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Town of 1VMontville
Building Department
310 Norwich-New London Tpke.
Uncasville, CT 06382
Tel. 860-848-3030,Ext. 382 Fax. 860-848-7231
CERTIFICATE OF OCCUPANCY APPROVAL
IP /mac
Property ddress
P
a /— '
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 Department Certificate of Occupancy Approval
Approval
❑ WPCA
SI.`_?ialure! date
Planning& Zoning ��� Q/ (✓c`- / Z/'Y
/
O(�
signature/ date
Er Health Department
/0 — `/-0/
Signature/ date
❑ Department of Public Works
Signature/date
❑ State Dept.of Transportation
Signature/date
❑ Police Department
Signature/ date
❑ Fire Marshal
Signature/ date
Comments/Conditions:
ggvise1Septem6er9,2004
r
CI- Town of Montville
Building Department
Date: 7J21/O LI Field Inspection Notice Permit#:
0
s PooC
Address: 3 0 PR-v , --r-r �1-n<<' A
Not Comments/Corrections Required—re-inspection required:
Inspection Approved Approved
❑ Footing 0 0 PQo L A L 01' t-N p)T e'Pfi A-,4T/til P PArta_K
❑ Backfill 0 0
o Concrete Slab 0 0
❑ Framing 0 0
I ❑ Rough Elec 0 0
❑ Elec Service 0 0
o Rough HVAC 0 0
o Rough Plumbing 0 0
❑ Gas Line 0 0
o Fireplace Throat 0 0
❑ Chimney 0 0
❑ Fire/Draftstopping 0 0
❑ Insulation 0 0
❑ Final Inspection 0 0
Cof0 0
r 1nn
--
❑ ❑ .A .iii
fn ector's Signature
Town of Montville
Building Department
Field Inspection Notice
Address: 30 Pruett Place
Job Description: Above Ground Pool
Permit Numbers: B2004-0391
Footing Not Approved: Approved:
Comments: 1.
Backfill Not Approved: Approved:
Comments: 1.
Framing Not Approved: Approved:
Comments: 1.
Rough Electric Not Approved: Approved:
Comments: 1. Trench approved 9/8/04 JS
Electrical Service Not Approved: Approved:
Comments: 1.
Rough HVAC Not Approved: Approved:
Comments: 1.
Rough Plumbing Not Approved: Approved:
Comments: 1.
Gas Line Not Approved: Approved:
Comments: 1.
Fireplace Throat/ Not Approved: Approved:
Chimney Comments: 1.
Fire/Draftstopping Not Approved: Approved:
Comments: 1.
Insulation Not Approved: Approved:
Comments: 1.
Certificate of Not Approved: Approved: 9/27/0.4 JS
Occupancy Comments: 1.
Not Approved: Approved:
Comments: 1.
Not Approved: Approved:
Comments: 1.
Not Approved: Approved:
Comments: 1.
Comments:
Page 1 of 1
TOWN OF MONTVILLE
Building Department
310 NORWICH-NEW LONDON TURNPIKE
UNCASVILLE, CT 06382-2599
TEL. (860) 848-3030 X382 FAX. (860) 848-7231
ELECTRICAL PERMIT
Permit Number: E2004-0219 Date: 15-Jul-2004 Map/Lot: 004/015-000 Owner ID: 5698000
Project Location: 30 PRUETT PLACE Unit:
Job Description: WIRE ABOVE GROUND POOL
Owner Name: Louay&Jennifer Saad Tenant Name: N/A
Careof:
30 Pruett PI
Oakdale CT 06370- Telephone:
Contractor Name: Telephone: (413)796-8500
DBA: BERG-RULNICK ELECTRIC CO INC Lic/Reg Type: E-1
79 EMBASSY ROAD — Lic/Reg No: 187792
Exp Date: 30-Sep-2004
SPRINGFIELD MA 01119-
Construction Value Permit Fees Construction Information
Building Value: $0.00 Building Fee: $0.00 Use Group: R-4
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code
Mechanical Value: $0.00 Mechanical Fee: w/2000 Amendment
$0.00
Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B
Total Value: $0.00 Penalty Fee: $0.00 Permit Code: R5
C of 0 Fee: $0.00 Comments:
Plan Review Fee: $0.00
State Ed Fee: $0.00
Total Fee: $0.00
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.
