`y”, � h` r,•i'• !. iii: '�.S ..�'r's'''"•.t`•1`,.-;.�rlitl.�. !�."•^�"'�"'r.• "•.. 3 "... ti7";,.. �" /� Lata: Z/Zb/ZUIU Time: 12 :42 PM To : First General Services 8 1-860-295-0301 Page: 004 ACORDM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMYY) 02/26/2010 PRODUCER (860)343-9025 FAX (860)343-7565 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McCutcheon Burr & Sons ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 49 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 1206 Middletown, CT 06457 INSURERS AFFORDING COVERAGE NAIC# INSURED FIRST GENERAL SERVICES OF HARTFORD, INC. INSURER A- Charter Oak Fire 25615 5 AUSTIN DR INSURERB Travelers Indem of Ill . 25674 MARLBOROUGH, CT 06447 INSURERC Travelers Indemnity 25658 INSURER D. Phoenix 25623 INSURER B. American Safety Insurance COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR INSRC DATE LMMIDDIYY) DATE(MWDDMI _ LIMITS GENERAL LIABILITY I6808997M411COF09 11/14/2009 11/14/2010 EACHOCCURRENCE _ $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 CLAIMS MADE I X 1 OCCUR PREMISES(Ea o MED EXP(Any onene e person) $ 5,000 A —_ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 —1 POLICY PRO- LOC AUTOMOBILE LIABILITY BA8997M50309SEL 11/14/2009 11/14/2010 COMBINED SINGLE LIMIT NY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS ' X SCHEDULED AUTOS BODILY INJURY $ B (Per person) X HIRED AUTOS — BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO — OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESSIUMBRELLALIABILITY ISFCUP1961T307IND09 11/14/2009 11/14/2010 EACH OCCURRENCE $ 1,000,000 X I OCCUR CLAIMS MADE AGGREGATE $ 1,000,000 C DEDUCTIBLE X RETENTION $ 10,000 — $ WORKERS COMPENSATION AND INUB1961T31909 11/14/2009 11/14/2010 X WCSTATu- ca,' EMPLOYERS'LIABILITY TORY LIMITS ER D ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 E PPL024192 09 Ol 11/24/2009 11/24/2010 Each Occurrence $1,000,000 Poi5ution Liability Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Wire. Denise Bailey/DENISE ACORD 25(2001!08) ©ACORD CORPORATION 1988 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. . ?l'{ rd )ivy < rkl� e Pro rty Address R- --A; r Rent Of\ boa. ► AA.- r. 1 — S . 61 • Job Description Required Department Permit Issuance Approval Approval Tax Collector n� �, ,, i %\ k o v v Signature/date Comments: ./ Planning & Zoning CsQQQQ„ l It Signature/date Comments: Fire Marshal - I )/'0 Signature/date Comments: Health Department Req ired for all permits except Plumbing,Electrical,Mechanical, Roofing,Siding,Windows&Doors Signature/date Comments: r4 WPCA, Administrative � ► O Required for properties on sewer Signature/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: ❑ 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 March 19,2010