HomeMy WebLinkAbout2003 - Electric Service - -
Town of Montville
Building Department
Field Inspection Notice
Address: 19 Bayberry Lane
Job Description: Elect.Service
Permit Numbers: E2003-0378
Footing Not Approved: Approved:
Comments: i
Backfill Not Approved: Approved:
Comments: 1
Framing Not Approved: Approved:
Comments: i. S
Rough Electric Not Approved: Approved:
Comments: 1
Electrical Service Not Approved: Approved: 12/01/03
Comments: 1
Rough HVAC Not Approved: Approved:
Comments:
Rough Plumbing Not Approved: Approved:
Comments: 1
Gas Line Not Approved: Approved:
Comments: i
Fireplace Throat / Not Approved: Approved:
Chimney Comments:
Fire/Draftstopping Not Approved: Approved:
Comments: i.
Insulation Not Approved: Approved:
Comments: i_
Certificate of Not Approved: Approved:
Occupancy Comments: L
Not Approved: Approved:
Comments: 1
Not Approved: Approved:
Comments: L
Not Approved: Approved:
Comments: L
Comments:
Pagel of l
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville, CT 06382
(860) 848-3030, Ext. 382
Electrical Permit
Permit Number: E2003-0378 Date: 02-Dec-03 Map/Lot: 030/051-000 Owner ID 5506
Job Location: 19 BAYBERRY LANE Unit
Job Description: Electric Service
Owner: Contractor:
Herbert W and April K Camp Paul Nadeau
21 Slocum Road
19 Bayberry Lane Hebron Ct. 06248-
Uncasville CT 06382 Telephone: (860) 228-1523
Lic/Reg Type/No. E1 185921 Exp Date: 30-Sep-04
Tenant:
Self
Telephone:
Construction Values 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: 1995 CABO
Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B
Electrical Value: $1,600.00 Electrical Fee: $10.00 Permit Code: R5
Other Value: $0.00 Other Fee: $0.00 Comments:
Total Value: $1,600.00 CO Fee: $0.00
Plan Review Fee: $0.00
State Ed Fee: $0.26
Total Fees: $10.26
It is the owners responsibility to schedule the following inspections (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: `~L"
r~
Town of Montville
]Building Department ~ Permit # 3 ~ 7e
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 82 Uncasville, CT.06382 Fax. 848-7231
One & Two Family Trades Permit Application Form
Plumbing [;3E"kco*af nMechaniwf
Heating
.stir Conditioning
-Gas Piping
not6er Job Location , y ~jCS s y
Job Description/Materi als goo ~IKP ~e~Ulc~ ~P~f~de J add' Cl to~'i+ y
Owner Mailing Address q Bayry
City iiC~PS v~/~~ State zip Tel
Contractor fqd P4~eov Mailing Address 6~ ` Sf c " KV
City State Zip D ~Cq ~ Tel
Contractor's License/Registration Type & Number Exp. Date 1 / .30
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 Si afore-_=~ J Q
~ Date.-J ~ ~ / . 3
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical $ $
Electrical
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education
Total'
f
Town of Jv'~ontville Building DepartmF- Receipt
Date No.i m b.
From:
A
Job Address:
Amount $ Cash t Check Check # 1
ircle one)
Permit
Received by 'J\
7~ I
1 STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: 1 9 y b eery 4d,
In the town of U I'l ca.S U', WC
Name of building permit applicant: c4d 6` pqje a-.
Please check one:
1. I am the owner of the above property.
2. V/ I am the sole proprietor of a business. C t'{ z?` ~ ~ ~(rcr ~ ~ I C
2A. Name of business: 1-=
2B. Federal Employer Identification Number (FEM
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]
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 h e 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)