❑ Footing-Prior to pouring concrete ❑ R Plumbing and leak test
❑ Backfill-Footing drains and waterproofing ❑ R Electrical
❑ Concrete Slab-Prior to pouring concrete 0 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 Draftstoppingd❑ Final Inspection
❑ Insulation ❑ Certificate of Occupancy
Building Official's Approval:
Town of Montville
Building Department
310 Norwich-New London Tpke.
Tel. 848-3030,Ext 382 Uncasville, CT 06382
Fax. 848-7231
Residential Trades Permit Application Form
Permit#
❑ fum6ing 2<ctricaf ❑9feckanicaf
CSS # ( Ji"eating
Air Conditioning
Gas PipingSn ❑ Two-Family
❑ Townhouse
Job Address 3e. Ack. C4&<)4( C/ C 1--e)
(Number) (Street)
l (Unit)
Job Description e/c'. i;e, CAj1s
Owner AaAy O&11//-Ft7q 544 4 D Mailing Address v-S
City
State Zip Tel 66c) / 4 36 C C
Contractor ?die&_ R.c.LtvtC< rt..i-t-,,Qtrc Mailing Address 4-41 Cict
X /tom
tee. ,.- .•
City 5 : State t14,4 Zip O I [1 Tel 4(3 / i(j €5 Q 6
Contractor's License Type&Number EL, icrG1 Exp.Date 4 C{/ 3 0 / 215 p 4+-
-4
-.E/ 191-*moi2.
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 I� '0 APF Date 4 / /c) / Z o4
Construction Value Fee vPlumbing
Mechanical $ $
Electrical $ $
Plan Review Fee �I�'
State Education $ Qv �
Total $ _
$
(Complete reverse side)
Town of Montville Building Department Receipt
Date P7 / 8 / O V No. 04024
From: �, '/O.c1>t;E"L- if://4
Job Address: 5 U al-4fif/7 1�
c
Amount $ . S) .shdIP Check # / 3`/3 I
(Ci
I
Received by _
../... 4.--,-- Permit #edCa/- 391
I�
Permit Fee Calculation Spreadsheet
MISCELLANEOUS PERMIT CALCULATION
Address:
Pools & Spas
Above Ground Round 1 EA $ 3,150.00 $ 3,150.00
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 SQ $ 225.00 $
Overlay SQ $ 130.00 $ -
Plywood SQ $ 105.00 S
Plumbing
Full Bath EA S 4,230.00 $ -
Half Bath EA $ 2,690.00 $
Garages
Attached, 1 car EA $ 8,885.00 $ -
Attached, 2 car EA $ 15,114.00 $ -
Attached, 3 car EA $ 20,914.00 $
Detached, 1 car EA $ 11,657.00 $ -
Detached, 2 car EA $ 17,456.00 $ -
Detached, 3 car EA $ 23,256.00 $ -
Sheds SF $ 26.25 $ -
Sheds with Electrical SF $ 26.25 $ -
Electrical Service
100 Amp EA S 825.00 $
200 Amp EA S 1,500.00 $ -
Siding $ -
Windows & Doors $ -
Decks/Porches/Sunrooms
Open SF $ 22.31 $
Covered SF $ 62.69 $ -
Enclosed SF $ 123.90 $ -
TOTAL BUILDING CONSTRUCTION COST $ 3,150.00
PERMIT FEE CALCULATIONS
Fee
Building $ $ 32.00
Plumbing $ $
Mechanical $ $ -
Electrical $ 158 $ 8.00
Work Commenced before permit issuance $ -
CO Fee $ 10.00
Plan Review $ 4.00
State Ed Fee $ 3,308 0.53
Total Fees $ 54.53
Based on 2003 RS Means Residential Cost Data
6/29/04
TOWN OF MONTVILLE
Building Department
310 NORWICH-NEW LONDON TURNPIKE
UNCASVILLE, CT 06382-2599
TEL. (860) 848-3030 X382 FAX. (860) 848-7231
ELECTRICAL PERMIT
Permit Number: E2004-0219 Date: 15-Jul-04 Map/Lot: 004/015-000 Owner ID: 5698000
Project Location: 30 PRUETT PLACE Unit:
Job Description: WIRE ABOVE GROUND POOL
Owner Name: Louay&Jennifer Saad Tenant Name: N/A
Careof:
30 Pruett PI
Oakdale CT 06370- Telephone:
Contractor Name: Property Owner Telephone: (860)437-3698
DBA: Lic/Reg Type:
Lic/Reg No:
Exp Date:
Construction Value Permit Fees Construction Information
Building Value: $0.00 Building Fee: $0.00 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/2000 Amendment
Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B
Total Value: $0.00 Penalty Fee: $0.00 Permit Code: R5
C of 0 Fee: $0.00 Comments:
Plan Review Fee: $0.00
State Ed Fee: $0.00
Total Fee: $0.00
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.
