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SFR 2005-2007
H o= N Q 0 N C Z O Z N (pal � a0+ c � o a C cu O � rn C 0 E E ^, 4) w IA > > co- O O m �` is � � a, e I E a) a. a. I V) L.) u .5 CJ L a=+ro m V Q a) O O O in N c4--,J Z < o E < < o a o m (1.9 ›-••:-1-2-, To A d- Z Q O c cu o a) E O 0 n3 w _0 o ~ c d- p c0 CI) CO O Z a E crz' .i-+ Q ai Z 1-1 V L 4.4 _J [r-I UI 3 -52 o b - 1O c � V to 111141 S U U co �1 U " � , co d i -6 k71 co c k. " c n3 Orn _ , u- a o ai , CC) a O' o o CD cUri: c# N a ' cU (nm J 4-1 4- i cn a)j rn �1 O U) Q c -1"' � V., G7 01 c E �O (n L an p O E m -'Cp p :4-' . 'orELo C7 0 V = L Q O- E •Q c U N cn OL O 'U cu z c U (1) d" C7 U) � c y a) ( ;: c (n 0- Ur dj '0 a) • c in 0 _0 L a) - a) c IHUN a o a D 0 CL 0 Town of Montville Building Department File Receipt Date: 12-Jan-07 Receipt No: 1999 Received From: Schramm Builders Job Address: 146 Polly's Lane Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $171.16 Check: $2.76 Check No: 1726 Short/Over: $0.00 Construction Value: $17,263.00 Demolition Value: $0.00 Received By Sandra Pandora ".--IcA01.------- Address: REM QTY S/UNIT TOTAL Building Plumbing Mechanical Electrical BUILDING AREA New Construction SF $ 114.17 $ - $ - Basement,Finished - SF $ 20.87 $ - $ - Basement,Unfinished - SF $ 11.28 $ - $ - - Crawl Sapce SF $ 8.46 $ - Interior Renovations 336 SF $ 31.90 $ 10,718.40 S 443.52 $ 884.43 MANUFACTURED HOMES Ground Anchors SF $ 5.86 $ - $ - $ - Basement - SF $ 11.28 $ - $ - $ Crawl Space SF $ 8.46 $ - $ - $ - AMENITIES Kitchen `. EA $ - $ - $ - Full Bathroom EA $ - § - Half-Bathroom _ EA $ - $ - GARAGE Attached SF $ 49.41 $ - $ - Detached SF $ 63.21 $ - $ - Under SF $ 9.12 $ - $ - Carport SF $ 18.08 $ - MECHANICAL Warm-Air Y YM $ 2,997.12 Hot Water Y YM $ 2,207.52 Electric N YM $ - Air Conditioning N YM $ - ELECTRICAL SERVICE Upgrade Amps $ - Overhead,new Amps $ - - Underground,new Amps $ - Subpanel EA $ 545.00 $ - Gen Set EA $ 3,500.00 $ - SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 5,907.00 $ - - Masonryw/tfireplace EA $ 6,451.50 $ - Masonry w/2 fireplaces EA $ 10,087.00 $ - Wood Stove,free standing EA $ 2,447.50 $ - Wood stove insert EA $ 1,690.70 $ - DECKS,PORCHES,SUNROOMS Deck SF $ 39.16 $ - Porch SF $ 135.80 $ - Sunroom SF $ 160.82 $ - $ - POOLS&HOT TUBS Hot Tub EA $ 7,287.50 $ - $ - - Inground Pool EA $ 19,430.40 $ - $ - Above Ground Round EA $ 4,635.88 $ • $ - Above Ground Oval EA 5 5,472.50 $ - $ - Pool Heater EA 5 8,167.50 $ - Infatable Type Pool EA $ 1,542.42 $ - SHEDS w/o electrical SF $ 18.50 $ - w/electrical s SF $ 18.50 $ - $ - RENOVATIONS Roofing,Overlay SF $ 3.38 $ - Roofing,Strip&reroof SF $ 3.76 5 - Roof Sheathing SF $ 1.19 $ - - Siding SF $ 2.30 $ - Windows EA $ 423.50 $ - - SkNights EA $ 955.54 $ - Doors,Exterior EA 5 401.50 $ - Oil Tank,275 Gallon EA $ - Oil Tank,550 Gallon EA $ - MISCELLANEOUS CALCULATIONS TOTALS $ 10,718.40 $ - $ 5,648.16 $ 894.43 PERMIT FEE CALCULATIONS Construction Value Fee Building $ 10,719.00 $ 88.00 Plumbing Y $ - $ - Mechanical Y $ 5,649.00 $ 48.00 Electrical Y $ 895.00 $ 8.00 Working before Permit Issuance N $ - Certificate of Occupancy Fee $ 10.00 Plan Review Fee $ 14.40 State Education Fee $ 2.76 TOTALS $ 17,263.00 $ 171.16 Figures are based on the 2006 RS Means Residential Cost Data Town of Montville Building Department Field Inspection Notice January 12, 2007 Address: 146 Polly's Lane Job Description: SFR Permit Number(s): B2005-0458—E2005-0264—M2005-0195—P2005-0107 Permit Date: 8/18/05 Not Approved Approval FOOTINGS Date: Deficiencies Special Conditions Date • 8/17105 DJ • Not Approved Approval BACKFILL Date: Deficiencies Special Conditions Date • 8/25/05 DJ • Not Approved Approval FRAMING Date: Deficiencies Special Conditions Date • • 10/21/05 DJ • Not Approved Approval ROUGH Date: Deficiencies Special Conditions Date PLUMBING • 12/13105 DJ Not Approved Approval ROUGH Date: Deficiencies Special Conditions Date ELECTRICAL 12/13/05 DJ • Not Approved Approval Date: Deficiencies Special Conditions Date 12/21/05 DJ NOT CONSTRUCTED IN ACCORDANCE . WITH APPROVED PLANS—Finished INSULATION room over garage not on plans • Room Use? • Framing? • Heat Loss • Insulation(RES check) ELECTRICAL Not Approved Approval SERVICE - Date: Deficiencies Special Conditions Date Overhead 1/17/06 JS • No access into house • 1/24/06 W Not Approved Approval Date: Deficiencies Special Conditions Date Not Approved Approval Date: Deficiencies Special Conditions Date 1/11/07 DJ • House number must be present • and displayed on the front of the Certificate of building. Occupancy • All bedroom receptacles must be 1/12/07 DJ on arch fault breakers. • The electric service must be bonded to the water system. Rev.Date:8/4/05 Page 1 of 1 I -c./-i-/e/4-t‘t tikk 6 -1e/R el 6_s ye3 - 9e ? 