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i - TOWN QF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 BUILDING PERMIT Permit Number: b2004-0539 Date: 01-Sep-04 Map/Lot: 043/009-021 Owner ID: 62000 Project Location: 20 ALLISON'S WAY Unit: Job Description: Shed Owner Name: Thomas S and Susan Dougherty Tenant Name: N/A Careof: 20 Allison's Way Oakdale CT 06370- Telephone: Contractor Name: Property Owner Telephone: (860)885-1199 DBA: Lic/Reg Type: Lic/Reg No: 0 - Exp Dae: - - - Construction Value Permit Fees Construction Information Building Value: $2,520.00 Building Fee: $24.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code Mechanical Value: w/2000 Amendment $0.00 Mechanical Fee: $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $2,520.00 Penalty Fee: $0.00 Permit Code: R9 C of 0 Fee: $10.00 Comments: Plan Review Fee: $2.40 State Ed Fee: $0.40 Total Fee: $36.80 It shall be the owners rel2sonsibilitY 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: 0 ❑ Fireplace Throat - One flue above throat ❑ R HVAC ❑ Chimney - One flue above thimble ❑ Gas Piping and leak test ❑ Firestop Draftstopping Q Final Inspection ❑ Insulation ❑ Certificate of Occupancy Building Official's Approval: t; ` Town of Montville Building Department 310. Norwich=New London Tpke. Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential Building Permit Application Form Permit # ❑ New Construction ❑ Addition ❑ Alteration ❑ Accessory Structure ❑ Single Family ❑ Two-Family ❑ Townhouse Job Address 2-0 ons wo - I-/- (Number) (Street) (Unit) Job Description I , p Owner '771 o rncs t- its c i D0 r t r .e Mailing Address 2-0 411%-©441 City (e State C % Zip 06 570 Tel D Contractor 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. Separate applications are required for electrical, plumbing, mechanical, etc. Owner /Agent Signature c~,~ G- Date. / 2 S,/ o Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ $ (See Z~verse side foradditionafrequirements) Town of Montville Residential Permit Requirements " ❑ Two (2) complete sets of construction documents (to scale) including site plan are required and shall show the following information if applicable. This list is not all-inclusive, additional information may be required for your particular project. • Supporting Documentation • Building Section(s) & Details Completed, signed and dated Building Permit Application Floor-to-floor heights Permit fee - calculated upon completion of plan review Material type, size, and spacing Completed building permit affidavit for property owners or sole Stair details (rise, run, treads, nosing, width, headroom) proprietors or copy of workers compensation insurance Handrail details Copy of Contractor Registration or license Guardrail details Construction permit sign-off sheet signed by all departments Roof ventilation Model Energy Code Analysis Heat loss calculations • Framing plans Engineering data for steel beams, engineered lumber, roof trusses or any Design loads - for floors, ceilings, roofs other engineered products or design Bearing partitions Street address of project on all drawings and documents Direction of framing • Site plan Spans, beam Wood species and grade Property lines Framed openings Distance from property to structure Sheathing type and thickness Structure dimensions Window and door header sizes Driveway Decking material, size, spacing Topography (existing and proposed) Note: Unusual structural conditions may require that additional Footing drain inverts, outlet and separation engineering back up be submitted Proposed utilities Wetlands and flood zone limits and elevation • Chimneys and Fireplaces Signed by P & Z, Wetlands, Uncas Health, WPCA Clearances to combustible materials Manufactures data for metal flues • Foundation Plan Exterior fresh air source for fireplaces Assumed soil bearing pressure Flue sizes Dimensions Manufacturers data and installation instructions for metal fireplaces Wall thickness Footing sizes • Electrical Plan(s) Anchor bolts, size and spacing Window and door sizes and locations Panel location(s) with