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Home My WebLink AboutStrip and Re-Roof 2005 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: B2005-0529 Date: 12-Sep-05 Map/Lot: 004/024-000 Owner ID: 5709000 Project Location: 85 PRUETT PLACE Unit: Job Description: Strip&Re-roof Owner Name: George H and Debra Leitkowski Tenant Name: N/A Careof: 85 Pruett Place Oakdale CT 06370- Telephone: Contractor Name: Gurnars Lacis Telephone: (860)739-3637 DBA: Lic/Reg Type: HIC Lic/Reg No: 507482 15 White Birch Circle Exp Date: 30-Nov-05 Niantic Ct 06357- Construction Value Permit Fees Construction Information Building Value: $4,950.00 Building Fee: $40.00 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: $4,950.00 Penalty Fee: $0.00 Permit Code: R4 C of 0 Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.79 Total Fee: $40.79 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 framing ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation El Certificate of Approval ific 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 Building Permit Application Form Permit#102_00 �' ��tc2? ❑ ,New Construction ❑Addition h Alteration ❑Accessory Structure ❑ Single(Family ❑ Two-rFamily ❑ Townhouse Job Address J PrJ- Pict Cr: (Number) (Street) (Unit) Job Description g1 t"Cl.1% g Q v "U Cf 11) SLI/ 4-7 5 Owner..bee4 Lc t--r'l t✓wsk ,, Mailing Address P✓'V c t4 014c City G' 'dd4 i-r StateCT Zip Tel eke/. /it39/ /i60 V Contractor t M Gtr> L(C-t S Mailing Address 15 44./kit, 8/ 1-1 �/✓c' City i' 1\Gt✓1.4[ C, State( t Zip 06)5" 7 Tel �� / 73%/ 36 3 7 Contractor's License/Registration Type&Number S 6 7 Y' Z Exp. Date Vow- an!-L'Nmr 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 required for electrical,plumbing,mechanical,etc. Owner/Agent Signature � ` � Date / 6 I er 5 Construction Value _ Fee Building Pok4-1-1 $ y JS cJ� $ zeio Plumbing $ $ Mechanical $ $ Electrical $ $ Work commencing before the issuance of a permit $ Certificate of Occupancy $ Plan Review $ State Education $ a,7 9 Total $ 4,5 — $ yd, 767 (See Wfverse side for additional requirements) vrrei February 25 2005 Town of Montville Building Department File Receipt Date: 06-Sep-05 Receipt No: 598 Received From: Lads Construction Job Address: 85 Pruett Place Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $40.79 Check: $0.79 Check No: 1235 Construction .lue: $4,950.00 Dem.' V. .-: $0.00 Received By Joseph Summers . . 1 State of Connecticut E jx4 . Li Workers' Compensation Commission o 7A <.,... .) :��/,02244 . Please TYPE or PRINT IN INK C4 Proof of Workers' Compensation Coverage when Applying for a Building Permit for the Sole Proprietor or Property Owner who WILL NOT act as General Contractor or Principal Employer Applicant for Building Permit 6 Name of Applicant for Building Permit a Lac I Property located at c P rO r v" A u C C- in the City/Town of OA k da l-Q C Attest If you are the owner of the above-named property or the sole proprietor of a business doing work on the site of the construction project at the above-named property and you WILL NOT act as the general contractor or principal employer,you are not required to have workers'compensation insurance coverage. CHECK ONE (1) BOX ONLY and complete the following: ❑ I am the OWNER of the above-named property.I WILL NOT act as the general contractor or principal employer. Signature of OWNER Applicant N,I(I am the SOLE PROPRIETOR of a business doing work at the above-named property.I WILL NOT act as the general contractor or principal employer. 1 Name of Business /4-C/ 5 (Gr/1$S1/' t C 71i v ✓l) Federal Employer ID#(FEIN) Signature of SOLE PROPRIETOR Applicant C"-Z::�`) i 1.. • Building Department 848-3030,'Ext 382 CONSTRUCTION PERMIT APPROVAL ‹.R frv-e ti I ct Property Address 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 Permit Issuance Approval Approval Tax Collector ,c��/v c�.�e__ 9/CVO: Signature/date ❑ WPCA Signature date ❑ Planning&Zoning Signature/date ❑ Health Department Signature/date ❑ Department of Public Works Signature date ❑ State Dept. of Transportation Siuxnature/date ❑ Fire Marshal Signature/date Comments/Conditions: