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Home My WebLink About2002 - Electric Service y Town o Montville Building" Department permit -4.,.~ Field Inspection Notice Date Job Location ' Type of Inspection ~ - /Approved ections : Not Approved Please call for re-inspection when the following corr have been completed i f G. 1 Build' vial r Town of Montville' BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 860-848-3030, Ext. 82 Electrical Permit Permit Number: E2002-198 Permit Date: 23-Jul-02 Permit Code R5 Job Location: 67 BEECHWOOD ROAD UNIT: MAP/LOT: 081/067-000 Job Description: Electrical Service Upgrade Owner Contractor EDMUND & FRANCES R GLYNN Ed Glynn 67 Beechwood Road 67 BEECHWOOD ROAD Unit: Oakdale, CT 06370 OAKDALE CT 06370-1704 Telephone: 860-848-9170 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: $750.00 Electrical Fee: $10.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $750.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.12 Total Fees: $10.12 It is the owners responsibility to schedule the following required inspections (minimum 48 hours notice requested): ❑ 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 Wl Electrical Service ❑ Insulation ❑ Rough Plumbing and Leak Test ❑ Final Inspection ❑ Gas Piping and Pressure Test iOccupancy - Prior to use or occupancy Building Official's Signature: ti Town of Montville Building Department Permit #Z >1 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form ElPfumbing J:fectiicaf F-19lechanicaf Meating Conditioning Gas Taping Other Job Location ~D tJ~ ~C ► ► Wood P-0( Job Description/Materials U b Q F Owner d !,f L>I, 61 Mailing Address City Q 1 State Zip D& 3? 0 Tel e kb / eq0 / 417 0 Contractor yt f) Mailing Address City State-6-t_ Zip 06 3 7 ~ Tel 6/ / 9 / 719 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. Owner /Agent Signature Date 7 / 6' / d 2- Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ 7 S" o ^ $ d Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ - Z-Total -25 $ / z Town of Montville Building.Department Receipt / per No. ,9 Date From: - f.~. Sob Address: - i P r, Cash Check Check # - AInount ~ ~ Rccclved by c STATE OF CONNECTICUT WORKERS' COWENSA-nON COhMESSION Building Permit AfTidavit for Property Openers or Sole Proprietors (Conn. Gen. Stat. § 3 i 286b) Property located at ---6 7 In the town of Ulu? , Name of building permit applicant: _ Yt Please check on . I • 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 M311 ~ Pursuant to § 3 1286b, "a property owner or sole proprietor rietor [ who] inttend] i end.s...to.. acct t as as ._a..geaaner .al.,... contractor or principal employer" may provide either a certificate of workers' compensation insurance or a "sworn notarized affidavit... stating that he will require proof of worker' compensation insurance for all those employed on the job site in accordance with this chapter Please cl7kfie: I I do not intend to act as a general contractor or principal employer. [Sign d 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. Afridavit I hereby swear and attest that I will require proof of workers' compensation insurance for every contractor, subcontractor, or other worker before helshe engages in work on the above accordance with the Workers' Compensation Act (Chapter 568). I understand that pursuantto § 31-275 C.G.S., officers of a corporation and partners in a partnership may elect to-be excludod 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 ofapplicant Subscribed and sworn to before me this day of .200 _o (Notary Public/ Commissioner of the Superior Court)