6 /9 7-1--"' . -r// Sc/AA / I:1eq Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 CERTIFICATE OF OCCUPANCY APPROVAL /V �'e'//f5 Z /4/V çA)c / /11.7/ s)Property Address \ S,r✓6 Le= 1 4�c tL 4! f/vus"c' /c/EW cam, s; 17 i ) Job escription / No Certificate of Occupancy will be issued until all of the required signatures have been obtained. Required Approval Department Certificate of Occupancy Approval ® WPCA I A, IQ-15 O(o Signature!iul"e' date Comments: Planning > Zoning �� '-.01 , / ° '07 Comments: Zo1- - /4 Y- r Health Department rri Cg.?I,_L; %-"/-07 Signature/date Comments: 'Pr2 _"-!L. _ El Department of Public Works Siga i-,, ! _ t Comments: State Dept. of Transportation (All conditions of STC Certificate of Operation(if applicable)have been satisfied) ig ati,irer date Comments: I I Police Department Comments: _ Fire Marshal Comments: nsed%tugust 5,2005 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 ELECTRICAL PERMIT Permit Number: E2005-0264 Date: 18-Nov-05 Map/Lot: 102/047-OOA Owner ID: 5652300 Project Location: 144 POLLY'S LANE Unit: Job Description: Electrical&Electric Service for new SFR Owner Name: Schramm Developers/Builders LLC Tenant Name: N/A Careof: 423 Groton Long Point Rd. Groton CT 06340- Telephone: Contractor Name: MacDougal electrical Services Telephone: (860)213-1553 DBA: Lic/Reg Type: El Lic/Reg No: 186613 54 Baldwin Brook Rd. Exp Date: 30-Sep-06 Canterbury Ct 06331- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 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: $0.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 Included on Building Permit State Ed Fee: $0.00 Total Fee: $0.00 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 framing 0 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 ❑ Certificate of .proval JØtsf Occupancy Building Officials Approval: , Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential Trades Permit Application Form Permit# ,O2 4 o cPCum6ing NECectrica( fv(eciiianicat CRS # 7feating Air Conditioning Gas Piping gSing&e Famity Two-Family ❑ Townhouse Job Address /Y y Po 1( S (Number) (Street) (Unit) Job Description /4.4.J C /0-0 „.....reft Owner Sc 0-4 Mailing Address >Zi 6%44-4 City L State CI” Zip Tel Pia / VZ / 'o r b Contractor AA.,c 1) ,,y J 1 .k 2.J J Mailing Address fy loG, nk►l� Ai( City (;,.f pj,/ry State C 1 Zip 04331 Tel IL') / 213 / iy-r3 Contractor's License Type&Number I Klp(0 l 3 C t Exp. Date 9 l -lo / 0 6 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 Signature Date 1/ / i( / ° Construction Value Fee Plumbing $ $ Mechanical $ $ Electrical $ y w p . " Work commencing before the issuance of a permit $ Plan Review $ State Education $ Total $ $ ft-visa 6November 1,2004 STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION � I ELECTRICAL U$UMI TED:CONTRACTOR El BRIAN T MACDOUGALL 54 BAtfoliMV`BROOB:RD CANTERli*CT O031 LIC.I REG NQ" EXPIRES 186613 —1 tau 101611-1(V,004-09/30/2006 •SIGNED . Town of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030, Ext. 382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL l y Y Poll ts Property Address /747-‘—e Cis/ x 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 Approval Department Permit Issuance Approval Tax Collector • \\\01\o% Signatur late Comments: ❑ WPCA,Administrative Signature/date Comments: ❑ WPCA, Technical Signature/date Comments: ❑ Planning&Zoning Signature/date Comments: ❑ Health Department Signature/date Comments: ❑ Department of Public Works Signature/date Comments: ❑ State Dept.of Transportation Signature/date Comments: ❑ Fire Marshal Signature!date Comments: RtvrseiAugust 5,2005 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 PLUMBING PERMIT Permit Number: P2005-0107 Date: 30-Nov-05 Map/Lot: 102/047-OOA Owner ID: 5652300 Project Location: 144 POLLY'S LANE Unit: Job Description: Plumbing for new SFR Owner Name: Schramm Developers/Builders LLC Tenant Name: N/A Careof: 423 Groton Long Point Rd. Groton CT 06340- Telephone: Contractor Name: Williams&Associates Mechanical Contracting, Inc. Telephone: (860)535-0382 DBA: Lic/Reg Type: P1 Lic/Reg No: 204430 P.0. Box 430 Exp Date: 31-Oct-06 North Stonington Ct 06359- Construction Value Permit Fees _ Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R-4 _ Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code Mechanical Value: $0.00 w/2004 Amendment $0.00 Mechanical Fee: Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $0.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 Included on Building Permit State Ed Fee: $0.00 Total Fee: $0.00 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 framing ❑ 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 ❑ Certificate of Approval - o cupancy 0, Building Official's Approval: , ,, 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: M2005-0195 Date: 30-Nov-05 Map/Lot: 102/047-OOA Owner ID: 5652300 Project Location: 144 POLLY'S LANE Unit: Job Description: Heating for new SFR Owner Name: Schramm Developers/Builders LLC Tenant Name: N/A Careof: 423 Groton Long Point Rd. Groton Cr 06340- Telephone: Contractor Name: Williams&Associates Mechanical Contracting, Inc. Telephone: (860)535-0382 DBA: Lic/Reg Type: S3 Lic/Reg No: 388811 P. 0. Box 430 Exp Date: 31-Aug-06 North Stonington Ct 06359- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 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: - $0.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 Included on Building Permit State Ed Fee: $0.00 Total Fee: $0.00 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 framing ❑ Electrical Service CRS No: 0 ❑ Framing 0 R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ❑ Certificate of A..roval Ce► cat: t Occupancy Building Official's Approval: • Town ofl!.!Ipntville Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential Trades Permit Application Form kVIl o 5 F, /q'v— Permit# .- /0 .7 E j lum6ing j j Electrical91 ecfianicat CRS # L.-- -e-ating Air Conditioning Gas Wiping Single'Family ❑ Two-'Family ❑ Townhouse Job Address /yy A 4/s ,ice_ (Number) / (Street) (Unit) Job Description 74u`,,.4./1", -ea7;,c,q Owner SCo77 Sc.