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LP Furnace 2014 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860)848-3030 X382 FAX. (860) 848-7231 MECHANICAL PERMIT Permit Number:-M2014-0069 Date: 0 lacy-14 Map/Lot:-016/099-T71 Owner ID: 5776000 Project Location: 71 RAINBOW DRIVE Unit: Job Description: _Replace LP Gas Furnace Owner Nam FilarneniajLesev Tenant Name N/A Careof: 71 Rainbow Drive Iincnsville CT 063.82- Telephones 18h01A4841w Applicant Name Prnnaity nyvaef Telephone: DBA: Lic/Reg Type Lic/Reg N _0_ Exp Date: Conet_ruction_Vn_luo Parrai FwgS ConstniCtioninfnrmntinn Building Value: SO.00_ Building Fee: S.O_OO Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: SO_QO_ Code: 2005 State Building Code Mechanical Valu S2.000.00 Mechanical Fe $3Q.01_ Electrical Value: $QOO Electrical Fee: $100 Construction Type IRC Total Value: $2,000.00 Penally Fee: $0,00_ Permit Code: R5 C of 0 Fee: Si100_ Comment Plan Review Fe $1100 State Ed Fee: S2 Total Fee Paid: $30.52 It shall be the owners repsonsibility 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. BUILDING PERMIT INSPECTIONS PLUMBING.MECHANICAL,ELECTRICAL PERMIT INSPECTIONS ❑ Fooling-Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical El Backfill-Footing drains and waterproofing ❑ Elec Trench-with conduit installed LI Concrete Slab-Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor frami ❑ Electrical Service CRS No: El Framing 0 El R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble El Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation 0 Certificate of Approval El Certificate of Occupancy _Building Dificiols_Aonrav t' a 1 2'-- t7„,dd,,,,,i0,- -- Town of Montville Building Department 310 Norwich-New London Tpke. Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231 RESIDENTIAL PERMIT APPLICATION FORM Permit No.: _� 4 !cul y Type of Work Occupancy Type Permit Type ❑New Construction ❑Single Family ❑Addition ❑Plumbin 0 Two-Family 0 Alteration Plumbing ❑Townhouse ,Mechanical 0 Accessory Structure 0 Electrical CRS#: Property Address: 7/ /I//1,,(aCt..) Z.> (Number) (Street) (Unit) Job Description: --170-Pc- /1(' / (3-4 c A( a4,yq Owner: /--/< D J i�.�it //6:37e Addresss:� 9 )1 lam,/ V ccJ D/L City: fi//li(,74 s vic C_e- State: 27. / Zip Code:G)L,;3) Telephone( F ( ) Applicant: - c)?1')71;- DBA: Address: City: State: Zip Code: Telephone p )Contractors - Complete the Following: License Type: License No.: Expiration Date: I hereby certify that the proposed work will conform to the State 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: J� yl�,� J V e..0-�„ , , s ".( Date: luL t '1 1 1 4-- Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: Mechanical Fee: Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: Total Fee: R.cvise6August 23,2007 Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL A..licant is res•onsible for obtainin• all of the re.wired a..royals. No •ermit will be issued until all the re.uired si•natures are obtained. 7/ A)/ //ti OwT-0/ _ Property Address /71 Job Description Required Approval Department Permit Issuance Approval Tax Collector ze„,.,`. / � —ilk 7//-f- Comments: Signature/date Planning &Zoning 7A(/ Comments: Signature/date ® Fire Marshal f2414( ' r 27/T Comments: Signature/date ❑ Health Department Required for properties with private septic or well Comments: ❑ WPCA, Administrative Required for properties on sewer Signature/date Comments: ❑ WPCA, Operations When Required by WPCA Comments: Signature/date ❑ Department of Public Works Required when project includes driveway work or certain drainage requirements Signature/date Comments: ❑ Montville Police Department • Required for all permits EXCEPT one and two family residential Signature/date Comments: ❑ State Dept. of Transportation Re•uired for Structures over 100 000 s..ft or with more than 200 .arkin• s'aces-Official co. of STC Certificate of O.eration re.uired—.er CGS 14-311 Signature/date Building Department Review Complete Signature!date Revised May 23,2011 �" ' State of - , rr-- c Connecticut o -j. •A Workers' Compensation Commission ,- ,}i'` trim.%.,„,„........4,Air. Please TYPE or PRINT IN INK Proof of Workers' Compensation Coverage when Applying for a Building Permit for the Sole Proprietor or Property Owner who WILL NOT act as General Contractor or Principal Employer . APPLICANT FOR BUILDING PERMIT Name of Applicant for Building Permit /7<. 0,31„--4.,4 Y Property located at 2/ /221 /W/J U c-c i 'J#L in the City/Town of //Ari./ ATTEST If you are the owner of the above-named property or the sole proprietor of a business doing work on the site of the construction project at the above-named property and you WILL NOT act as the general contractor or principal employer,you are not required to have workers'compensation insurance coverage. CHECK ONE(1) BOX ONLY and complete the following: 4 I am the OWNER of the above-named property.I WILL.NOT act as the general contractor or principal employer. Signature of OWNER Appficant�JJt ,owC t \J__ n p t p LI I am the SOLE PROPRIETOR of a business doing work at the above-named property.I WILL NOT act as the general contractor or principal employer. Name of Business Federal Employer IDI(FEIN) Signature of SOLE PROPRIETOR Applicant