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Home My WebLink AboutStrip and Re-Roof 2004 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: B2004-0627 Date: 18-Oct-04 Map/Lot: 102/029-000 Owner ID: 5633000 Project Location: 95 POLLYS LANE Unit: Job Description: Strip&Re-roof Owner Name: Mary H Mcclure Tenant Name: N/A Careof: Po Box 43 Uncasville CT 06382- Telephone: Contractor Name: HO&HO Jr. Inc. Telephone: (860)535-3506 DBA: Lic/Reg Type: HIC Lic/Reg No: 583325 39 Montauk Ave. Exp Date: 30-Nov-04 Stonington Ct 06378- Construction Value Permit Fees Construction Information Building Value: $9,000.00 Building Fee: $72.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code Mechanical Value: $0.00 Mechanical Fee: $0.00 w/2004 Amendment Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $9,000.00 Penalty Fee: $0.00 Permit Code: R4 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $1.44 Total Fee: $73.44 It shall be the owners revsonsibility 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. ❑ Footing-Prior to pouring concrete ❑ R Plumbing and leak test ❑ Backfill-Footing drains and waterproofing ❑ R Electrical ❑ Concrete Slab-Prior to pouring concrete ❑ Elec Trench-with conduit installed ❑ Framing ❑ Electrical Service CRS No: 0 ❑ Fireplace Throat-One flue above throat ❑ R HVAC Rs ❑ Chimney-One flue above thimble ❑ Gas Piping and leak test ❑ Firestop Draftstopping Final Inspection ❑ Insulation ❑ Certificate of Occupancy Building Official's Approval: //�� 4iinlr1 7 Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville,CT 06382 R Fax. 848-7231 Residential Building Permit Application orm�O Permit#97-4,01-1-°6?-7 Sep � � eve 3°ftit ❑New Construction 0 Addition [r Alteration 0 Accessory Structure 'U//V rA Mpg 1[ SingCe'Family 0Two-Family EI Townhouse Job Address 74r9T`9 (B// c5' 4ø' (Number) (Street Job Description �' ��'f/4 e,;--- .1_, - ,-/ r (Unit) _3o S4 Owner 17 ,4( c5 ,`o� L , MailingAddress /.42=1--- I-4:2 .4--A- ---- City 1Wa/(LJ - !.life. ""olf,� State -7 Zip Tel / / Contractor/1`e-ce-6�7, /'- 'e--- Mailing Addresses "AZ City C S'�.Uf.t lit '�� State 2 Zip P67 Tel Or—An 7,.../ k't'6 Contractor's License/Registration Type&Number 1/45-.9-0-7:51---i— Exp. Date /l /("8 , 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 am au ri to make application fora permit-for such work as described above. Separate applications are required for electrical,plumbing,mechanical, etc. Owner/Agent Sign a ��% Date 9 /L3cf, /d V- V Construction Value Fee Building $ 9 gc,c $ -2Z" Plumbing $ $ Mechanical $ $ Electrical $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ J-y I Total $ leo t $ 73 11-1-) (See 4verse sidefor additional'requirements) R.MsefSeptem6er9,2004 • STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: Jc9(4-- T &y it /e In the town of /YJbf�j fl f ./f. 2,°` Name of building permit applicant: j7'5 " <.Py '- Please check one: 1. 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(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 contractor or principal employer. [Sign and stop here] Signature of applicant 2. V 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 appr. . 'ate District Office; and that a sole proprietor of a business is not required to hay/coverage unless ent to accept coverage. Signature o applicant Subscribed and sworn to before me this day of , (Notary Public/Commissioner of the Superior Court) -STATE OF CONNECTICUT DEPARTMENT OF CONSUMER 1110TECTION HOME IMPROVIlli 1104111 C9,14TRACTOR AVE . 4 Si .8 CalitiWolidiVILLY JR 4.4 LIC./REG v EXPIRES 583305 —.-./77-001112004 .,---Z-11/30/2004 1 5 3-44--y— • ' 9 / SIGN L...d #A Ap L. r • Town of Montville Building Department Receipt Date 7 / 3o / GN No. 0431 From: 01 TLC 1/4% / Job Address: /o t Oh) t3 Amount $ 23. i rr/ Cash Agi ` ___ Check # t Circle one) Received by J, ��r+�--e l,� Permit # Town of Montville . Building Department 848-3030, Ext 382 CONSTRUCTION PERMIT APPROVAL >X/tl r7/' Property Address i y/4-�� 1C3�1B�/k'p�2_S , �t 2 Job Description The applicant is responsible for obtaining all of the required approvals checked off on this form. No building permit will be issued until all of the required signatures have been obtained. Required roval Department Permit Issuance Approval Approval Tax Collector a�Gc- Sign'tur' date WPCA • 3 04 5° Signature//date ❑ Planning& Zoning Signature/date ❑ Health Department Signature/date El Department of Public Works Signature/date El State Dept. of Transportation -S i r atuire,--date ❑ Fire Marshal Signature!date Comments/Conditions: RjpviceiSeptem6er9,2004