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HomeMy WebLinkAboutStrip and Re-Roof 2015 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: B2015-0488 Date: 05-Nov-15 Map/Lot:_0681015_.000 Owner ID: ________5687000_ Project Location: 25 POWERHOUSE ROAD Unit: Job Description: Stria& Owner Nam ,teff Radack Tenant Name N/A Careof: 1Il(Jt lc-my Road Waterford CT 06385- Telephone: Applicant Name _Kristin Perkins Telephone: (860)694-9193 DBA: K. Perkins Lic/Reg Type HIC Lic/Reg N 624193 23 Braman Road Exp Date: 30-Nov-.1 Z_ Wateitard CT 06385- _r_nndnui'tkuL Vnh is Parmi � - _-----.-._- Cnnefntann Infnrmatinn Building Value: 50.00 Building Fee: S0,00 Use Group: IRC___ Plumbing Value: _�. S0.00 Plumbing Fee: S0.00 Code: 2005 State Building Code Mechanical Valu_ S0.00 Mechanical Fe Electrical Value: S0.00 Electrical Fee: _ S0.00_. Construction Type IRC Total Value: S0.00 Penalty Fee: 50.00 Permit Code: R4' y C of 0 Fee: S0 00 Comment Plan Review Fe SOOQ Fees Included with Remodeling Permit State Ed Fee: S0.00 Total Fee Paid: S0.00 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 frami ❑ Electrical Service CRS No: ❑ Framing n ❑ RHVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation ertificate Approval ❑ Cate of Occupancy Buil�iinsx_C?Ifir ial's_AnnTovsl:__.___ • Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.: fbaCj(`rj—NSE Type of Work Occupancy Type Permit Type ❑New ConstructionSlagle Family ❑Addition ❑Two-Family ❑Plumbin A ❑Mechanical❑Townhouseg 0 Accessory Structure 0 Electrical CRS#: Job Address: umber) (Street) /�� � (Unit) Job Description: it cr( /,‘ s-ic, j l c /' vx. roof' 4rcA, f C/vY/vi 'cove Owner: 7,1i.„,n j WA.e. 7P //7 / Address: City: 64,,C c".:5 L I? Zip Code: State: ��� Telephone: J Contractor: /'pert„kc ky f ro-d DOA: rie) � P 40 r\ Address: r . ,n.,pNh City: /nJ Y State: r Zip Code: ��3 Telephone:Q��Q " License T e: �� )r —T- yP �C License No.: -,�Z` / Expiration Date: ��� I hereby certify that the proposed work will conform to the State 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. ❑ By checking this box, I will follow the requirements of the 2005 NEC .s the alternative compliance per section E3301.2.1 of the Residential Code, instead of the electrical requirements in cha. - - 33 th gh 42 of,Residential Code. 0001.1 Owner/Agent Signature: � - — Date: Construction Value Permit Fees Building Value: Plumbing Value: Building Fee: Mechanical Value: Plumbing Fee: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of O Fee: Plan Review Fee: State Ed Fee: Total Fee: ftliceue Decem6er31,2005 State of Connecticut r' C . .. •4 Workers' Compensation Commission 4 , L. CZT4�� coma w Please TYPE or PRINT IN INK ce 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 Name of Applicant for Building Permit Property located at in the City/Town of 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: LII am the OWNER of the above-named property.I WILL NOT act as the general contractor or principal employer. Signature of OWNER Applicant-. ❑ 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 226/2015 Pitt Lookup Detais I ti State of Connecticut Lookup Detail View Name and ArkIkess Name :DBA Address KRISTIN PERKINS K PERKINS CONTRACTING 23 BRAMAN RD WATERFORD,.CT 06385-3502 Regesbabon Vrifannzlikin I Registration# 1Registration Type Effective Date tapkation Date iStatus II 4 HIC0624123 I HOME IMPROVEMENT CONTRACTOR 12/01/2014 j 113or2015 I ACTIVE GeneraSed art 2/2512G15 io-rzsz I I. fr 1 ...._...--.1% '!— KRISPER-01 LMILLER A� ►RE) CERTIFICATE OF LIABILITY INSURANCE DATES 10114/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such er arsemer4(s PRODUCER 1 warmer NAME Bailey Agencies,Inc. F 15 Thames Street,Suite 100 kV. •No.Ems:(860)4464255 (AIC No):(860)448-1608 Groton,CT 06340 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC P INSURER A:Main Street America Assur Co 06120 INSURED s:Tran , Kristin Perkins C: 23 Braman Road MISURERD: Waterford,CT 06385 INSURERS. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE MSD y/D POUCY NUMBER POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY (MMIDD/YYYY) (NM/DD/YYYY) LIMITS EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR MPT0717C 09/06/2015 09/06/2016 DAMAGETRENTED PREMISES(OEa occurrence) $ 500,000 --- MED EXP(Any one person) $ 10,000 I PERSONAL&ADV INJURY $ 1,000,000 GI3EL AGGREGATE IJRiiT APPLIES PBt I � BE PL AGGREGATE $ 2,000,000 PRO- POLICY J LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LUIBRITY COMBINED SINGLE UMIT $ (Ea acddent) — ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED — AUTOS AUTOS BODILY INJURY(Per acddent) $ NON-OWNED MED AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ — DED RETENTION$ $ WORKERS COMPENSATIONTH- AND EMPLOYERS'LIABILITY X STATUTE ER B AN PPROP�RIETTOOR/PARTTNE ICER /EXECUTIVE YIN NtA 6S6OUB-4985P01-8-15 01/05/2015 01/05/2016 E.L.EACHACGDENT $ 100,000 " EL DEMME-EAEMPLOYEE $ 100,000 Eyes,desarbe under — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Insurance for Kristin Perkins dba K.Perkins Contracting. CERTIFICATE HOLDER _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Kristin Perkins THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 23 Braman Road ACCORDANCE WITH THE POLICY PROVISIONS. Waterford,CT 06385 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL Applicant is responsible for obtaining all of the required approvals. No •ermit will be issued until all the re.uired si•natures are obtained. C'k. ,C j h(so, Property Address ',fY1+ Q ` Job Description Required Department Approval Permit Issuance Approval /® : :tor C // /l��� /S Signature/tiat9 J Planning & Zoning ` i C . ` / Signature/date t Comments: ;/® Fire Marshal _///-;)// Signature/date Comments: ❑ Health Department Required for properties with private septic or well Comments: ❑ WPCA, Administrative Required for properties on sewer Signature/date Comments: ❑ WPCA, Operations When Required by WPCA Signature/date Comments: ❑ Department of Public Works Required when project includes driveway work or certain drainage requirements Signature/date Comments: ❑ Montville Police Department . Required for all permits EXCEPT one and two family residential Signature/date Comments: ❑ State Dept. of Transportation Re•uired for Structures over 100 000 s..ft or with more than 200 .arkin• s'aces-Official co• of STC Certificate of 0•eration re.wired—.er CGS 14-311 Signature/date Building Department Review Complete Signature/date Reviser f May 23,2071