HomeMy WebLinkAboutStrip and Re-Roof 2004 Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville,CT 06382
(860)848-3030, Ext.382
Building Permit
Permit Number: B2004-0217 Date: 10-May-04 Map/Lot: 068/016-000 Owner ID 121008
Job Location: 23 POWERHOUSE ROAD Unit
Job Description: Strip&Re-roof
Owner: Contractor:
Michael F Swiacke David Gilmore
P.O. Box 93
23 Powerhouse Rd East Lyme Ct. 06333-
Uncasville CT 06382 Telephone: (860)739-9338
Lic/Reg Type/No. HIC 502832 Exp Date: 30-Nov-04
Tenant:
Self
Telephone:
Construction Values Permit Fees Construction Information
Building Value: $4,144.00 Building Fee: $28.00 Use Group: R4
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO
Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B
Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R4
Other Value: $0.00 Other Fee:
$0.00 Comments:
Total Value: $4,144.00 CO Fee: $10.00
Plan Review Fee: $0.00
State Ed Fee: $0.66
Total Fees: $38.66
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 CRS#: 0 ❑d Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature:
FTown 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
Permit11,42(5. .ted 07/ 7
❑ New Construction ❑Addition El Alteration ❑Accessory Structure
pZSingle(Family Li Two-Family 0 Townhouse
Job Address 2 3 ?t,Pv -tt /yduse gol .
(Number) (Street) (Unit)
Job Description vl/ Roo ; v //9y,,t )0u ive.„w live/
ehi
Owner Pl. k t S i'v t'!cF a ke_ Mailing Address 2 3 PD t.✓G R t t
.SL 401 .
City L (VCA j Iii/ie 1 Or, State el. Zip O63$2.Tel e960 / gyAti 999
ContractorJ
l9 4 �i /�'1G/2L� Mailing Address �is �Ip,,-' 93
City 19. r 7.-)71-/C State C/r Zip .0633,3 Tel a6' / 737/ 93
Contractor's License/Registration Type&Number 0 O$ 02.g'3 Exp. Date /C / 3 O/ 20ar
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 permit for such work as described above.
Separate applications are require r el c lumbing,mechanical, etc.
Owner/Agent Signature Date �/ 7 / Y
Construction Value Fee
/4 Building $ $ (9 5
Plumbing $ $
Mechanical $ $
Electrical $ $
Certificate of Occupancy $ l(5
Plan Review Fee $
State Education $ i 6 6
Total $ $ 0 6', 6 6
(See Reverse side for additional requirements)
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: 2 3 !p r,1/e rA Gl H 6 ,
In the town of Owen 5 PV/4-
Name of building permit applicant: Q p6 F./
D
Please check one:
1. ) am the owner of the above property.
2. I am the sole proprietor of a business.
2A. Name of business: C! z rr�
2B. Federal Employer Identification Number(FEIN)
Pursuant t o § 3 1-286b, "a property owner o r s ole proprietor [who] intends t o act as a general contractor or
principal employer" may provide either a certificate of workers' compensation insurance or a "sworn
affidavit...stating that he will require proof of workers' compensation insurance for all those employed on the
job site in accordance with this chapter."
Please ch k ne:
1. I do not intend to a t . general contractor or principal employer.
[Sign ands phi /
J
Signature of ap if cant
2. I intend to act as a general contractor or principal employer. Applicant must either provide a
certificate of workers' compensation insurance or sign the affidavit below.
Affidavit
I hereby swear and attest t hat I w ill require p roof o f w orkers' c ompensation insurance for e very c ontractor,
subcontractor, o r o ther w orker b efore h e/she engages i n work on the above property in accordance with the
Workers' Compensation Act (Chapter 568).
I understand that pursuant to § 31-275 C.G.S., officers of a corporation and partners in a partnership may elect
to be excluded from coverage by filing a waiver with the appropriate District Office; and that a sole proprietor
of a business is not required to have coverage unless he files his intent to accept coverage.
Signature of applicant
Subscribed and sworn to before me this day of , 200 .
(Notary Public/Commissioner of the Superior Court)
en License
Deparrment of Consumer Protection
regu a cc y C a e
License Details
Name: GILMORE, DAVID
Business Name: D & E LAWNCARE
DAVID GILMORE
Address: 205 FLANDERS RD
EAST LYME CT 06333
Credential Type: HOME IMPROVEMENT CONTRACTOR
Status: ACTIVE
Credential Number: HIC.562832 Effective Date: 01/20/2004
Sub Category: Expiration Date: 11/30/2004
To view Complaint or Disciplinary History click button46:01111117011 Co' ol ,is
Permit Fee Calculation Spreadsheet
MISCELLANEOUS PERMIT CALCULATION
Pools&Spas
Above Ground Round EA $ 3.150.00 S
Above Ground Oval EA $ 5,250.00
In-Ground EA $ 18,900.00 $
Heater EA $ 3,465.00 $
Hot Tub EA $ 5,250.00
Roofing
Strip&Reroof 20 SQ $ 207.20 $ 4,144.00
Overlay SQ $ 127.05
Plywood SQ $ 101.85 $
Sheds SF $ 26.25 S
Electrical Service
100 Amp EA $ 816.43
200 Amp EA S 1,519.19 $
400 Amp EA $ 6,039.29 S
Breezeway/Decks
Open SF $ 22.31 $
Enclosed SF S 94.76 $
Porches
Open SF $ 62.69 $
Enclosed SF $ 123.90 S
TOTAL BUILDING CONSTRUCTION COST $ 4,144.00
PERMIT FEE
BuildingS 28 00
Electrical S -
$ -
S -
CO Fee S 10.00
Plan Review $ _
State Ed Fee S 0,66
Total Fees $ 38.66
Based on 2003 RS Means Residential Cost Data
5/7/04
i
Town of Montville Building Department Receipt
Date 1-" / 7 / , , V No. 0 3 7 9 0
From: ____Ac .4.. irp 0
1, . .r. -a _ / • i
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Job Address: a .� -Ii , AIL ai
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Amount $ 0_6Cash (Check., Check # _p___
(Circic one)
/ AdOr /
Received by • ,! ./ /I: ,0..e.„,;? Permit # p -- p2
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