HomeMy WebLinkAboutElectric/Electric Service for SFR
Town of Montville
Building Department
Date 0'3 Field Inspection Notice Permit # 4 Z-ao3
Jab Location //r Forte- ROO
Approved Type of Inspection 2~-: d Cc ~'~~v! ~E
k . a Not Approved - Please call for re-inspection when the following corrections have been completed:
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Building Official
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville, CT 06382
(860) 848-3030, Ext. 382
Electrical Permit
Permit Number: E2003-0093 Date: 25-Apr-03 Map/Lot: 043/009-007 Owner ID 49533
Job Location: _ii8 FO YTH ~OA~ Unit
Job Description: Electrical & Electric Service
Owner: Contractor:
Rtt Development Inc Millovitsch Electric
43 Lisbon Heights
35 Blais Rd Lisbon Ct. 06351-
Uncasville CT 06382 Telephone: (860) 376-2153
Lic/Reg Type/No. E1 104995 Exp Date: 30-Sep-03
Tenant:
Self
Telephone:
Construction Values Permit Fees Construction Information
Building Value: $0.00 Building Fee: $0.00 Use Group: R4
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO
Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B
Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5
Other Value: $0.00 Other Fee: $0.00 Comments:
Total Value: $0.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $0.00
Total tees: $0.00
It is the owners responsibility to schedule the following ink ion (minimum 48 hours notice required).
❑ Footing - Prior to pouring concrete ❑ Rough HVAC
❑ Backfill - Footing drains and waterproofing ❑ Fireplace Throat
❑ Concrete Slab - Prior to pouring concrete ❑ Chimney - One flue above thimble
❑ Rough Framing ❑ Firestopping/draftstopping
Rough Electrical ❑ Insulation
Electrical Service ❑ Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature:
~r
Town of Montville
Building Department r!~ Permit #
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231
One & Two Family Trades Permit Application Form
[]Plumbing ~lectricaf nMechanicaf
Heating
Air Con4tioning
[]Other GasPiPm9
Job Location__ O.
Job Description/Materials
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Owner t-~'~Mailing Address
City l~ `r IQ State zip Tel
Contractor < Mailing Address
City a State lz' > % Zip 6(, S Tel 2I
Contractor's License/Registration Type & Number L %
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 a application for a permit for such work as described above.
7
Owner (Agent Signature ' . s Date~,~ /
Cons ction Value Fee
Building
Plumbing $
Mechanical $ $
Electrical
Other $
Certificate of Occupancy $
Plan Review Fee
State Education
Total' $ $
STATE OF CONNECTICUT '
WORKERS' COMPENSATION CONMUSSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at:
In the town of
Name of building permit applicant:
Please chec 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
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 chec one:
1. I do no intend to act as a general contractor or principal employer.
[Si d stop here
Sign ure o applicant
2. I int d to act as a g nerai contractor or principal employer. Applicant must either provide a
e ' icate of workers' ompensation 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.
Signature of applicant
Subscribed and sworn to before me this day of , 200.
(Notary Public/Commissioner of the Superior Court)