‘ rgic'y Mailing Address City State Zip Tel / / bc.41 -4, ..s a* (xi 4T— Contractor /y/.ctifw,k.,..1 e0-4-7 ,.,,„.X., Mailing Address tee), , y....46) City A4,4 S b,i/, t,,i State et Zip ?16 35s? Tel 1'66 / 35–/ b 3 g`s-- Contractor's License TypePt Zo Y 30 &Number 53 aga�// Exp. Date /6 /3/ /2_0.0 4, 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 Signature a24. /t/. 4 Date // /'6 / D S-- Construction Value Plumbing $ $ Need Mechanical $ $ , It Electrical $ $ Work commencing before the issuance of a permit Plan Review State Education _ $ Total $ $ Wrvised.Novem6er1,2004 • Williams and Associates Mechanical Contracting, Inc. PO Box 430 North Stonington, CT 06359 Phone/Fax 860.535.0382 Nov 17,2005 Dear Building Official, In view of Connecticut Occupational Licensing Law Sec. 20-338b, please recognize this letter as our authorization for it's bearer to sign the building permit application as an agent of Williams and Associates Mechanical Contracting,Inc. The work will be performed in the Municipality of /z// t/1l,_, The location where the work will be performed is ice© . The work is described as ;' _ ,_ - .(a The starting date is The name of our authorized agent is 24 ydGce- '`,y,,A c Thank you for your cooperation. // Sincerely, Wane N. Williams T P1 # 204430 i 4 al Bruce W. Williams CT S3 # 388811 47:56/6/0" ,‘„‘—__.,. STATE OF CONNECTICUT STATE OF CONNECTICUT OLP:IRIIIENT OF CU:\".S( IILR PRO 7"F(TION ' PLUMBING&PIPING UNLIMITED CONTRACTOR /FP 1 R Lll/:AT U1 CUA SI.111/1 PK(17F.C1111 PI PING&COOLING LIMITED CONTRACTOR WAYNE N WILLIAMS S3 45 YAWBUX VALLEY RD BRUCE W WILLIAMg 4e, t N STONING'TON,CT 06359 1 PRENTICE WILLIAMS.4R 1, *•. 3TONINGTON,CT 06378 i t 4' LIC./REG NOErFEC'TIVE EXPIRES ' EXPIRES 204430 i,o LIC ./REG NO. EFFECTIVE u, 11/01/2005,,` 10/31/2006 t: " ;?',9 _IA,# ,v° , 09/01/., Ial_ 006 SIGNED ! l-ey_ee'. .__ .. LGt "&a:17-‘24' T' tri 7-,24 it ���" _ SIGNED f,1C ______________..____ 11/29/2005 07:42 8605359857 BRUCE WILLIAMS PAGE 01/02 FAX yr TO: „dz( refolLt: Company: Fax lumber: Phone Number: Fax Number: Phone Number: -. Notes: 14f-re 777.71:1W75 �- ee/tfr--1-6e. 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Jk .,�'v♦., ,+►• + L i..♦..;,�.�`. ,,,,p� < „./.1,..` �' er,N.#r**;; '?: 11.29.2005 10:45 FAX 8605362649 GROVER INSURANCE LLC 1 U001 .4C[3RD,� CERTIFICATE OF LIABILITY INSURANCE { DATE(MMIDDIYYrit :COLICER 1 11/29/2005 j860) 536-2644 THIS CERTIFICA 1E IS ISSUED AS A MATTER OF INFORMATION Rover Insurauae LLC ONLY A.ND C.f3.IFER ND RIGHTS UPON. THE CERT(FI.C41TE HOLDER. THIS .1ERTIFICATE DOES NOT AMEND, EXTEND OR Gravel Street ALTER T'NE C'C7't ERAGE,TFFORJ1Eo Er THE IAOt•tetes&ELO04: .0. Box 56 -� gestic CT 06335- r14'SURERSAFFORf A'&C1?1r.54At+ ,VAJG# SURED IALSIIRER A.HARTFO?IID UNDERWRITERS illiams & Assoc_ Mechanical Contrasting,Ina, J IN5'u3ER a TWIN C::TY FIRE 5 Yawbux Valley Rd ' INSURER 0 HARTFO)ID CASUALTY INSURER D orth Stoningtan CT 06359- ' INSURER E OVERAGES 7-1E POLICIES OF Mc/IN-AWE LISTED BELOW HAVE BEAN 15S:.IE)TO TILE JNSURFLINAMFD.ALROVE Fri; THE POLICY PE.RJ00 INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WI IICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, "HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED THEREIN HS SUBJEt i TO ALL TrIE TER AS, EXCS.tiSIONB MCI CO4,tiO(WOKS OF F1.J I PO,:IJFS. ,GG.REGATE IJMITS SI-toWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'R ADD'L POLICY E�PECTIVE POLIO' EXPIRATION R j9tSRD TYPE OP INSURANCE I POLICY NUMBER }rDATE IARMIDDiYY) DATE(MWDDIYY) LIMITS X GENERAL LIABILITY , 02SBAT8B717 10/23/2005 10/ '_3/2006 EACH OCCURRENCE 5 1,000,000 X I COMNERC,ALGENERAL LIAEI'LITY ? Mu (7EENru nce) c 300,000 1CLAIMS MADE U OCCURI10/23/200412/ 3/2005 MED EXP(Any ww person)_ 1U,D00 I PERSONALS ADV INJURY 5 1,000,000 / ! / adliE C'At S12E0AT4- 5 2,000.0ø0 GEN'L AGuREc ATS-I;II1iIIT APPLIESPER; PRODUCTS-CD MOW AGCi 3 2,000,000 7 p...v:, iY j,Pas, r i RAC / / / / AUTOt,MOB1LE LIABILITY / / / / I COMBINED SINGLE'LIMIT S 1 ANY AUTO I I I (Ea accident) ,{1a0�ALLDnNEOAUYDS OZVECUF4EJ. 10/23/2005 10/?3/2006 BcEILYIN.URY X I' sCHEDULED AUTOS I�rti1 p�+41,e) 5 XI1IREDALITps II?!Z3/2(?d4 13/-3/2305 BODILVINJURY NON-OWNED AUTOS (Pel eccldanU / II PPOPERr'CAVAGE $ (Per axitlent) G4R4flF LJA9JLJTY - I AUTO ONLY-EA ACCIDENT $ ANY A4'(O / / / / OTHER THAN EA ACC $ AUTO ONLY. AGG 1S N 10(CESSMBRELLA LIABILITY 02SBATH8717 10/23/2005 10/e3/2006 L EACH OC C'URRENCE (S 1,COO,0170AIb A l OCCUR GLMADE I I AOSREGATE IS 1,404,aQQ I � DEDUCTIBLE I • 1Q/23/2004 10/13/2005 S X Re E� NTIOO• $20,CRS IS R �WQRKERS COMPENSATION AND I O2WECNJBWBG 10/23/2005 1D/23/2006 X TCIRYLMT5 Ef3 , EMPLOYERS,LIABILITY I ! NV PRoa�,ETOR/P,e,4?'e'FR/EXE aITIVE I EL EAC-I ACCIDENT $ 500,000 OFFICER/VENEER EXCLUDED? 10/23/2004 10/23/2005rQ Ir yRG,describeantler I E.L.DISEASc-EA EMPLOYEEI 500,000 SPECIAL PROVISIONS below E.L.DISLI EASE.POCY LIMIT 5 560,000 OTHER I / / /. / 1 / / 1 / / / I I E P.IPT ION OF OPERATIONS&LOCA.TIONSNEHtCL ES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ERTIFICATE HOLDER CANCELLATION ) ( ) SHOULD ANY OF THi ABOVE DESCRIBED F06.I0155 BE CANCELLED BEFORE THE TOWN Off'' MONTVILLE EXPIRATION DATE r IEREOP, THE MILANO INSURER WILL E'IdDEAVOR TO IMAM_ 010 Mrs WRftTCi AOT10E THE CER 15t:ATt:,1V.DE4 NAMED.TO THE LFF.T,&UT VERNON NIESSE//SUMLDING 08EIC.AL FAILUPF_'?+1 DO SO SKILL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE FAX 860-948-7231 INSURER,ITS AGENTS )R REPRESENTATIVES. AUTHORIZED REPRESE!TATIVE — -C --- ——.- - /. t ^a _::.--)V-----. r'-"Z":.