HomeMy WebLinkAbout12x16 Shed 2001 Town of Montville
Building Department
Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231
Building / Trades Permit
Permit Number BP2001-598 Permit Date 10/12/01 Permit Type Building Permit Code R9
Job Street# 104 Job Location POLLYS LANE Map/Lot 102/037-000
Job Description Shed 12'x 16'
Owner Contractor
Danielle Kaminski Carefree
Address 104 Pollys' Lane Address 48 Westchester Road
City Uncasville State Ct. City Colchester State Ct.
Zip 06382 Telephone 848-7113 Zip 06415 Telephone 1-860-267-7600
Lic/Reg Number 517101
Lic/Reg Type HIC Exp Date: 11/30/01
Use Group R4 Code 1995 CABO Type Construction 5B
Building Value $4,800.00 Building Fee $28.00
Plumbing Value $0.00 Plumbing Fee $0.00
Mechanical Value $0.00 Mechanical Fee $0.00
Electrical Value $0.00 Electrical Fee $0.00
Other Value $0.00 Other Fee $0.00
Total Values $4,800.00 C/O Fee $10.00
Comments: Plan Review Fee $2.80
State Ed Fee $0.77
• .I Fees $41.57
Building Official's SignatureAr) /
//i �--U
��-�'z' � Date
It is the owners res•onsibili to schedule the followin• re•uired 1' •ections (minimum 24 hours notice required):
r
Footings -prior to pouring concrete
Backfill -footing drains and waterproofing ❑ Fireplace Throat
Concrete Slab, prior to pouring ❑ Fireplace Final
❑ Rough Framing ❑ Chimney-one flue above thimble
❑ Rough Electrical ❑ Firestopping/draftstopping
❑Electrical Service ❑ Insulation
[Rough Plumbing and leak test ❑ Pool bonding
❑ Gas piping -pressure test and installation ❑ Final Inspection
❑ Rough HVAC d Certificate of Occupancy - PRIOR to use or occupanc
Town of Montville Pew2�� 5f
Building Department
310 Norwich-New London Tpke.
Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231
Application for Building or Trades Permit
Building Permit Trades Permit
❑.New Construction Ei Accessory Structure6i(Ptum
ElAddition ❑�DemoCztion � ng ❑�fectianicat
❑Alteration ElOther Electrzcat �feating
Air Conditioning
Gas 1ping
Job Location 1 O L} R3 1,.L.y's LA•KIE
Job Description/Materials '3 h eq / / X 7 . %
Owner .DA 1E;L )?A l Mailing Address I 04 QOLLY'S I-AJ!C—
City \�—S\11wc State C:! Zip ys2 Tel 00 /$L/g / 1113
Contractor (PFZ,filEZ, Mailing Address `-I c c_ttEs;
City cn .�t*...scE'2.. State .l-" Zip 41 s Tel 184,0 /27 / "1(6
00
Contractor's License/Registration Type&Number S I 11 c)I Exp. Date I 1 / 30 / 01
New Home Construction Contractors:
Have you entered into a contract with a consumer for the proposed new home? ❑ Yes ❑ No
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.
Owner/Agent Signature4;3.- Date f 4 / y /
Construction Value Fee
Building $ ,;1e•00.,.- $ ,/
Plumbing $ $ ��
Mechanical $ $
Electrical $ $
Other $ $
Certificate of Occupancy $
Plan Review Fee /0
State Education $ ,�`fr�
Total $ '/Y./C)'11 -- $ A/. �7
Town of Montville BuildingDepartment Receipt
3) Date _Lai /_e2j_
No. 01152
From:
Job Address: r
: .0 Amount $_ ..i
Cash Check Cheek #
Circle one) ______________
Received by \ /,
r►4�1. Permit # . er
Permit Fee Calculation Spreadsheet
MISCELLANEOUS PERMIT CALCULATION
Pools&Spas
Above Ground Round EA $ 3 00000 $
Above Ground Oval EA $ 5,000.00 $
In-Ground EA $ 18,000.00 $
Heater EA $ 3,300.00 $
Hot Tub EA $ 5,000.00 $
Roofing
Strip&Reroof SQ $ 210.00 $
Overlay SQ $ 175.00 $
Sheds
With Electric SF $ 25.00
No Electric 192 SF $ 25.00 $ 4 81:r
Deck SF I. 15.00 $
Porch SF 23.00 $
TOTAL BUILDING CONSTRUCTION COST $ 4,800.00 I
PERMIT FEE
Building $ 4 80) $ 28.00
Mechanical S . $ -
Electrical $ $ -
$ -
CO Fee $
$ 10.00
Plan Review
$ 2.80
State Ed Fee $ 4 800 $ 0.77
Total Fees $ 41.67
Based on 2000 Average Construction Cost
10/4/01
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at I C -3 PCju.. s LANI
In the town of U..)CkR.i- if i
Name of building permit applicant: 'M ICNc B.... 4.4ntikAiLyNKI SQ
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 § 31-2866, "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 notarized 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. 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)
Town of Montville
Building Department
848-7166
CONSTRUCTION PERMIT SIGN-OFF SHEET
Property Address Map/Lot
Job Description:
The owner/agent shall be responsible for the completion of the form, no construction permit will be issued until all
signatures below have been obtained.
