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HomeMy WebLinkAboutStrip and Re-Roof 2001 Town of Montville Building Department Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231 Building / Trades Permit Permit Number BP2001-200 Permit Date 4/30/01 Permit Type Building Permit Code R4 Job Street# 131 Job Location POLLYS LANE Map/Lot 102/015-000 Job Description Roofing-Strip Owner Contractor Richard Friedrich Mark P. Eaton Address 131 Polly's Lane Address 39 Mowry Avenue City Uncasville State Ct. City Norwich State Ct. ZIP 06382 Telephone Zip 06360 Telephone 887-2161 Lic/Reg Number 525708 Lic/Reg Type HIC Exp Date: 11/30/01 Use Group R4 Code 1995 CABO Type Construction 5B Building Value $4,300.00 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 $4,300.00 CIO Fee $0.00 Comments: Plan Review Fee $0.00 State Ed Fee $0.69 Total Fees $28.69 Building Official's Signature r' Date / / /G It is the owners respon- itv to schedule the following required inspections(minimum 24 hours notice required): Footings -prior to pounng 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 0 Certificate of Occupancy -PRIOR to use or occupancy Town of Montville Permit# $pz oo I—z_oo 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 ❑Tlum6ing ❑9Kechtanical ❑Action ❑0emotItion ❑Electrical ❑Alteration ['Other lZo .7feating ��� � Air Conditioning —Gas Wiping Job Location 1,3 I PO I/ '/ S LAN Job Description/Materials S T121 P Owner g i CI-NovJ Frl e> i c l f Mailing Address 13/ ?d ) /'/ City l) NC F s v ! I IT State CT Zip O 8 2– Tel / / Contractor i►1 Iv IL Mailing Address .?9 yv\0 i.-)r A -e City n(ci rw LL State C / Zip O 6� G c� Tel 5'Go /8871- 2/G J Contractor's License/Registration Type&Number .1-21-20e- Exp. Date I 1 /3 O /6/ 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 SignaturePV ...,0� Date 0 y /00 / O l Construction Value Fee Building $ S Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ -WOO. © $ Certificate of Occupancy $ ----, Plan Review Fee State Education $ 6 Total $ —, g, Town of Montville Building Departript Receipt l t Date 9 /��/OC No. 00626 From: -- LLir L=A?'ar1 Job Address: /3/ 170 t_L. ' _ _L/2N6- c41) z . Amount $ '? 69 Cash Check Check #.S_ 7_Z_A_ li (circle onc) i____ Received by • ce t,.I,tr.e/S Permit # �C1) _ 00 • STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at 1,3 i PO I 1_ -L In the town of U u C tS y, i/ 7- C / Name of building permit applicant: fvini2 K Please check one: 1. I am the owner of the above property. 2. X I am the sole proprietor of a business. 2A. Name of business ►n'' (_--)I °"J C cU , 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 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. X I do not intend to act as a general contractor or principal employer. [Sign and stop here] iArlie/ v 'ignature of appli t 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)