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HomeMy WebLinkAboutElectric/Electric Service for SFR TOWN-OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 ELECTRICAL PERMIT Permit Number: E2004-0315 Date: 01-Nov-04 Map/Lot: 043/009-017 Owner ID: 52000 Project Location: 5 ALLISON'S WAY Unit: Job Description: Electrical & Electric Service Owner Name: RTT Development Tenant Name: N/A Careof: 35 Blais Road Uncasville CT 06382- Telephone: Contractor Name: Millovitsch Electric Telephone: (860)376-2153 DBA: Lic/Reg Type: El Lic/Reg No: 104995 43 Lisbon Heights Exp Date: 30-Sep-05 Lisbon Ct 06351- Construction Value Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code Mechanical Value: $0.00 Mechanical Fee: $0.00 w/2004 Amendment Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $0.00 Penalty Fee: $0.00 Permit Code: R5 C of O Fee: $0.00 Comments: Plan Review Fee: $0.00 Included on Building Permit State Ed Fee: $0.00 Total Fee: $0.00 It shall be the owners rensonsibility to schedule the following inspections a minimum of 2 business days in advance Field set of approved construction documents shall be available onsite during all inspections. ❑ Footing - Prior to pouring concrete ❑ R Plumbing and leak test ❑ Backfill - Footing drains and waterproofing R Electrical ❑ Concrete Slab - Prior to pouring concrete Elec Trench - with conduit installed ❑ Framing Electrical Service CRS No: 382064 ❑ Fireplace Throat - One flue above throat ❑ R HVAC ❑ Chimney - One flue above thimble ❑ Gas Piping and leak test ❑ Firestop Draftstopping ❑ Final Inspection ❑ Insulation ❑ Certificate of Occupancy Building Official's Approval: a Town of MontuiIfe Building Department 310 Norwich-New London Tpke. Tel. 848-3030, Ext 382 Uncasville, Cr 06382 Fax. 848-7231 Residential Trades Permit Application Form Permit ❑Plum6ing electrical [1911echanicaf CAS # 9featina __Air Condawning Gas Piping ellslingle Family El Two-Family 7ownFiouse Job Address (Number) _ . o (Street) (Unit) Job Description c Owner-~2 Jfi Mailing Address - . City State - o Zip Contractor\ Mailing Address City State :Z\ Zip. ; Tel Contractor's License Type & Number Exp. Date e_//~ 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 ~Q C nstruction Value Fee U Plumbing . $ $ Mechanical $ $ Electrical $ $ Plan Review Fee State Education $ Total $ (Complete reverse side) STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Properly Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: In the town of QX~ 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 business. 2A. Name of business: 2B. Federal Employer Identification Number (FEIN) O d 12,c~ I t 1 Pursuant t o§ 31-286b, " a p roperty owner o r s ole p roprietor [ who] i ntends t o a ct a s a g eneral c ontractor o r 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. do not intend to act as a ge ral contractor or principal employer. [Sign and stop here] Signature of applicant 2. 1 intend to act as a ge ter)contractor or principal employer. Applicant must either provide a certificate of workers' compensation insurance or sign the affidavit below. Affidavit I hereby swear a nd a ttest t hat I w ill r equire p roof o f w orkers' c ompensation insurance for e very c ontractor, subcontractor, o r o ther w orker b efore h e/she a ngages i n 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 r. (Notary Public/Commissioner of the Superior Court) Towgi of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-303.0, Ext. 382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL Property Address Job Description The applicant is responsible for obtaining all of the required approvals checked off on this forma No building permit will be issued until all of the required signatures have been obtained. Required Department Permit Issuance Approval Approval Tax Collector o J<P.Le~ /J- -~Pl C`f date ❑ WPCA jj L ❑ Planning & Zoning ❑ Health Department SigT,,wure/ date ❑ Department of Public Works ❑ State Dept. of Transportation ❑ Fire Marshal Comments/Conditions: 1?§ sedSeptem6er9, 2004 i ELECTRICAL "NUMITED CONTRACTOR E1 JOSEPH N MILLOVITSCH JR 43 LISBON HEIGHTS LISBON:, CT 06351 u~d © 1 X0604 09,/~' 5 i SIGNED