❑ 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
Cl 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 Ij Final Inspection
❑ Insulation ❑ Certificate of Occupancy
Building Official's Approval:
/6
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: B2004-0391 Date: 12-Jul-04 Map/Lot: 004/015-000 Owner ID: 5698000
Project Location: 30 PRUETT PLACE Unit:
Job Description: Above ground pool
Owner Name: Louay&Jennifer Saad Tenant Name: N/A
Careof:
30 Pruett PI
Oakdale CT 06370- Telephone:
Contractor Name: Property Owner Telephone:
DBA: Lic/Reg Type:
Lic/Reg No: 0
Exp Date:
Construction Value Permit Fees Construction Information
Building Value: $3,150.00 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/2000 Amendment
Electrical Value: $158.00 Electrical Fee: $8.00 Construction Type: 5B
Total Value: $3,308.00 Penalty Fee: $0.00 Permit Code: R8
C of 0 Fee: $10.00 Comments:
Plan Review Fee: $4.00
State Ed Fee: $0.53
Total Fee: $54.53
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 ❑d R Electrical
❑ Concrete Slab-Prior to pouring concrete ❑d 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 ❑ Final Inspection
❑ Insulation } Certificate of Occupancy
Building Official's Approval:
c i Town of Montville
Building Department
310 Norwich-New London Tpke.
Tel. 848-3030,Ext 382 Uncasville,CT 06382 Fax. 848-7231
Pool Permit Application Form
Permit#
)2t/A6ove Ground 0 In ground 0 ECectrica( 0 Deck 0 Tool-heater ❑.7fot Tu6/Spa
fOther
Job Address Soa� [.U
(Numbe )
Owner t 0/kriidaiiing Address <14 rta c_t_
City Octt
I i State (34 Zip 0.6:._?7() Tel Bd /Y37/ 1
Contractor 304-
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 I am authorized to make application for a permit for such work as described above.
Separate applications are req fired for electric 1, �biinng, echanical,etc.
Owner/Agent Signature C'`� Date 6 7 d
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical $ $
Electrical $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $
Total $ $
(See Weverse side for additiona(requirements)
i
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at:36 f2rçiht'
In the town of C a k c -L , cf.,
Name of building permit applicant: (OLtL / _OM/4r 1'17.
ja_a_Ad--
Please check one:
1. )( I am the owner of the above property.
2. I am the sole proprietor of a business.
2A. Name of business:
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 c ontractor o r
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 check one:
1. I do not intend to act as a general contractor or principal employer.
[Sign and stop here]
Signature of applicant
2. x 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 i nsurance 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 t appropriate District Office; and that a sole proprietor
of a business is nod e s uire s to have c ve ge s e les his intent to accept coverage.
ature of aeplicant
Subscribed and sworn to be e me this 1 4 t` day of J , 200 4.
(Notary Public/Commissioner of the Superior Court)
NOTARY PEIBLIC
.9YCOMMISSION-EXPIRES OCT.31,2007
Town of Montville
Swimming Pool Alarm Affidavit
V�
Job Address Prtudl--- lac)e,
(Number) (Street (Unit)
OwnerLAA.,7 l •' �\�(J�a Mailin Addres,^ ��jj oack_.,City ookStateC Zip O 0 1 1\ Tel 1L6 Al 31 /3
I, A o d. , owner of the above referencedro ert herebyswear and attest
p p Y�
that I am aware of the requirement for a pool alarm to be installed in the pool to be constructed at the above
referenced property. Further, I am aware that the alarm must be installed and functioning at the time of the
Certificate of Occupancy inspection for the pool.
61,1,y4111 ignature) (Da
Subscribed and sworn to before me this� day of 3 , 200L.
Ulk
t (Notary Public/Commissioner of the Superior Court)
MELINDA L. ROBERTS
NOTARY PUBLIC
MY COMMISSION EXPIRES OCT.31,2007
The alarm was inspected and operational on;
(Building Inspector Signature) (Date)
Town of Montville
. Building Department
848-3030, Ext 382
RESIDENTIAL SWIMMING POOL
CONSTRUCTION PERMIT
SIGN-OFF SHEET
36 Piffa ã & Cf O3
Property Address
Job Description: andx, TO 60 0
The applicant is responsible for the completion of the form, no permit will be issued until all signatures below have been
obtained.