`ORD 26(2401/08) zo 4CCFRO COrZIPORATM''3SS 1NS025(D1D9)-O$ E cLTR 0Nt ..ASER FORIBS,INC -',VatZ 927.0545 Page 1 1= Town of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030,Ext. 382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL /y/ Property Address au 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 Approval Department Permit Issuance Approval 11 Tax Collector /,/ /off Si lature: dile Comments: ❑ WPCA,Administrative la-1( / Sigm re! date Comments: ❑ WPCA, Technical Signature!'date Comments: ❑ Planning&Zoning Signature/date Comments: ❑ Health Department Signature/date Comments: ❑ Department of Public Works Signature/date Comments: ❑ State Dept.of Transportation Signature!date Comments: ❑ Fire Marshal Signature/date Comments: 4Ivise1 ugust5,2005 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: 82005-0458 Date: 18-Aug-05 Map/Lot: 102/047-00A Owner ID: 2295000 Project Location: 144 POLLY'S LANE Unit: Job Description: Single Family Residence Owner Name: Schramm Developers/Builders LLC Tenant Name: N/A Careof: 423 Groton Long Point Rd. Groton CT 06340- Telephone: Contractor Name: Property Owner Telephone:p (860)823-9086 DBA: Lic/Reg Type: NHC Lic/Reg No: 1367 Exp Date: 30-Sep-05 Construction Value Permit Fees Construction Information Building Value: $181,027.00 Building Fee: $1,456.00 Use Group: R-4 Plumbing Value: $15,594.00 Plumbing Fee: $128.00 Code: 1999 State Building Code Mechanical Value: $11,050.00 Mechanical Fee: $96.00 w/2004 Amendment Electrical Value: $9,123.00 Electrical Fee: $80.00 Construction Type: 5B Total Value: $216,794.00 Penalty Fee: $0.00 Permit Code: R2 C of 0 Fee: $25.00 Comments: Plan Review Fee: $176.00 State Ed Fee: $34.69 Total Fee: $1,995.69 It shall be the owners repsonsibility to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING, MECHANICAL, ELECTRICAL PERMIT INSPECTIONS O Footing - Prior to pouring concrete Lj R Plumbing and leak test Deck Piers R Electrical • Backfill-Footing drains and waterproofing 0 Elec Trench -with conduit installed E l Concrete Slab-Prior to pouring concrete ❑ Pool Bonding d❑ Anchor Bolts-with sill plate and prior to floor framing El Electrical Service CRS No: 0 © Framing R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test • Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION d❑ Insulation ❑ Certificate of Approval Certifi . - .f 0 c %.ncy Building Official's Approval: 2/Z/1‘, Town of Montville Building Department Residential Plan Review Form Date: A/l.6 usr 3, 2- x7 S Job Address: //1/ PO L -(r S L,p �r Job Description: A-)0-4., s"'j3.)_ The following information must be included on both sets of plans or accompanying documents(two sets are required)(C.G.S. 29-252a.) This list is offered as a guideline only. It is not meant to be all-inclusive for every permit application,nor is it meant to take the place of the building code. Your application is being rejected for the following reason(s)that are checked-off or commented on: Supporting Documentation Plan must be the same as submitted and approved Windows&Doors Building permit ar on ne c pleted by the Zoning Department and Uncas Health,(if Door and window sizes _Permit fee$ 6 '7-,0, t applicable) Emergency escape&rescue opening required in Permit fee to be calculated Retaining Walls the basement or two code compliant stairs Worker's comp.Affidavit or worker'comp. Plans required (R310.I) Insurance required Documents required to be stamped and signed by a Indicate required light(8%of floor area per room) _ Copy Contractor's registration or license CT registered Professional Engineer and ventilation(4%of floor area per room)for Construction permit sign-off sheet with approvals Foundation Plan each habitable room or space �/ required Plans required Indicate safety glazing in areas required such as: Provide all documentation to show compliance Dimensions doors,windows,tub&shower enclosures,etc. with the 2003 International Energy Conservation - pall thickness Indicate bedroom egress windows(5.7 sf net clear Code(www.energycodes.gov) Footing sizes opening,24"clear opening height,20"clear Street address of project on all drawings and Column footings-size opening width) documents required Frost protection not indicated or insufficient Egress window sill height Field set of approved plans need to be picked up Foundation indicate the assumed soil conditions Window and door header sizes from our office that the system has been desi Window well details Twosets of construction documents required,this fined for or provide — es engineering data,calculations,and other engineering data If presumptive soil conditions Garage documentation cannot be met,provide soil bearing engineering Plans required data Minimum 5/8"Type X gypsum board separation Wind Limitations Design Criteria Concrete strength-foundation,floors,exterior (on garage side)to all living spaces-•all Submit supporting data to show conformance with porches,walks,slabs combustible support framing to be covered with the wind limitations(3 second gust @ 115 mph) Vapor barrier between sub-grade and concrete minimum 5/8"Type X gypsum board if it supports Design publication needs to be identified(WFCM, basement floor required habitable rooms chapter 3,WFCM,chapter 2,ASCE 7-2002) Floor thickness and control joint location Openings between the garage and residence Documents required to be stamped and signed by a Lally column size,attachment and spacing required to have a minimum 1 3/8"solid wood CT registered Professional Engineer Waterproofing details door,1 3/8"solid core steel door,1 3/8" Documents required to be stamped and signed by a Fireplace/chimney base honeycomb core