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HomeMy WebLinkAboutRoof Overlay 2001 Town of Montville Building Departnfent Phone: 848-7166 310 Norwich New London Tpke p Fax: 848-7231 Building /Trades Permit Permit Number BP2001-390 Permit Date 7/09/01 Permit Type Building Permit Code R4 Job Street# 240 Job Location RAYMOND HILL ROAD Map/Lot 087/001-000 Job Description Roofing -Overlay Owner Contractor Mr. & Mrs. Roy Brown J & R Construction Address 240 Raymond Hill Road Address 238 Old Colchester Road City Uncasville State Ct. City Quaker Hill State Ct. Zip 06382 Telephone 848-8864 Zip 06375 Telephone 848-8773 Lic/Reg Number 553056 Lic/Reg Type HIC Exp Date: 11/30/01 Use Group R4 Code 1995 CABO Type Construction 5B Building Value $1,200.00 Building Fee $10.00 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 $1,200.00 C/O Fee $0.00 Comments: Plan Review Fee $0.00 State Ed Fee $0.19 Total Fees $10.19 Building Official's Signature ' Date 7 It is the owners respo i ' o =dule the following required inspections(minimum 24 hours notice required): ❑ Footings-prior to p g concrete ❑ Backfill -footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab, prior to pouring ❑ Fireplace Final ❑ Rough Framing ❑ Chimney-one flue above thimble ❑ Rough Electrical ❑ Firestopping/draftstopping ❑ Electrical Service ❑ Insulation ❑ Rough Plumbing and leak test ❑ Pool bonding ❑ Gas piping-pressure test and installation V Final Inspection ❑ Rough HVAC ❑ Certificate of Occupancy-PRIOR to use or occupancy Town of Montville Permit #0,7zov i-- 3 7e Building Department 310 Norwich-New London Tpke. Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231 Application for Building or Trades Permit Building Permit Trades Permit ❑ New Construction 0 Accessory Structure OTlum6ing [JKecfwnical ❑Action [Demotrtion DElectncal ❑.Alteration 0 Ott Heating Air Conditioning Gas ung Job Location 2 tfb Phi/Me A,D /9/LG Der? aNC1916//,11 P CT 6628 Z Job Description/Materials 90 Ole en, ex IST) ifs ,Qm4- &pow afi/evje w,'74 Cep rAlbt/Teed .feiL i ikg aS5iAfn 3 6. .rhi 'SLe.c CS mot,/ 4,1,,te) /3 S. . Owner Mg_ 4 k i .r 420 y alto Le 4/ Mailing Address .2 y o 12/gy n i o ni D /It L L ED, City 14/VCif f 1/1 Lie State C T Zip Q 63}7'2 Tel no /$'y8'/ P'8-6 S/ Contractor 4 YZ Col./J7-'2Y Cr fia II T!/Ce. Mailing Address ,231 oto Cold cjleg RP. City awoken f l LL State C t Zip et..? 7f Tel Iva / ry z-/ F723 Contractor's License/Registration Type&Number ... ^J.'o J Exp. Date 1/ / 30 / O J New Home Construction Contractors: Have you entered into a contract with a consumer for the proposed new home?❑ Yes RI 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. Z� / Owner/Agent Signature V,c Date / 7' / 4 / Construction Value Fee Building $ /2c" $ /b Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ O Total $ /2oo-oil— $ /p,/c- AIMIIIIMN.IIIIIIIIIIINMNmumml Town of tintville Building DepartmeoReceipt , c Date / /0/ No. 06874 From: .. /92L____Cee2s ________L-er_;!•-• Job Address: Amount $ /9 -) Cl";");1( (Circle oCheck ne) , tr Received by 4„..,t,-.-v_ Permit # It STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-2866) Property located at o2 VQ ag/ly OVD ill t-C ted., ilIICW1'yIIIe, 0:1196,372 7,6.3t'2 In the town of p i(7,(LLQ Name of building permit applicant: -0—ot)2 Over �,,rC Please check one: I. I am the owner of the above property. 2. I am the sole proprietor of a business. 2A.Name of business ' d t &.,r7.: /SCG. 2B. Federal Employer Identification Number(FEIN) Q6- ©99S.SW Pursuant to § 31-2866, "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 coverage.'' ti ,,ol gnatu of applicant Subscribed and sworn to before me this +� ,2001 . �p � day of �'�,�,� -)6.\,..2. j, �c�— r��o 4,,... (Notary Public/Commissioner of the Superior Court) Melinda L Roberts Notary Public My Commission Expires Oct.31,2002 A