,i HEALTH DISTRICT 848-3030,Ext.339
e. Approved No Permit
ti I'd?'S, 641/ ❑ Permit#: �1 Required
Se ticystem
� te
p Y
� 6).*I/ S.
fDate
Approved No Permit
ele91'6- y ° (pl� Q ❑ Permit#: z Required
Private Well
WPCA DEPARTMENT 848-3030,Ext.376
Approved No Permit
❑ Permit#: ❑ Required
Municipal Sewer Date
Building Trap ❑ Outside ❑ Inside
Approved No Permit
❑ Permit# ❑ Required
Municipal Water Date
/PLANNING&ZONING DEPA MENT,.....7,- 848-3030.Ext.379
Inr-Co.manee No Permit
Ga/.P�O ❑ Permt ❑ Required
Zoning Date
, //�^ In-Compliance No Permit
N !� ❑ Permit#: ❑ Required
Inland-Wetlands Date
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T/T:d T222_8178:01 1922169098 A001 1HH1:Wa8S:T T 17002-LT-Nflf
Town of Montville
Residential Pool Plan Review
Date: 74/9 V
Job Address: 30Pku%-/-j- 4 .
Job Description: P600 C.-
We have received a building permit application for the above referenced property. In accordance with Connecticut General Statute
29-263,your application is being rejected for the following reason(s)that are checked-off or commented on:
• Supporting Documentation Deck plans required
Plans are to be drawn to scale including dimensions of rooms and
Piers-size,material,depth below grade(minimum 42"required)
Indicate joist hangers at flush framing and ledger
spaces and all framing information(112.1)
Building pernut application t completed,signed,dated Stairs,handrails,and guardrails
Permit fee s -6—X673Direction of framing
--"C
Worker's comp.Affidavit or worker'comp_Insurance Beam spans,size,species,grade
Framed openings
Copy Contractor's registration or license Joistsspecies and
Construction permit sign-off sheet grade(minimum Fb and E), size, direction, and
Street address of project on all drawings and documents spacing
Joists over-spanned
Engineering data for pool
Pool alarm affidavit Headers/beams over-spanned
• Electrical Plan(s)
• Plans
Time clock required
Site Plan Pool pump outlet location
Property lines not provided General purpose outlet location
Distance from property to structure Wiring method not provided
Structure dimensions Wiring type not provided
Driveway Bonding of metal components
Topography(existing and proposed) -
Proposed utilities • Mechanical plan(s)
Wetlands and flood zone limits and elevations
Plans LP-gas tank size,location and piping
Pool barrier not proper Manufactures data for equipment
Pool sidewall support brackets not protected
Door(s)to be self-closing or alarmed
Comments:
Buil ing Official
Town of Montville
Residential Pool Plan Review
Date: JUNr,7 2`3 ,. 2_oot4
Job Address: 3O Piakdi TT a_ CL--
Job Description: ` oci L
We have received a building permit application for the above referenced property. In accordance with Connecticut General Statute
29-263,your application is being rejected for the following reason(s)that are checked-off or commented on:
• Supporting Documentation h Deck plans required tur(A.1-C.- �-e C
Plans are to be drawn to scale including dimensions of rooms and Piers size,material,depth below grade(minimum 42"required)
Spaces and all framing information(112.1) Indicate joist hangers at flush framing and ledger
:wilding permit application not co leted,si ed dated Stairs,handrails,and guardrails
(1►� �- Na C_ Direction of framing
ermit fee$
t� Beam spans,size,species,grade
Worker's comp.Affidavit or worker'comp.Insurance Framed openings
Copy Contractor's registration or license Joists - species and grade(minimum Fb and E), size, direction, and
Construction permit sign-off sheet
n- Street address of project on all drawings and documents spacing
til X Engineering data for pool Joists over-spanned
{``�_
Headers/beams over-spanned
Pool alarm affidavit
• Electrical Plan(s)
• Plans
Time clock required
Site Plan
Pool pump outlet location
Property lines not provided
General purpose outlet location
Distance from property to structure Wiring method not provided
Structure dimensions Wiring type not provided
Driveway Bonding of metal components
Topography(existing and proposed)
Proposed utilities • Mechanical plan(s)
Wetlands and flood zone limits and elevations
Plans LP-gas tank size,location and piping
Pool barrier not proper Manufactures data for equipment
Pool sidewall support brackets not protected
Door(s)to be self-closing or alarmed
Comment'O T,4f-/it1 4.)/24.3- /S /Nui L/S Te7i7 F,2/2 6,/'YT LoGA oN
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