steel door,or 20 minute rated CT registered Professional Engineer if based on Concrete piers and anchor details door from the garage to the house and its basement ASCE 7-02 or WFCM chapter 2 Foundation drainage or attic Shearwalls not identified or insufficient Beam pockets-minimum clearances Indicate self-closing devices on all doors from Ridge connection not identified or insufficient Engineered foundation plan required garage to the house and its basement or attic Roof-to-wall connection not identified or Indicate slope for garage floor insufficient Crawl Spaces Wall-to-wall connection not identified or p Elevations insufficient Crawl space data-clearance to joists,slab Plans required Wall-to-sill connection not identified or thickness(if provided),vapor barrier Type of siding insufficient Crawl space ventilation,location,type and size Type of roofing Provide engineering data for the piers to resist Crawl space access,location and size Finish grades gravity,lateral,shear and uplift loads,stamped and Floor plan(s) Building heights signed by a CT licensed design professional Plans required Dimension height of chimney above roof Hold-down devices,location and type not Construction documents shall be of sufficient Roof pitches identified or insufficient clarity to indicate the location,nature and extent of Elevations to match site grading Foundation anchor spacing not identified or the work proposed(RI06.1.1) Building Section(s)&Details insufficient Construction documents are to match the Plans required Construction documents do not match the orientation on the site plan reversed plans are not Floor-to-floor heights engineering data submitted acceptable,a full plan review can not be Flashing detail-windows and doors-type, Cold_ rued_steeLfr=ing;slialik.�-desi neat.,,'-- -_performed}vithlhe_submitted_documentetio. material accordance with COFS/PM-2001 edition Construction documents are incomplete or un- • Additional sections and details required Site plan clear,a full plan review can not be performed with Fire-resistance rating details required for exterior Plans required the submitted documentation wall(s) Plan does not match building plans Basement floor plan required Wall/ceiling fireblocking detail Finish floor elevation Second floor plan required Stairs Property lines not provided Dimensions Stair not shown on basement plan Distance from propertyline to structure Finish floor elevation SKitchen layout Riser height not indicated Drivewa drmensions Bathroom layout and space clearances Tread depth not indicated } Ceiling heights Nosing required for closed risers Topography(existing and proposed) Attic access location and size not indicated or Handrail required on at least on side of the stair Footing drain inverts,outlet and separation insufficient Stair to be minimum 36"in width above the Proposed utilities to be indicated Attic access cannot be in a closet handrail height Delineation of flood hazard areas and design flood Identify the use of each room Handrails and guardrails-detail,including height elevation required(R106.1.3) and maximum opening,handrail cross-section, Private sewage disposal system to be identified on continuity and required returns the plan(R106.2.1) Show minimum headroom in stairways- Grading is to slope away from the building, measured from nosing plane to lowest point of provide more details ceiling Deck/porch not shown 36"landing required at the bottom of the stairs A-Aa 0=Basement R.=Rpof S=Site 1=Tirst T'foor 2=Second Troor 3=Third f door &vtredApril5,2005 Town of Montville ` Residential Permit Requirements Checklist This list is to be used as a guide only and is not all-inclusive, additional information may be required for your particular project. Not Provided Applicable Item Provided Not Item Applicable Supporting Documentation Building Section&Details 1,'"'"' Completed, signed and dated Building Permit t/ Floor-to-floor heights Application t/ Material type,size,and spacing Completed building permit affidavit for property owners ✓' Stair details(rise,run,treads,nosing,width,headroom) V or sole proprietors or copy of workers compensation t/ Handrail details insurance 1,---- Guardrail details Copy of Contractor Registration or license V Roof ventilation V, Construction nstructt o permit sign-off sheet signed by all Framing Plans P Documentation showing compliance with the Energy V Design loads-for floors,ceilings,roofs ‘.--"TConservation Code(www.energycodes.gov) ✓ Bearing partitions identified on the plan 1------* Street address of project on all drawings and documents I/ Direction of framing 1.--- Two complete sets of construction documents Y Spans,beam ✓ Documentation showing compliance with the Wood species and grade requirements for construction in 115 mph wind zone 4---- Framed openings Site Plan 1/..-- Wall framing size and spacing identified V. Property lines i---- Sheathing type and thickness 1.--, Distance from property to structure 1/ Window and door header sizes 1." _ Structure dimensions I/ Decking material,size,spacing ✓' Driveway — V. Engineering data for engineered lumber(LVL's and I- r' Topography(existing and proposed) joists) t---" Footing drain inverts,outlet and separation 1.---- Framing plan for engineered lumber 1.