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HomeMy WebLinkAbout2003 - Windows - Replacement Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 r Building Permit Permit Number: B2003-0243 Date: 30-May-03 Map/Lot: 076/060-000 Owner ID 7002 Job Location: 7 BFECdW4nQ ROAD Unit Job Description: replacement windows Owner: Contractor: Jeffrey R and Myma G Lindstrom Jeffrey Lindstrom 7 Beechwood Road 7 Beechwood Rd Oakdale Ct. 06370- Oakdale CT 06370 Telephone: (860) 848-0113 Lic/Reg Type/No. 0 Exp Date: Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $3,500.00 Building Fee: $22.00 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: R4 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $3,500.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.56 Total Fees: $22.56 It is the owners res nonsibiliW to schedule the following inspections (minimum 48 hours notice reauired)• ❑ 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 k ❑ Insulation ❑ Electrical Service F Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: tit iTown of Montville Buitding Department Permit #A 310 Norwich-New London Tpke. Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 One & Two Family.Building Permit Application Form [l Nw Construction. E] .dCitim YA(Umt4M, Accessory Stnufure ❑Other Job Location 'r C662 od ( cj Q C Job Description/MaterialsRU 16, XAL JQ lA kp qc4e~ WX 44 d "J6 Wit d Q tAX- _ OwnerJ e-VIM if CA 0% . ~ . Mailing Address P IA Cit3' kCWI State.Cr Zip d t Tel Contractor Mailing Address. City State Zip Tel f Contractor's Liceiise/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. Owner /Agent Signature- ~ Date O~C f~3 Construction Value Fee Building $ 35c~ Plumbing $ $ Mechanical Electrical Other $ $ Certificate of Occupancy Plan Review Fee $ State Education. Total $ ^(See *verse 44 for ado nut requirements) Town of 1,v--ntville Building Departmer-i-,Receipt No.~ Ii Date From: Job Address: E_ Check # ec Cash k Permit # k~~a a ozy~ Received by v I Y - e _ I STATE OF CONNECTICUT WORKERS' COMPENSATION CONIIWMION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: E C 4141©0 01 In the town of 40- CT- MQA4 r sZ C `7 Name of building permit applicant: J4 Please chec one: 1. I am the owner of the above property. 2. 1 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. I do not intend to act as a general contractor or principal employer. [Sign stop he ] - Si o 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 re d to h ve c Vera e unless he files his intent to accept coverage. Signs o plicant Subscribed and sworn to before me this 3 day of .20Q--. (Notary Public/Commissioner of the Superior Court)