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HomeMy WebLinkAboutWater Heater 2003 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Plumbing Permit Permit Number: P2003-0084 Date: 08-Aug-03 Map/Lot: 103/069-000 Owner ID 120501 Job Location: $ PORACH ROAD Unit Job Description: Replace Elect Hot Water Heater Owner: Contractor: David and Beverly A Clang Roch Plumbing&Heaing 20 Susie Ave 8 Porach Rd Moosup,Ct Uncasville CT 06382 Telephone: (860)564-3840 Lic/Reg Type/No. P-1 279715 Exp Date: 31-Oct-03 Tenant: Not Applicable n/a Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R-4 Plumbing Value: $310.00 Plumbing Fee: $10.00 Code: 1995 CABO Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $0.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.04 Total Fees: $10.04 It is the owners responsibility to schedule the following inspections(minimum 48 hours notice required); ❑ Footing-Prior to pouring concrete ❑ Rough HVAC ❑ Backfill-Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab-Prior to pouring concrete ❑ Chimney-One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service ❑d Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: , � �� /11 Town of Montville Building Department Permit#PGO3 -01-1 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form Cum6ing DECectrica( ❑WechanicaC .7feating Air Conditioning Gas moping Other Job Location e ,,&/ sizi L ,1CU S ' 1/43 Job Description/Materials 2c-i, I /1-0-v- A--r-06,2•6P___,K9tAi /l S.2Aja a..„,tE;Z - ,•. Owner AIL,'i .0 (14/36 Mailing Address ,JZE9 k PI City Le'?i.-GG'-S 1' ,/l- _ State 6./ Zip a .3 '; Tel =r�di 5 pAtic etoPP Contractor pa 11. / fe,-- Mailing Address ca( .zC S / c- i4i, City .S Noos,r StateG 7 Zip 06 95 Tel 1(6/-�k/ - J6 Contractor's License/Registration Type&Number tP7 9 2/3 f/ Exp. Date 10/ 3/ / (23 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 ���� V----' Date .--c";/ �) r Construction Value Fee Building $ Plumbing $ 3/1) /egl $ /d Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ ,c2.( Total $ $ /C= I I Town of Montville Building Department Receipt t Date / 03 From: F H LK j,5/A/ C. Job Address: • Ac !-f 10 I Amount $ 0 - 0 Y ash dap Check # U _jr- (circie one) Received by / r f •, i/01F Permit # aGb 3 -0�- y STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION PLUMBING&PIPING UNLIMITED CONTRACTOR PAUL A LAJEUNESSE 20 SUSIE AVE MOOSUP,CT 06354 TYPE: P1 LIC./REG NO. EFFECTIVE EXPIRES 279715 Ir 11/01/2002 „1O/31/2003 F' SIGNED /3r'J. > STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Buildin: Permit Affidavit for Pro.e Owners or Sole Pro•rietors (Conn. Gen. Stat. k31-286b) Property located at In the town of ,1A-Cts • �y�I . Name of building permit applicant Please check one: I. I am the owner of the above property. 2. I am the sole proprietor of a business. _2A.Name of business 1 2B.Federal Employer Identification Number ()3�� Pursuant to §31-286b,"a property owner or sole proprietor[who]intends to act as aeneral contractor or principal employer"may provide either a certificate of workers'com g insurance or a"sworn notarized affidavit... stating that he will on require proof of compensation insurance for all those employed on the job site in accordance wiworkers' chapter." Please check one: 1. I do not intend to act as a general contractor or principal employer. Signature of appli . 2. I intend to act as a ktneral contractor orprincipal provide a certificate of workers' compensation employer.Applicant mast either. below. or sign the affidavit Affidavit I hereby swear and attest that I will require proof orkers'com contractor,subcontractor,or other worker before he/she engagesncninsuaance for perry accordance with the Workers'Com in on work on the above property in Compensation Act(Chapter 568). I understand that pursuant to§31-275 C.G.S., officers of a corporation partnership may elect to be excluded from coverage byfiling and the appropriates in a District Office;and that a sole proprietor of a business is not waiver to haveith coverage files his intent to accept coverage. ' unless he Signature of applicant Subscribed and sworn to before me this day of ,200 . (Notary Public/Commissioner of the Superior Court)