---- Proposed utilities Engineering data for steel beams,signed and sealed by a CT registered design professional 1,-"' Wetlands and flood zone limits and elevation 1. Septic system shown and located on the plan Engineering data for trusses,signed and sealed by a CT t/' ✓ registered Professional Engineer Well and piping shown and located on the plan Note: Unusual structural conditions may require that Foundation Information additional engineering back up be submitted ✓ Assumed soil bearing pressure Chimneys&Fireplaces ✓ Dimensions Clearances to combustible materials Y Wall thickness t/" Manufactures data for metal flues ✓" Footing sizes V Exterior fresh air source for fireplaces ✓- Frost protection ✓ Flue sizes Y Foundation anchor type,size,locations W(> Manufacturers data and installation instructions for Window and door sizes and locations y V"- metal fireplaces Y Hatchways Electrical Information ✓ Columns N location(s)lionwith main size (11.- Drainage details (s) 1/ Waterproofing details i...".. Meter socket location 1/". GFCI outlet locations Crawl space ventilation size and location Y Crawl space access size and location V Smoke detector locations Concrete strengths i,"" Lights and switches Floor Plan Information Mechanical Information t✓ Dimensions 1.----" Dryer vent t..."" Bathroom exhaust ventilation (natural or mechanical) Door and window sizes,egress window ✓ type and size ✓ Glazing in hazardous locations _ s.--- Hood exhaust to— Garage/dwelling opening protection 1/ Type of heat(oil,electric,gas) 10-- Garage/dwelling separation 1i Heating,ventilation,and air conditioning plant location Kitchen layout 1/ Oil tank size,location,and r in 1...-- Bathroom layouts,tub sizes in gallons,space clearances P P g t/' V LP-Gas tank location,size,and piping Indicate use of all rooms 4/ Combustion air requirements ✓' Stair location t/ Attic accessV Manufacturers data for equipment location and size Heat loss,Heat gain calculations Ir Square footage for each habitable level of the structure Plumbing Information Required light and ventilation for each habitable room Elevations Building trap location if on municipal sewer 1.-- Type of siding 1.--** Sewer location 1.--• 1./.. Domestic water location Roofing Water heater size,type,and location 1! Other finishes v Finish grades i,""-. Manufacturers data for whirlpools,corner tubs,&larger V Building heights tubs I.— Height of chimney above roof ✓ Roof pitch Revised Fe6ruary 25 2005 Town of Montville Building Department 36"landing required at the top of the stairs Ridge beam,rafters are to bear on top of beam or Provide detailed plans for stairs bear on ledger strip Townhouse Separation st have a listing for (R317.2) I Walls I Ridge beam supports One-hour rated assembly must have Sheathing type and thickness Valley rafters-provide engineering data exposure from both sides(two walls) Stud size and spacing,species and grade Valley rafter support Common wall assembly must be 2-hr fire- Sheathing-size,thickness,type Ventilation-ridge,gable,soffit resistance rated and listed Siding,material,type,style-underlayment per Provide minimum net ventilation data Mechanical equipment,ducts or vents not allowed mfg. Roof sheathing-type,size,thickness in common wall I Collarties-size,placementElectrical penetration detail required for common Framing plans I spacing wall Plans required Roof covering-shingles-type,nailing,provide Common wall shall be continuous from the Bearing partitions not identified or unclearproper underlayment-show interior horizontal distance of double underlayment at eave,etc. foundation to the underside of the roof sheathing Direction of framing Overhang detail Each individual unit shall be structurally Beam spans,size,species,grade Provide engineering data for all rooftrusses- independent Framed openings 8Parapet required or the roof decking or sheathing �A�0 Joists—species and (truss drawings must be signed and sealed by a is of noncombustible materials or approved fire spacing grade,size,direction and Connecticut Licensed Professional Engineer) (required prior to installation)must be designed to retardant wood for 4 ft on each side of the wall(s) Joists over-spanned ASCE 7-02 Electrical Plan(s) Headers over-spanned DeckstPorches Plans required Joist hangers for flush framing conditions or ledger Plans required Panel location(s)with main size Beams over-spanned Dimensions required Wiring means and method not identified or I Provide design data for all unaligned wall and Joists-size,span,spacing,direction,species and insufficienteter sok floor bearing points. grade Meter socket location Indicate of all point loads Ledger-show attachment and flashing to house Receptacle locations need to be identified Cantilevered locationofless than 18"to DeckingmaterialGFCI outlet locations need to be identified framing grade to bedand size Lights and switches need to be identified pressure treated or decay resistant Beam-design data if required Engineering data for steel beams,must be stamped Beams-size,span,spacing,direction,species and Smoke alarms shall be installed in each sleeping grade and signed by a CT registered design professional room outside each separate sleeping area in the ��� Engineering data for LVL's and similar products Posts-size,material,and height immediate vicinity and on each additional story of Engineering data for J joists Piers-size,material,depth below grade the dwelling,including basements Loadbearing walls not indicated Provide engineering data for the piers to resist Load calculations required Design loads not indicated or insufficient: gravity,lateral,shear and uplift loads,stamped and Whirlpool tub/hydromessage tub disconnect _ _ signed by a CT licensed design professional location not identified Ceiling