HEALTH DISTRICT
823-1189
❑ Permit#: El
Applicable
Septic System Date
❑ Approved Not Applicable
Plans for Food Service Establishment '.Date
13- Permit#: ❑ Not Applicable
Private Well Date
h.WPCA DEPARTMENT
848-7094
C7Sk---'1 \
/0/C(4' ' ❑ Permit#: 1./ Not Applicable
Municipal Sewer Date
❑ Permit# ❑ Not Applicable
Municipal Water Date
DEPARTMENT OF PUBLIC WORKS 848-7473
Director
111 Permit#: 111 Not Applicable
Date
POLICE DEPARTMENT
848-7510
'h\❑ Plan iewedt Applicable
Officer in Charge Date '�
PLANNING & ZONING DEPARTMENT 848-8549
F_., //-<003),,, ( Y/ ❑ Permit#: 2%/—07 $ ❑ Not Applicable
Zoning Date
Permit#:
❑ [ Not Applicable
Inland-Wetlands Date
FIRE MARSHAL'S OFFICE
848-1175
Plan Review
Approved Not Applicable
Fire Marshal Date
.
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10/'04/2001 11:07 860-2671018 CAREFREE
AACORD, CERTIFICA E OF LIABILITY I PAGE 02j02
PRODUCER (S Ba)2 4,3_296 3
FAX �A• DATE(M61r1DD1YY)
Arthur No11 Agency, Inc. C8fi0).28,8-9212 IHI$ CE' 07/18/2001
A enc ONLY AND CONFERS •- T • • T
NO RIGHTS UPON THE C7-cRTr
Corporate Place -
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
3 Barnard Lane ALTER TI-OE•COVERAGE AFFORDED IBYTHE POLICIES BELOW.
- -
Bel d, CT 06002 INSURERS AFFORDING COVERAGE
INSURED `
Carefree Building Co. Inc INSURER A: Star Tnsura.nce Company
48 Westchester Roc INSURERS:
Colchester, CT 06415 INSURERC:
INSURER D'.
COVERAG S NSL RER E.
I THE POLICIES OF INSURANCE LISTE■ B
ANY REQUIREMENT,TERM OR ELOIN HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED
ANY RETHE SURA OCE A FORDED FBT Y CONTRACTOR OTHER DOCUMENTCERTIFICATE BE i H
MPAY
PES AIN T E INS LfNl1 HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TT HE TERMS,EXCLUWHICH THIS SION'S AND CONDITION SF SUCHO
TS SHOWN MAY HAVE BEEN REDUCED MAY ISSUED OR
LrTrrar- TYPE'OPYN BY PAID CLAIMS, S 4r
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GENERgL1,S4HiLl'KY 'fE'{MIPf/Of]/YY) OATEIYdM#�appgy.� • .T ""
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COMMERCIAL GENERAL L'ABIUTY EACH OCCURRENCE g ' __,,
CLAIMS MADE 0 OCCUR FIRE DAMAGE(My One fire) E
HIED EXP(Arty enc N r80nj $
it PERSONAL$ADV INJURY $ ^
GEMAGGREGATE LIMIT APPLIES PER; I GENERAL AGGREGATE
POf_f0Y PRO-
JECT $ ...
L
JJ LOC
AUTOMOBILE LIABILITY
T�ANY AUTO COMBINED SINGLE LIMIT
AIL OWNED AUTOS
(Es accident) $
SCHEDULED AUTOS
BODILY INJURY HIRED AUTOS /Per person)
$
NON-OWNED AUTOS 68011Y INJURY
(Per accId9nUI $
PROPERTY DAMAGE •-....
