HomeMy WebLinkAbout2002 - Above Ground Pool - Electrical for Second Replacement
Town of Montville
Building Department
DateField Inspection Notice Permit #
` Job Location
(l Approved Type of Inspection, "
XNot Approved - Please call for re-inspection when the following corrections have been completed:
40:~~~Build~ingOffi-cial
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville, CT 06382
860-848-3030, Ext. 82
Electrical Permit
Permit Number: E2002-142 Permit Date: 10-Jun-02 Permit Code R5
Job Location: 3 BEECHWOOD ROAD UNIT: MAP/LOT: 076/061-000
Job Description: Electrical for above ground pool
Owner Contractor
JOHN D & JULIE F CUFF John D Cuff
3 Beechwood Road
3 BEECHWOOD ROAD Unit: Oakdale, Ct 06370
OAKDALE CT 06370 Telephone: 860-848-1032
Lic/Reg Type:
Use Group R-4
Lic/Reg Number: 0
Code 1995 CABO
Exp Date:
Construction Type 5B
Construction Values Permit Fees
Building Value: $0.00 Building Fee: $0.00
Plumbing Value: $0.00 Plumbing Fee: $0.00
Mechanical Value: $0.00 Mechanical Fee: $0.00
Electrical Value: $0.00 Electrical Fee: $0.00
Other Value: $0.00 Other Fee: $0.00
Total Value: $0.00 C/O Fee: $0.00
Comments: Plan Review Fee: $0.00
State Ed Fee: $0.00
Total Fees: $0.00
it is the owners responsibility to schedule the following required inspections (minimum 48 hours notice reauested)•
❑ Footing - Prior to pouring concrete ❑ Rough HVAC
❑ Backfill - Footing drains and waterproofing ❑ Fireplace Throat
❑ Concrete Slab - Prior to pouring ❑ Fireplace Final
❑ Rough Framing ❑ Chimney - One flue above thimble
Rough Electrical ❑ Firestopping/draftstopping
❑ Electrical Service ❑ Insulation
❑ Rough Plumbing and Leak Test d❑ Final Inspection
F-1 Gas Piping and Pressure Test ifcate ancy - PriorX use or occupancy
Building Official's Signature:
-Town of Montville
a Building Department Permit # 3
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231
One & Two Family Trades Permit Application Form
[:]T1umCnng i Efectricaf F-1,IWechanical
J eating
_Air Conditioning
Cjas 1r'iping
Other
Job Location 3 ~5W woo 12 0cLI4d(5r-(Q_
Job Description/Materials 5la~ ,G, .TTrt e v Cl d 0 . Ccl)du-j
_ ~u Mailing Address CL. C~a1~
Owner ~.3 nk C)
City State C-j Zip ®6 374 Tel l/ / ~C~.3Z
Contractor S-,e--f Mailing Address
City k caJ State Zip Tel
Contractor's License/Registration Type & Number No ,-2 ~ 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.
Owner /Agent Signature , Date__6_/ / 2
Construction Value Fee
Building $ $
Plumbing $ $
Mechanical $ $
Electrical $ $
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education $
Total $ $
e~.
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: ~L B rr'
In the town of C~C.i-l1cf~z
Name of building permit applicant:
Please chec ne:
1. V 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. V I do not intend to act as a general contractor or principal employer.
[Sign and stop here]
L-1 U
Si lure of applicant
2_ 1 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)