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HomeMy WebLinkAboutAlteration Full Bath 2001 Town of Montville Field Inspection Notice Permit # Location: //.4 1741-1-`r t E Type of Inspection: /Z. P LJNj,( , )re,j Issued to: Delivered to: APPROVED NOT APPROVED The following orders are hereby issued for their correction: Please call for inspection when corrections have been com• -ted 860-8 : 7166 Date: 2//Vol By: // �� Building Official Town of Montville Building Department Phone: 848-7166 310 Norwich New London Tpke .... Fax: 848-7231 Building / Trades Permit Permit Number BP2001-40 Permit Date 1/31/01 Permit Type Building Permit Code R4 Job Street# 116 Job Location POLLYS LANE Map/Lot 102/040-000 Job Description Alteration Owner Contractor Donald P. Woodmansee Lathrop Bros. Address 116 Polly's Lane Address P. O. Box 248 City Uncasville State Ct. City Uncasville State Ct. Zip 06382 Telephone 848-8487 Zip 06382 Telephone 848-3773 Lic/Reg Number 554264 Lic/Reg Type HIC Exp Date: 11/30/01 Use Group R4 Code 1995 CABO Type Construction 5B Building Value $2,900.00 Building Fee $16.00 Plumbing Value $4,000.00 Plumbing Fee $22.00 Heating Value $100.00 Heating Fee $10.00 Electrical Value $500.00 Electrical Fee $10.00 A/C Value $0.00 A/C Fee $0.00 Other Value $0.00 Other Fee $0.00 Total Values $7,500.00 C/O Fee $10.00 Comments: Plan Review Fee $1.60 paid check State Ed Fee $1.20 To rel Fees $70.80 Building Official's Signature �' �ld� v�tG Date // j// ll/ It is the owners responsibility to schedule the following required i p ections(minimum 24 hours notice required): ❑ Footings-prior to pouring concrete ❑ Fireplace Throat ❑ Backfill -footing drains and waterproofing ❑ 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 VI Certificate of Occupancy-PRIOR to use or occupancy its "' Town of Montville '"''d Permit # 092a0crI- 9O 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 ❑ Accessory structure ❑ Plumbing DMechanical UAddition ❑ Demolition ❑ Electrical Heating pui Alteration D Other Air conditioning Gas piping Job Location // 6 Pe4-C /s �/el� Job Description/Materials (,A./ 7 T4LL:4 n4 t> U ,�c/C"c L3/-9-F70/ Ownerp vt,,pm}t,o ,f, Owene,( 5'. " Mailing Address /(Co ,ateL c--},'s City (�!�' - LI '" State �7— Zip O&3f 2_Tel.rtep ftir - a-7 Contractor ` older S Mailing Address /0, f'o)Cia City C/ c St44-c"‘ State C.:17- Zip D6 3er&Tel.kQp -Fi - .3 273 Contractors License/Registration Type &Number !Y..� K Exp. Date i( / 3O / O( New Home Construction Contractors: Have you entered into a contract with the consumer for the proposed work? [jYes El No 70 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 . .plication for a permit for such work as described above. %).411011P,° Owner/Agent Signature Date / / 3 ( I D I Construction Value Fee Building $ 3 d O O $ Plumbing $ 4/1'00 $ ,R Heating $ JO? n $ /0 Electrical $ o $ /'D Air Conditioning $ $ Other $ $ Certificate of Occupancy $ / !� Plan Review Fee $ /- ‘.0 State Education Fee $ j , D Total $ 7/400 $ 7e3 ,_s'a Town of Montville Building Department Receipt Date _ / �3/ / O / No. Ci From: SI Job Address: 0 ___c fria 7 t,_y_Ai Am!° -' ount �y --�`�-� $— {-�► Q_ Cash Check Check # (ci Ie one) --J-746.5.— ii, Li cP Received by I /�• �%� Permit • Ned STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at 1/ /SOL C- V-Sr L/q4// In the town of wAlry Name of building permit applicant: Lav`, ll" Please check one: 1. I am the owner of the above property. 2. }C I am the sole proprietor of a business. 2A. Name of business L_ (1' '-- a-.c 2B. Federal Employer Identification Number(FEIN) 06-0639310 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 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. ,j 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 acceptsoverage Signature of applicant Subscribed and sworn to before me this 3 day of y ,200 I . K 0 :O (Notary Public/ rt) Lisa DiMarco Notary Public My Commission Expires Oct 31 2002 • ,...' I 4.... 44 i v.i I ,.... Iii \ , 1 „II . 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