GARAGE L1Aa1LITY (Per Bdeidmry S
1111 ANY AUTO AUTO ONLY-EAACCID✓_NT S
+I OTHER THAN EA ACC $
EXCBgg LIABILITY "'"" AUTO ONLY.
AGG $
jOCCUR E CLAIMS MADE EA.r!i CiJ.RP-.ENCS g
AGGREGATE —� 5
DEDUGT1'8LE $ ^
RETENTION g $
woftfcens COMPENSATION AND CD 12 S 1 7 ., $
_ 01/08/2001 01/08/2002 +TORYLtrwlTR
sl E
A -- .i.
ems.EACH AC iUENT 1 ...500,•000
EL,DISEASE-eAEMPLOYE d 500,000
-T OTHER E.L.DISEASE-POLICY LIMIT g
540 600
DESCRIPTION•F OPERATIC SILO A t•NSNEHICLESIEXCLUSION$AO•ED,Y P_•FIOORSEMENTJ$PEGSAL PROVISS6?SS
7.:E-TI ICAT `OLDER III ADDITIONAL INSURED;INSURER LETTER CANC TION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION OA TE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
Northeast Utilit'f•5 10 DAYS WRITTEN NOTICE TO TIRE CERTIFSCATE HOLDER NAMED TO THE LEFT,
BUTFAILURETOMAILSUCHNOTICESHALLIMPOSENOOBLIGATIONORLAAPILITY
Attention! Claims & Insurance Department
PD BOX 270
OF ANY KIND UPON THE COMPA_ago,AGENTS OR REPRESENTATIVES.
Hartford, CT 06144-0270 AIM•RIZ D REP EBENTATIv,
Arthur Noll
- •-• •-r• • • • •'-
10/04/2001 10:28 860-2671018 CAREFREE
B
pEFP PAGE 01
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Double 2 x 3 Header li
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2x4Jack StudT.*r218°Imillik ' 'IMIIIIII..1.1111 .1.111Millu..- •
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Metal Truss Plate
Alum' L-- ll Asphalt Shingles
Aluminum Dripedge "� ! ragles
'� I 4� wood
w= -' 'MI Aake Trim
2 x 4 Top Plate T1-11Aluminum
II I � num
2 x 4 Wall Studs + 12 x 12
,�-Dap
(16"on center)
III II �� f I! Wood Louver
2 x 4 Bottom Plate 11
Wood
I Corner Trim
3/4" PTS Exterior
Plywood Decking L.._ I 5/8"
2 x 6 PT Floor Band
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4 x 4 PT Foundation Runner .iiJ V, Siding
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CROSS SECTIONS VBM12-1/95
GPREF/RF
Date_f -- (-
PURCHASE ,----! ;.-- 11E1 t.
AGREEMENT .YU. ,
,J G Number
SMALL BUILDINGS
"Built To Law A lifetime"
48 Westchester Road•Colchester,CT 06415
Tel.(860)267-7600 Fax(860)267-1018
PURCHASER I -' tt/I f r LLE: k1 f ti.r Z-P,
STREET I :- t
TOWN C.//rC r-i•=-, 4 t i.. I- f STATE ZIP /7s1-2--- - '-'
PHONE:
_ - 'PHONE: HOME:•r; ; C,y '-' - f ii ' WORK 11,,c4 _ S. -, FAX
r
STYLE ` / ; 7 SIZE
1�'G'
COLOR (cit.':r1 TRIM l -// / r
SHINGLES 'f-r-4 C! i/ SIDING in l — 2 .//
DOOR 1-1 ii i;, J�)t '/ WINDOWS / 1/4/F W/SHUTTERS&BOXES
OPTION#1 f V r
OPTION#5
•PTION : A % _ • .7t r /V OPTION#6
OP •N#3 OPTION#7
OPTION#4 OPTION#8
SPECIAL INSTRUCTIONS: TOTAL OPTIONS , /,i-.t A '1
SIZE 7 X 1.6LOADING -)BLDG. PRICE \' f, '`,�7: c-i a 7 r .,<;..
1 l
DELIVERY V;�Q':
•
SUB TOTAL
t L t j (� t Ir SALES TAX - ( '^
J - CT. OVER WIDTH
t t ' "'t j PERMIT FEE $25.00 $25.00
T t '1. I
k1/ 4 f ie SITE-BUILT CHARGE -- ,"
TOTAL 1 /11.