Plan(s) I Indicate joist hangers at flush framing and ledger I Mechanical plan(s) Plans required Stair,handrails,and guardrails details Plans required Ceiling joists-plan required for geometry Joists over-spanned Dryer vent Ceiling joists-spacing,span direction,species Heating,ventilation,and air conditioning plant and grade Beam over spanned locations Combustion air requirements Ceiling joists required to support minimum 30 psf Height of deck above adjacent live load 1 j grade Type of heat(oil,gas,elec) Ceiling joists over-spanned I Chimneys and Fireplaces I —_Heat Toss gain calculations Indicate clearance of masonry to combustible Input rating of furnace/boiler IRoof Plan(s) I framing materials and clearance from fireplace I Gas Systems Plans required opening to finished trim Plans required Rafters-pitch,spacing,s an, Show data for mechanical flue sizing LP tank location and size p species,and grade Show exterior combustion air source Trench depth Provide framing details of trayed/vaulted ceilings Provide detail of cathedral ceiling structure and Flue sizes Plumbing plan(s) I venting _Manufactures data and installation instructions for Plans required Indicate connection of lower chord of roof trusses metal fireplaces Building trap location and ceiling joists to the top plates and wall studs. Dimension height of chimney above the roof Sewer location Calculate roof tie-down sizes for wind conditions I Two-Family Dwelling Unit Separation(8317.1) I Domestic water location Separation by I-hr fire-resistance construction, Manufacturers data for whirlpools,corner tubs,& Show framing for gables in cathedral ceiling construction provide a listed assembly larger tubs Roof rafters over-spanned Rated wall and/or floor assemblies shall be tight Water heater size,type,and location against exterior walls and to the underside of the Input rating of hot water heater Ridge strapping required roof sheathing,provide more detail Supporting construction shall have an equal or Ridge beam,engineering data required greater fire-resistive rating,provide details Comments__ `i �igOfficial A=Alt <13=Basement 4Z=Roof S=Site 1=first ffoor 2=Second(Moor 3=Tiirrf kE'Coar 4icviredApril5,2005 Town of Montville Building Departnient 310 Norwich-New London Tpke. Tel.848-3030,Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential Building Permit Application Form REEVED Permit# ,_ 0�3 �] New Construction Addition J U L 2005 ❑A ❑Alteration ❑Accessory Structure ❑ Single�Fami(y ❑ 'Two-(FamiCy ❑ 'Townhouse BUILDING DEPT. Job Address /y17/ I e4Z yS 4,4-A)6 A1/4 (Number) (Street) (Unit) Job Description Go V i(2 U GT A/Eytl S'A/ ZF F;z L }- f/oM g NI'tiling Owner $Cf t'fMM ()VELeP�Q)5vitE# fMaiing Address 1/2 3 6--Arrrew L aiJ6 PT ,E'D City 6 i-o-f / State G Zip 0671l0 Tel g60 / 9Z3 / ?og‘ Contractor Scµe,¢sc ,pc-/EGoPF,es/eu/Ogailin g Address Z[� 3 6-,E'07Uicl 40nl6- PT � City Ge— - .J State c 7— Zip O ?L Tel gid/ e221 ?0 Contractor's License/Registration Type&Number 1 3 6 7 Exp. Date 09' l 30 / Z S- 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. Separate applications are required for electrical,plumbing, mechanical, etc. Owner/Agent Signature //c��G'� Date 7 / Z Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Work commencing before the issuance of a permit $ Certificate of Occupancy $ Plan Review $ State Education $ Total $ $ (See Reverse sidefor additional requirements) &vise-February 25 2005 Town of Montville Building Department File Receipt Date: 08-Aug-05 Receipt No: 495 Received From: Schramm Developers/Builders, LLC Job Address: 144 POIIy's Lane Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $1,995.69 Check: $34.69 Check No: 1436 Construction Value: $216,794.00 Demolition Value: $0.00 Received By Sandra Pandora ii iif/j 41, NEW RESIDENTIAL PERMIT CALCULATION (2 STORY) Address: 144 Polly's Lane QTY $/UNIT TOTAL Living Area 1768 SF $ 76.79 $ 135,i'64.7. Finished Basement SF $ 20.27 $ - Unfinished Basement 952 SF $ 7.67 $ 7,301.84 Kitchen 1 EA $ 9,100.00 $ 9,100.00 Plumbing Full Bath 1 EA $ 5,000.00 $ 5,000.00 Half Bath 1 EA $ 3,200.00 $ 3,200.00 Garages Attached, 1 car EA $ 10,775.00 $ Attached, 2 car 1 EA $ 18,600.00 $ 18,600.00 Attached, 3 car EA $ 25,810.00 $ Detached, 1 car EA $ 13,850.00 $ Detached, 2 car EA $ 21,100.00 $ Detached, 3 car EA $ 28,350.00 $ Under, 1 car EA $ 2,150.00 $ Under, 2 car EA $ 3,500.00 $ Fireplace& Chimney Prefab EA $ 4,000.00 $ Masonry, exterior EA $ 4,250.00 $ Masonry, interior EA $ 4,000.00 $ W/2 fireplaces EA $ 7,500.00 $ Decks/Porches/Sunrooms Open 120 SF $ 17.17 $ 2,060.4:; Covered SF $ 62.69 $ - Enclosed SF $ 123.90 $ TOTAL BUILDING CONSTRUCTION COST, LESS MEP $ 181,026.96 PERMIT FEE CALCULATIONS Fee Building $ 181,027 $ 1,456.00 Plumbing $ 15,594 $ 128.00 Mechanical $ 11,050 $ 96.00 Electrical $ 9,123 $ 80.00 Work Commenced before permit issuance $ - CO Fee $ 25.00 Plan Review $ 176.00 State Ed Fee $ 216,794 34.69 Total Fees per Residential Unit $ 1,995.69 Based on 2003 RS Means Residential Cost Data 8/3/2005 li.) -..; --I I—. 0 Z ...... — LIJ I - in 0 0 rsi ---- a ci —J -LI Citl --.I •--• ''"" V,„03,. 1•..v.---,i,,,, •:-`,,, --1 •••=•• Z -- vi. '- - `at t''''''''• -': 1 ..., -- 5, "3 ,,•••••,..--4T 1 • • .-,-,. , ..... 0 < - r-- I • EU ._. -- P v�`v 1:) x,N State of Connecticut •N . r Workers' Compensation Commission 6 7B ������.