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HomeMy WebLinkAboutSiding 2001 Town of Montville Building Department Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231 Building / Trades Permit Permit Number BP2001-585 Permit Date 10/2/01 Permit Type Building Permit Code R4 Job Street# 160 Job Location PRUETT PLACE Map/Lot 001/004-R00 Job Description Siding Owner Contractor Bernard &Suzanne Gogolinski — Bernard &Suzanne Gogolinski Address 160 Pruett Place Address 160 Pruett Place City Oakdale State Ct. City Oakdale State Ct. Zip 06370 Telephone 444-1913 Zip 06370 Telephone 444-1913 Lic/Reg Number Lic/Reg Type Exp Date: Use Group R4 Code 1995 CABO Type Construction 5B Building Value $10,000.00 Building Fee $58.00 Plumbing Value $0.00 Plumbing Fee ��– $0.00 Mechanical Value $0.00 Mechanical Fee $0.00 Electrical Value $0.00 Electrical Fee $0.00 Other Value $0.00 Other Fee $0.00 Total Values $10,000.00 CIO Fee $10.00 Comments: Plan Review Fee $0.00 State Ed Fee $1.60 Total Fees $59.60 1 Building Official's SignatureDate .141 / / ` It is the owners respons'. to schedule the following required inspections (minimum 24 hours notice required): Footings -prior to po.1-g concrete Backfill -footing drains and waterproofing ❑ Fireplace Throat Concrete Slab, prior to pouring ❑ Fireplace Final ❑ Rough Framing ❑ Chimney -one flue above thimble ❑ Rough Electrical ❑ Firestopping/draftstopping ❑Electrical Service ❑ Insulation [Rough Plumbing and leak test ❑ Pool bonding ❑ Gas piping -pressure test and installation ® Final Inspection ❑ Rough HVAC ❑ Certificate of Occupancy - PRIOR to use or occupanc Town of Montville Permit ti Building Department 310 Norwich-New London Tpke. Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231 Application for Building or Trades Permit Building Permit Trades Permit ❑New Construction 0 AccessoryStructure ❑Pfum6ing ❑Yec(zanical ❑Action fDemo&tion El Alteration ❑Ott. ❑` ctrzcaC ?fearing Air/� Conditioning � n 4,7 Gas PipingJob Location Jl- ( ' �/ /--�— , (._./�Cif / Job Description/Materials 1/ /9i Al Owner /Q,�N/�-ku ,S(ezqu, Gp1�' �'�Mailing Address /60 a � City 7)1/41 .0/9 L C State Zip QlQ J 126 Tel f(oo /5/gV/ Contractor S(T L f Mailing Address City State Zip Tel / / Contractor's License/Registration Type&Number Exp. Date / / New Home Construction Contractors: Have you entered into a contract with a consumer for the proposed new home? ❑ Yes D No 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 '�,��G � Date / / Construction Value Fee Building $ Plumbing Mechanical $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ /e State Education Total $ /'r 4,0 Town of 'Montville Building Departnint Receipt Date /is /a / o WG No. 1 1 13 r' a• From: ..4. - - _...:. .......r.. Job Address: . I/Ir A, , _ AIra—... .,,, . , imir fi/ r i, ' 0 Amount $ -- 6 t1 Cash Chcc Check # (circle one) oir,__ Received by ,/f - /ig, a i, ;moi Pennit #6jr 0�2/ 4_ _ rte _ 5- i • • STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors // (Conn. Gen. Stat. § 31--/2866) Property located at /�c� d %4g (Ic In the town of Name of building permit applicant: �� � -)1( 9-zj 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 to § 31-286b, "a property owner or sole proprietor[who] intends to act as a general contractor or principal employer"may provide either a certificate of workers'compensation insurance or a"sworn notarized 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. 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 that I will require proof of workers'compensation insurance for every contractor, subcontractor,or other worker before he/she engages in 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,, 6verage. VY/61 ' 10PL44-"ILL Signatureef applicant Subscribed and sworn to before me this / s 7day of �r ,200_. (Notary Public/Commissioner of the Superior Court) Melinda L.Roberts Notary Public 9 '> Commission Expires Oct.31,2002