1-
- ❑MC❑VISAACheck❑Cash
it v'_ e''r�_-/n /(j DEPOSIT j 0 . , ,j
Estimated delivery date week of: r, ADDITIONAL DEPOSIT �- C
—
You will be contacted for an exact elivery date. DUE ON DELIVERY ._ ',Iy,
Order subject to review by Carefree main office for errors
•
PURCHASER 1,Y--, ,:..7.'( ' 1J1/.-..-1-f - PLEASE . i ,
Y PRINT t �`
SIGNATURE (I HA READ ANDLUNDEI.STAND"SCHEDULE A"ON REVERSE SIDE) r t
DEALER / / ' .-r ,� _ - -- ..._-_.---
SALESMAN /1/ 4�
4/ 1
DATE DELIVERED PAYMENT RECEIVED BY
NAME
RECEIVED BY PLEASE
PRINT
PA 11-97
104 P0k\Y\3 Lan e•
ZONING PERMIT
IT IS THE APPLICANT'S RESPONSIBILITY TO FURNISH THE FOLLOWING
INFORMATION:
PROPERTY LOCATION I d`-I POLLY'S LAN * MAP t C-'Z. LOT 37
PROPERTY OWNER 1)1C41\-11a1 I= 1.6Ar-k11JSIU
CONTRACTOR Cc• Y f It -e•F CONTRACTOR LICENSE#
CONTACT ADDRESS TELEPHONE
ZONE a -Z C'' LOT AREA 7dj��6s STRUCTURE AREA HEIGHT
NATURE OF REQUEST/PROPOSED USE 17, /iv c l e C-
A SKETCH, OR PROVIDE TWO COPIES OF PLANS DRAWN TO A SCALE OF AT LEAST 1" a 40' SHOWING: DIMENSIONS OF THE LOT,
THE SIZE, AREA, AND LOCATION OF EXISTING, PROPOSED, PRINCIPAL AND ACCESSORY STRUCTURES, DRIVEWAYS, SANITARY
FACILTIIES AND WATER SUPPLY, PARKING FACILITIES, AND ADJACENT STREETS; DISTANCES OF PROPOSED STRUCTURES FROM
PROPERTY LINES AND WETLANDS. A PLAN PREPARED BY A CONNECTICUT REGISTERED LAND SURVEYOR MAY BE REQUIRED.
THE PROPOSED USE SPECIFIED ABOVE SHALL NOT BE AUTHORIZED UNTIL AN ACTUAL CERTIFICATE OF COMPLIANCE IS ISSUED
BY THE COMMISSION OR ITS APPOINTED AGENTS.
Office use only
YES N/A
SKETCH PLAN OR GRADING PLAN P o
HEALTH DISTRICT/WPCA APPROVAL 0
STATE HIGHWAY PERMIT 0 P
WETLANDS PERMIT 0
HAS A VARIANCE EVER BEEN GRANTED FOR THIS PROPERTY 0 ®-1
HAS BOND BEEN FILED 0
FEE (� 0 CASH/CHECK# 0
ZONING PERMIT NUMBER 2 0 f -Z 7 �l OR DN/A EXPIRATION DATE /g/y/C)/
THE APPLICANT IS RESPONSIBLE FOR AND AGREES TO:
1_ ADHERE TO ALL THE APPLICABLE REQUIREMENTS OF THE ZONING REGULATIONS.
2. FURNISH ALL NECESSARY INFORMATION AND DOCUMENTATION TO PROCESS APPLICATION.
3. NOTIFY THE COMMISSION OR ITS APPOINTED AGENT OF ANY ALTERATION IN THE PLANS.
4. CONTACT THE ZONING OFFICER 1848-8549 AT LEAST 24 HOURS BEFORE CONSTRUCTION BEGINS AND
UPON COMPLETION OF PROJECT TO ALLOW ZONING OFFICER TO INSPECT LOCATION.
. 1110
APPLICANT'S S TORE /
:�Sj f �.�,. ♦ SATE. I I Q
2/:-(=4A-19_ ��DATE � Y "Cc>L��, rU DATE S�C'/
COMMISSION AGENT CERTIFICATE OF COMPLIANCE
THIS SIGNED PERMIT AUTHORIZES THE APPLICANT TO PROCEED TO THE BUILDING DEPARTMENT FOR ANY REQUIRED PERMITS
THE SIGNED CERTIFICATE QF COMPLIANCE La NEEDED PRIOR TO A CERTIFICATE OF OCCUPANCY BEING ISSUED BY THE BUILDING
INSPECTOR
REV. 6/29/99