�` '`,.. Please TYPE or PRINT IN INK c Proof of Workers' Compensation Coverage when Applying for a Building Permit for the Sole Proprietor or Property Owner who WILL act as General Contractor or Principal Employer Applicant for Building Permit / Name of Applicant for Building Permit Sc.:./ /' A �1 �-2. ./a //S e/L�L—,2 S ZG C Property located at /9 4/ P' j '4-/' in the City/Town of PPI d,217'V/112 C 77 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 act as the general contractor or principal employer,you must provide proof of workers'compensation insurance coverage for all employees. Complete this form and,if applicable,sign the Affidavit below in the presence of a Notary Public or a Commissioner of the Superior Court. CHECK ONE (1) BOX ONLY, provide the appropriate information, and sign: ❑ I am the OWNER of the above-named property.I WILL act as the general contractor or principal employer and,as such,will submit proof of workers' compensation insurance coverage for all employees who are doing work on the site of the construction project at the above-named property. Signature of OWNER Applicant ❑ I am the SOLE PROPRIETOR of a business doing work at the above-named property.I WILL act as the general contractor or principal employer and,as such,will submit proof of workers'compensation insurance coverage for all employees who are doing work on the site of the construction project at the above- named property. Signature of SOLE PROPRIETOR Applicant i1I am the OWNER of the above-named property or the SOLE PROPRIETOR of a business doing work at the above-named property.I will not personally submit proof of workers'compensation insurance coverage,but I will attest to the following: AFFIDAVIT I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor, subcontractor,or other worker before he or she does work on the site of the construction project at the above-named property in accordance with Section 31-286b of the Workers'Compensation Act. 7 Signature of OWNER or SOLE PROPRIETOR Applicant ` 7 / �� , Name of Business—if applicable S 4 A'/ZCL4 -1/ --2Q/0E,e'....(/.61/iLA�� ( /' Z• C Federal Employer ID#(FEIN)—if applicable Subscribed and sworn to before me this f a ,__,A, day of _3 J`�-( , 200,`) . c 1 Signature of Notary Public/Commissioner of the Superior Cou 'C- C- • - MELtriuA L. ROBCRTS 1 lr i AV c AM,tSSt4NTARy EXPIRES PUBLIC QCT.31,20f" . Building Department 848-3030, Ext 382 • CONSTRUCTION PERMIT APPROVAL /4/17/ oa'/Y 4A/ Property Address 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 De artment Approval p Permit Issuance Approval Tax Collector Of_)(17%.). -. -1\1 k 03 Signature/date WPCA " \ '� kij I Si ire/date1 _ Planning& Zoning -�g,a � I 7//A--f c S /6 5 Signature,date ❑ Health Department Signature/date Ai" Department of Public Works e ; 'A 7_ it-05' -•�,� ature/date ❑ State Dept. of Transportation Signature/date ❑ Fire Marshal Signature/date Comments/Conditions: , t3 z 4.,- O_ v O o WQ ul N p ,zz — — 0 0a 7 t7 < z Ll1 2,... ,L1. — s Z V w QOJtkiN W o I i 1 1 1 -• N 1 1 j I I .I; il I 1 _ 1 1 1 ..c -t 3 .c � cm c _ 1 1 1 c c 1 D . �` 0 N ` 1' I L _ __. J '� 1 I 1 a 0 Cl) 0 O MW �I a i O x11 = E o c oO O a. 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M v Permit# i 1 yI/ P&L y s L 4ivi ✓ AIL-ill-Lt L Cr. / Permit Date REScheck ftware Version 3.7 Release 1 b ComplianceSoCertificate RECEIVED Du: 292005 Project Title: Cape Cod House w/ garage & future playroom Report Date: 12/31/05 BUILDING DEPT. Energy Code: 2003 IECC Location: Norwich, Connecticut Construction Type: Single Family Glazing Area Percentage: 13% Heating Degree Days: 5869 Construction Site: Owner/Agent: Designer/Contractor: 144 Polly's Lane Schramm Developer/Builder LLC Schramm Developer/Builder LLC Montville,CT 423 Groton Long Point Rd Groton,CT 06340 860 823 9086 Compliance:Passes Maximum UA:346 Your Home UA. 342--> 1.2% Better Than Code(UA) Gross Cavity Cont. Glazing UA Assembly Area or R-Value R-Value or Door Perimeter U-Factor Ceiling 1:Flat Ceiling or Scissor Truss: 734 30.0 0.0 26 Ceiling 2:Flat Ceiling or Scissor Truss: 100 30.0 0.0 4 Ceiling 3:Cathedral Ceiling(no attic): 125 19.0 0.0 7 Ceiling 4:Flat Ceiling or Scissor Truss: 144 30.0 0.0 5 Ceiling 5:Cathedral Ceiling(no attic): 276 19.0 0.0 14 Wall 1:Wood Frame, 16"o.c.: 820 13.0 0.0 53 Window 1:Vinyl Frame:Double Pane with Low-E: 94 0.370 35 Door 1:Solid: 20 0.290 6 Door 2:Glass: 40 0.370 15 Door 3:Solid: 18 0.250 5 Wall 2:Wood Frame, 16"o.c.: 642 13.0 0.0 45 Window 2:Vinyl Frame:Double Pane with Low-E: 98 0.370 36 Wall 3:Wood Frame, 16"o.c.: 100 13.0 0.0 7 Window 3:Vinyl Frame:Double Pane with Low-E: 15 0.370 6 Wall 4:Wood Frame, 16"o.c.: 273 13.0 0.0 22 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space: 952 19.0 0.0 45 Floor 2:All-Wood Joist/Truss:Over Unconditioned Space: 336 30.0 0.0 11 Boiler 1:Other(Except Gas-Fired Steam):81.9 AFUE Compliance Statement:Statement of Compliance:The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2003 IECC requirements in REScheck Version 3.7 Release lb and to comply with the mandatory requirements listed in the RESche klns•- tion Ch- klis,. AY • 4 C-e—s---.. .5e.,41A24 A4A4 b6:V/BZOS G,I e /Of 0_5 Builder/Designer Company Name Date Project Notes: 28 x 34 cape w/22 x 24 garage&future room above Cape Cod House w/garage&future playroom Page 1 of 1 V I. � ^ K k 0 IM a \ i \ p ° I o O Q OJ (� Pi = wn lO_ :41 O o O p \� WVNl`J 1`\ M J, ''1 -li ,i ,,' N^ • u O . u x ! �° Y 't a \\ Ith 2a . 4 0: ill Ii sk a � 4_ a — �� � o o Q 'oE a• : . - ; Ire'° ' - i p 7. .,,,5 1 li (i.j. ' O ; o, c, S ENI r O r . i yCi r lk III fl t N Ti • \ O o u w -- ent-i• , ! . 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