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Home My WebLink About12x14 Shed 2002 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ext.82 Building Permit Permit Number: B2002-561 Permit Date: 26-Sep-2002 Permit Code R4 Job Location: 200 RAYMOND HILL ROAD UNIT: MAP/LOT: 087/001-00B Job Description: Shed Owner Contractor _ Stacey Terrial&Michael Frank Pittisinger Michael Pittisinger 200 Raymond Hill Road 200 Raymond Hill Road Unit: Uncasville,Ct.06382 Uncasville,CT 06382 Telephone: 848-8405 Lic/Reg Type: Use Group R4 Lic/Reg Number: 0 Code 1995 CABO Exp Date: Construction Type 5B Construction Values Permit Fees Building Value: $4,200.00 Building Fee: $28.00 Plumbing Value: $200.00 Plumbing Fee: $10.00 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 Value: $4,200.00 C/O Fee: $10.00 Comments: Plan Review Fee: $2.80 State Ed Fee: $0.67 Total Fees: $41.47 It is the owners responsibility to schedule the following required inspections(minimum 48 hours notice requested); ❑ Footing-Prior to pouring concrete ❑ Rough HVAC ❑ 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 ❑ Final Inspection ❑ Gas Piping and Pressure Test ertifi of Occupan, .•o o use or occupancy Building Official's Signature: / / _ Town of Montville Building Department Permit# 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Building Permit Application Form VewConstruction ❑Addition ❑Alteration 0 Accessoty Structure 0Other Job Location O rn0k) /A 1/ RJ) OmcASVi l/E e7-068a Job Description/Materials 8Ot L /0) ` x /41 ' Too L S/1L- L Owner JyltC//A E/ R r7ES,iU6E R. Mailing Address app Ri7trzoAib l/i// R 1� City &NeAs Ue //g- State CT Zip 063 F19._ Tel 2"6o / 85'?/ k'906- Contractor SELF 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. Owner/Agent Signature Date ? / /b'' / p00,,,) Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ -gyp, 4TO $ W.4/"") Town of Montville BuildingDepartment Partment Receipt Date __ /_____LL/ o z_ 1 IC From: No. 0 1 1 7 0 Job Address: Zv0i tt Amount $-_______A,-- g__)- Cash Check Check # (Circle one) _________ __ Received by _---- Permit # Z o Permit Fee Calculation Spreadsheet MISCELLANEOUS PERMIT CALCULATION Pools&Spas Above Ground Round EA $ 3,000.00 $ - Above Ground Oval EA $ 5,000.00 $ - In-Ground EA $ 18,000.00 $ - Heater EA $ 3,300.00 $ - Hot Tub EA $ 5,000.00 $ - Roofing Strip&Reroof SQ $ 210.00 $ - Overlay ;SQ $ 175.00 $ - Sheds With Electric SF $ 25.00 $ - No Electric :168 SF $ 25.00 $ 4,200.00 Deck SF $ 15.00 $ - Porch SF $ 23.00 $ - TOTAL BUILDING CONSTRUCTION COST $ 4,200.00 PERMIT FEE Building $ 4,200 $ 28.00 Mechanical $ - $ - Electrical $ - $ - $ - $ - CO Fee $ 10.00 Plan Review $ 2.80 State Ed Fee $ 4,200 $ 0.67 Total Fees $ 41.47 Based on 2000 Average Construction Cost 9/18/02 STATE OF CONNECTICUT WORKERS'COMPENSATION COMMISSION BuiIdin Permit Affidavit for Pro e Owners or Sole Pro rietors (Conn.Gen.Stat.§31-2861)) Property located at In the town of Name of building permit applicant Please check one: 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(F Pursuant contractor�3I 286b,"a property owner or sole proprietor-wh � - ...d....... .ag.n..._.».. principal employer"may provide either a °)intends to act as general insurance or a"sworn notarized affidavit_„ stating that he of workers'compensationkers compensation insurance for all those employed on the job site in accordance f workerthis c " Please check one: �� ' 1- I do not intend to act as a general contractor or principal em 1 [Sign and stop here] P oyer. Signature of applicant 2. I intend to act as a general contractor or principal employer.Applicant must provide a certificate of workers'compensation veither below insurance or sign the affidavit IAffidavit................................................... hereby swear and attest that I will require proof of workers'corn contractor,subcontractor,or other worker before he/she engagesin nn work on the he abo a for everyaccordance with the Workers'Compensation Act(Chapter 568). above property in I understand that pursuant to§31-275 C.G.S.,officers of a corporation and partnership may elect to-be excluded partners in a District Office;and that a sole from coverage by filing a waiver with the appropriate files his intent to acceptgmpnet°r of a business is not required to have coverage unless he coverage. Signature ofapplieant Subscribed and sworn to before me this day of 200_ (Notary Public/Commissioner of the Superior Courtl Town of Montville Building Department 848-3030, Ext 82 ONE & TWO FAMILY CONSTRUCTION PERMIT SIGN-OFF SHEET c900 �� MCI-KJ c ti ) s� Property Addfess Job Description: 80,Lb A /a X /y S'bis The owner/agent shall be responsible for the completion of the form, no construction permit will be issued until all signatures below have been obtained. HEALTH DISTRICT -I�� 848-3030,Ext. 882' &44--(3/ l 9v-20-0 Z ❑ Permit#: D Not Applicable Septic Syste Date 0 Permit#: ❑ Not Applicable Private Well Date WPCA DEPARTMENT 848-3030,Ext. 881 ❑ Permit#: Not Applicable Municipal Sewer Date 0 Permit# t 4 Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 4011 Permit Permit#: OA Not Applicable Director Date PLANNING&ZONING DEPARTMENT 848-3030,Ext.81 etate--^ 1/41241,4A" 9/iik'- C Permit#: aJ50 Not Applicable ing Date allay? 5fid0 a-- 0 Permit#: :�� Not Applicable pPlicable Inlandetlands Date