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2011 - Line for Gas Logs Field Inspection Notice Town of Montville Building Department 860-848-3030 Ext. 382 Address: 27 Rankin Court Job Description: Gas Piping for Gas Logs Permit Number(s) M2011-0219 Permit Date: December 29,2011 Not Approved Approval INSPECTION Date: Deficiencies Special Date Conditions Shutoff valve 1/3/12 DJ Pressure Test 1/3/12 DJ • Final inspection and • 1/3112 DJ certificate of approval Rev. Date: 1/18/06 Page 1 of 1 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: M2011-0219 Date: 29-Dec-11 Map/Lot: 101/059-00A Owner ID: 5789000 Project Location: 27 RANKIN COURT Unit: Job Description: Gas Piping for Gas Logs Owner Nam Pamela S.and Craig_ . Massey Tenant Name N/A Careof: 27 Rankin Court Uncasville CT 06382- Telephone: (860)884-0085 Contractor Nam Steve Marien Telephone: (860)576-2683 DBA: Lic/Reg Type P1 Lic/Reg No 280327 246 Beaumont Highway Exp Date: 31-Oct-12 Lebanon CT 06249- Construction Value v_v Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: IRC Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code Mechanical Valu $500.00 Mechanical Fee $10.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type IRC Total Value: $500.00 Penalty Fee: $0.00 Permit Code: R5 C of 0 Fee: $0.00 Comment Plan Review Fe $0.00 State Ed Fee: $0.13 Total Fee Paid: $10.13 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 ❑ Footing-Prior to pouring concrete ❑ R Plumbing and leak test ❑ Deck Piers ❑ R Electrical ❑ Backfill-Fooling drains and waterproofing ❑ Elec Trench-with conduit installed ❑ Concrete Slab-Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts-with sill plate and prior to floor framin ❑ Electrical Service CRS No: 0 ❑ Framing ❑ R HVAC _ k ❑ Masonry Fireplace Throat or Chimney Thimble 0 Gas Piping and leak test ❑ Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETION ❑ Insulation f Certificate of Approw.I ■ Ce.' to .f• upancy Building Official's Approval: 4 f• 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.: 11',�CiI—O�‘ Type of Work Occupancy Type Permit Type ❑New Construction Single Family 0 Building ❑Addition 0 Two-Family 0 Plumbing ❑Alteration ❑Townhouse 0-Mechanical 0 Accessory Structure ❑Electrical CRS#: Property Address: C +- (Number) (Street) (Unit) Job Description: c -S ,j2/'p `'"') .(r,s (;—"'s Owner: 6)e.(n-r J C': S i'Vl'-53&Y Address: City: ON Lti s .J, / (r State: C Zip Code: 06 3 fl2 Telephone( 0 )f1`l - Vv�5 Applicant: _/ c -c 111444-- DBA: Address: ? y6. en,N + / City: Lz State: C-1 Zip Code: 0 6 2-'-1 ? Telephone(SGZ. )'� 7 6 - -s 1r-3 Contractors - Complete the Following: License Type: ih -I License No.:02 S.v3J 7-9/Expiration Date: i 0/3/iz 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. ❑ By checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Code, instead of the electrical requirements in chapters 33 through 42 of the Residential Code. Owner/Agent Signature: cam-- Date: /2/Z Y'/#i Construction Value Permit Fees Building Value: Building Fee: Plumbing Value: Plumbing Fee: Mechanical Value: ,:500•L Mechanical Fee: IU ,O Electrical Value: Electrical Fee: Total Value: Penalty Fee: C of 0 Fee: Plan Review Fee: State Ed Fee: I'7 Total Fee: 1 (1) - lo� Revised August 23,2037 Town of Montville Building Department File Receipt Date: 28-Dec-11 7067 Receipt No: Received From: Steve Marien Job Address: 27 Rankin Court Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check/Card $10.13 Check/Card $0.13 Check No: 5584 Short/Over: $0.00 Construction Value: $500.00 Demolition Value: $0.00 Received By Carmen Kneeland �--( a/l� CYI� Y1i'1. State of Connecticut N r7AWorkers' Compensation Commission �. " "� 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 \ 4 y'Cy 11 1 6--(i Lt1 Property located at J] f'Cts\ C ( C 0 ( in the City/Town of `AyT *3S3- 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: ❑ I am the OWNER of the above-named property.I WILL NOT act as the general contractor or principal employer. Signature of OWNERApplicant14_ 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 J ,--r ra, Signature of SOLE PROPRIETOR Applicant STATE OF CONNECTIC T DEPARTMENT OF CONSUMER PROTECTION PLUMBING&PIPING`UlTED CONTRACTOR STEPHEN G MAIN 246 BOI Y LESWCS 40'062 ' �3 l LIC./REG NQ F?FECTIV E4"{ EXPIRES 'LM.0280331-'P--1-g 114011204 10/31/2012 ter.........:::.. t4P • • SIGNED • Town of Montville Building Department CONSTRUCTION PERMIT APPROVAL Applicant is responsible for obtaining all of the required approvals. No permit will be issued until all the required signatures are obtained. cY 1 Pcki) t Co L * Property Address GO-5 P'i01(\ c 1-05S Job Detcription Required Department Approval Permit Issuance Approval I Tax Collector Signature/date Comments: III Planning & Zoning C .LQ.L- : -.�-- L2 (1A\k\ Comments: 'C Signature/date Fire Marshal ( 29 - , Signature/date Comments: n Health Department Required for properties with private septic or well Comments: ,y WPCA, Administrative 1)--\D%\ 1 Required for properties on sewer Signture/date Comments: ❑ WPCA, Operations When Required by WPCA Signature/date Comments: I� 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 Required for Structures over 100,000 sq.ft.or with more than 200 parking spaces-Official copy of STC Certificate of Operation required-per CGS 14-311 Signature/date Building Department Review Complete Signature/date 9iev ceeMay23,2011