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Home My WebLink AboutPlumbing for SFR Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Plumbing Permit Permit Number: P2003-0057 Date: 12-Jun-03 Map/Lot: 043/009-007 Owner ID 49533 Job Location: 118 FORS)gjE R0AQ Unit Job Description: plumbing Owner: Contractor: Rtt Development Inc Robert Giusti P & H P. 0. Box 482 35 Blais Rd Waterford Ct. 06385- Uncasville CT 06382 Telephoner (860) 444-7062 Uc/Reg Type/No. P1 279284 Exp Date: 31-Oct-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 Fees: $0.00 It is the owners responsibility to schedule the following iins ion (minimum 48 hours notice reamired); ❑ 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 ❑d Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: Town of Montville Building Department Permit # raj t5 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT.06382 Fax. 848-7231 One & Two Family Trades Permit Application Form Plumbing pE(ectricoe pMecF4nk4d Air Conditioning Gas Piping Job Location Job Description/Materials Owner__ Mailing Address I r 5°Z City- l J r, r ~o1r I State Zip Tel 'A I Contractor Kok,i c~~ , /9"4 L ° k~1&Iilin Address iL__ ~ 'z`~ L city- State' CT_ Zip' Tel c /q W/ 2C& 9 Contractor's License/Registration Type & Number 29 q g ,,R Exp. Date A? / 1 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____~~ y a--~ Construction Value Fee Building $ _ $ Plumbing $Z Cc ° $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ . State Education $ Total- $ $ STATE OF CONNECTICUT WORKERS' COMPENSATION COMMSSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: ~ a In the town of M, rr Name of building permit applicant: Please check one: 1. I am the owner of the above property. 2. I am the sole proprietor of a b ' e s, t 2A. Name of business: 2B. Federal Employer Identification Number (FEIN) `70 Ca~ 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 check one: 1. 1 do not intend to act as a general contractor or principal employer. [Sign and st re 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. Signature of applicant Subscribed and sworn to before me this day of 200. (Notary Public/Commissioner of the Superior Court) f r~ PLUbgg IIVG&P , j: w f'P1 ACT Fi7 ~~~~I II~~GII ~j OR ~ L/C. / SG 1 }Tl:r$5 N 279284 SIGNED p~RES `_=ur 1013112003 o~0 CIO • o~ ~5 C, oil ~k12 V`\\ o C .0 X, C-3, 0 ~F~~ X2002