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
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Owner AIL,'i .0 (14/36 Mailing Address ,JZE9 k PI
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Contractor pa 11. / fe,-- Mailing Address ca( .zC S / c- i4i,
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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)