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Home My WebLink AboutRoof 2004 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: B2004-0719 Date: 09-Nov-04 Map/Lot: 068/018-000 Owner ID: 5681000 Project Location: 11 POWERHOUSE ROAD Unit: Job Description: Roofing Owner Name: Jose A and Narcisa Valentin Tenant Name: N/A Careof: 11 Powerhouse Road Uncasville CT 06382- Telephone: Contractor Name: Property Owner Telephone: (860)848-0416 DBA: Lic/Reg Type: Lic/Reg No: 0 Exp Date: Construction Value Permit Fees Construction Information Building Value: $3,900.00 Building Fee: $32.00 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: $3,900.00 Penalty Fee: $0.00 Permit Code: R4 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.62 Total Fee: $32.62 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. ❑ Footing -Prior to pouring concrete ❑ R Plumbing and leak test ❑ Backfill - Footing drains and waterproofing ❑ R Electrical ❑ Concrete Slab-Prior to pouring concrete ❑ Elec Trench -with conduit installed ❑ Framing ❑ Electrical Service CRS No: 0 ❑ Fireplace Throat-One flue above throat ❑ R HVAC ❑ Chimney-One flue above thimble ❑ Gas Piping and leak test ❑ Firestop Draftstopping ❑d Final Inspection ❑ Insulation ❑ Certificate of Occupancy Building Official's Approval: - r Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville,CT 06382 Fax. 848-7231 Residential Building Permit Application Form Permit# ❑ New Construction ❑Addition ❑Alteration ❑Accessory Structure ❑Single Eami y ❑ Two-(Family ❑ Townhouse Job Address / / R w'err 61.c7 u se fr (.L/'Co-g Li 14 (Number) (Street) (Unit) e Job Description R,,,,/,‘,3 ,....s.-6 Owner s-e U �7(/ti Mailing Address// R we"(/447 4" SP rt) City ZAa ) Cct S U/74 StateC/ Zip iC 32?Z Tel 26 o irw) I D s,-7 Contractor Mailing Address City State Zip Tel / / Contractor's License/Registration Type&Number Exp. Date / / 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 Larri authorized to r—ml.ce application for a p�rrnit for such work as described above. Separate applications are requir for electrical,plumbing,mechanical, etc. Owner/Agent Signature Date if / .Z , r Y Construction Value Fee Building $ ...3,2cc_ -- $ 3a---- Plumbing $ $ Mechanical $ $ Electrical $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ D.6-Z Total $ 76 c.— $ 3Z l Z (See lverse side for additional requirements) 9QyviseiSeptember 9,2004 Town of Montville Building Department Receipt Date // / 3 / 09No 't i, d, From: --\a-re...- V4--1.,-c,�-tti r Job Address: 1/ Pzc.L_k .. i Amount $ 7�.Z. g Z Cash CO10 Check # 7 Z o �' ((ircic one Received by - v��-.- Permit #7Zody —0) @ State of Connecticut 7Q - 7B - 7C ', if. Workers' Compensation Commission 6DIRECTIONS -�v�- DIRECTIONS for FILING FORMS 7A, 7B and 7C lz ;)Strt Building Permit Requirements for Workers' Compensation Section 31-286b of the Workers'Compensation Act requires anyone who requests a building permit to first submit"proof of workers'compensation coverage for all of the employees who are engaged to perform services on the site of the construction project for which the permit was issued." The only exceptions to this law are the sole proprietor or property owner who will not be acting as general contractor or principal employer. What to give to the Building Official to obtain a Building Permit: 1. The General Contractor or Principal Employer must provide a written certificate of workers' compensation insurance for all of the employees on their project.This certificate may not be for liability, disability or any other type of insurance. 2. The Sole Proprietor or Property Owner who will not act as a general contractor or principal employer is not required to have workers'compensation coverage. In order to obtain the building permit, a FORM 7A should be completed and given to the building official. 3. The Sole Proprietor or Property Owner who will act as a general contractor or a principal employer must provide a written certificate of workers' compensation insurance for all of the employees on their project and must file a FORM 7B with the building official—OR he will sign a sworn notarized affidavit on FORM 7B, stating that he will require proof of workers'compensation insurance for all those employed on the job site. 4. The General Contractor or Principal Employer who has properly excluded himself from coverage using the appropriate WCC form (see NOTE below) must file the FORM 7C with the building official.This form certifies that they have properly excluded themselves, and attests that they will require proof of workers' compensation insurance from every employee that works on the designated job site. NOTE: The general contractor or principal employer may exclude himself from workers'compensation coverage by filing one of the following forms with the appropriate Workers'Compensation Commission district office: Form 6B for employees who are Officers of a Corporation or Managers/Members of an LLC Form 6B-1 for employees who are Members of a Partnership vow M,x C State of Connecticut = Workers' Compensation Commission 6 7A h � � Please TYPE or PRINT IN INK tztztzli; Proof of Workers' Compensation Coverage when Applying for a Building Permit for the Sole Proprietor or Property Owner who WILL NOT act as General Contractor or Principal Employer Applicant for Building Permit 2 Name of Applicant for Building Permit r ®S P �J 77/ ‘11.- Property /✓Property located at //- �� W-e L(j L,t Sf /) in the City/Town of Z/17`-I Cc, S C."1/ ////(e' C/ C 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 NOT act as the general contractor or principal employer,you are not required to have workers'compensation insurance coverage. CHECK ONE (1) BOX ONLY and complete the following: ajkI am the OWNER of the above-named property.I WILL NOT act as the general contractor or principal employer. Signature of OWNER Applicant 1 2 - ❑ I am the SOLE PROPRIETOR of a business doing work at the above-named property.I WILL NOT act as the general contractor or principal employer. Name of Business Federal Employer ID#(FEIN) Signature of SOLE PROPRIETOR Applicant Town of Montville Building Department 848-3030, Ext 382 CONSTRUCTION PERMIT APPROVAL Property Address 120( 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 Signati date WPCA � 1 l j 'Li Sigmatur to ❑ Planning&Zoning Signature./date O Health Department Signature/date ❑ Department of Public Works Signature/date ❑ State Dept. of Transportation Sip-laurel-date- 0 islat titer-date❑ Fire Marshal Signature/date Comments/Conditions: SlviseiSeptem6er9,2004