main size Meter socket location Hatchways Outlet locations Columns GFCI Floor construction data outlet locations details Smoke detector locations Drainage Lights details ights and switches Crawl space ventilation Appliance/equipment circuits Stair illumination l space access Craw Concrete strengths • Mechanical plan(s) • Floor plan(s) Dryer vent Dimensions Bathroom exhaust ventilation (natural or mechanical) type and size Door and window sizes, egress window Hood exhaust Glazing in hazardous locations Type of heat Garage/dwelling opening protection Heating, ventilation, and air conditioning plant location Garage/dwelling separation Oil tank size, location, and piping Kitchen layout LP-Gas tank location, size, and piping Bathroom layouts, tub sizes in gallons, space clearances Make-air requirements Indicate use of all rooms Manufacturers data for equipment Stair location • Attic access location and size Plumbing plan(s) Square footage for each habitable level of the structure Building trap location if on municipal sewer Required light and ventilation for each habitable room Sewer location Domestic water location • Elevations - minimum of two required Manufacturers data for whirlpools, corner tubs, & larger tubs Type of siding Water heater size, type, and location - Roofing Other finishes Finish grades Note: One set of approved plans is Building heights Height of chimney above roof required to be kept on during Roof pitch construction. n of Montville Building Department Receipt r- Tow Date From Job Address: C~s lice Check Amount Permit # Received by.-' V w, Permit Fee Calculation Spreadsheet b MISCELLANEOUS PERMIT CALCULATION Address: Pools & Spas Above Ground Round EA $ 3,200.00 $ - Above Ground Oval EA $ 6,000.00 $ - In-Ground EA $ 20,700.00 $ - Heater EA $ 3,465.00 $ - Hot Tub EA $ 5,250.00 $ - Roofing Strip & Reroof SQ $ 300.00 $ - Overlay SQ $ 185.00 $ - Plywood SQ $ 105.00 $ - Plumbing Full Bath EA $ 4,230.00 $ - Half Bath EA $ 2,690.00 $ - Garages Attached, 1 car EA $ 8,885.00 $ - Attached, 2 car EA $ 15,114.00 $ - Attached, 3 car EA $ 20,914.00 $ - Detached, 1 car EA $ 11,657.00 $ - Detached, 2 car EA $ 17,456.00 $ - Detached, 3 car EA $ 23,256.00 $ - Sheds 96 SF $ 26.25 $ 2,520.00 Sheds with Electrical SF $ 26.25 $ - Electrical Service 100 Amp EA $ 825.00 $ - 200 Amp EA $ 1,500.00 $ - Siding - Windows & Doors Decks/Porches/Su n rooms Open SF $ 22.31 $ - Covered SF $ 62.69 $ - Enclosed SF $ 123.90 $ - TOTAL BUILDING CONSTRUCTION COST 2,520.00 PERMIT FEE CALCULATIONS Fee Building $ 2,520 $ 24.00 Plumbing $ - $ - Mechanical $ - $ - Electrical $ - $ - Work Commenced before permit issuance $ - CO Fee $ 10.00 Plan Review $ 2.40 State Ed Fee $ 2,520 0.40 Total Fees $ 36.80 Based on 2003 RS Means Residential Cost Data 9/1/04 E t STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) f Property located at: ;;-20 /<114 KI D V ® a ka6e lQ In the town of~ Ae-- Name of building permit applicant: p n~ct.S v` S Gt S ~t +cy ~y Please check one: 1. X 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 check one: 1. I do not intend to act as a general contractor or principal employer. [Sign and stop here] dC. 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) Town of Montville , Building Department 848-3030, Ext 382 RESIDENTIAL CONSTRUCTION PERMIT SIGN-OFF SHEET r 2o C1 Ce kdk~l_e_ Property Address Job Description: ?j"e 4w tf The applicant is responsible for the completion of the form, no permit will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030, Ext. 339 Approved No Permit ❑ Permit Required ❑ Sep i System Date Approved No Permit ❑ Permit ❑ Required Private Well Date WPCA DEPARTMENT 848-3030, Ext 376 Approved No Permit ❑ Permit ❑ Required Municipal Sewer Date Building Trap ❑ Outside ❑ Inside Approved No Permit ❑ Permit # ❑ Required Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 Approved _ No Permit ❑ Permit ❑ Required Director Date PLANNING & ZONING DEPARTMENT 848-3030, Ext. 379 Approved No Permit o° z S~ ®y Permit Required Zoning Date c Approved No Permit ❑ Permit ❑ Required Inland-Wetlands Date