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Strip and Re-Roof 2001 Town of Montville Building Department Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231 Building / Trades Permit Permit Number BP2001-596 Permit Date 10/12/01 Permit Type Building Permit Code R4 Job Street# 39 Job Location RANKIN COURT Map/Lot 101/056-000 Job Description Roofing -Strip Owner Contractor Michael R. Pettengill Michael R. Pettengill Address 39 Rankin Court Address 39 Rankin Court City Uncasville State Ct. City Uncasville State Ct. Zip 06382 _ Telephone 848-8886 Zip 06382 Telephone 848-8886 Lic/Reg Number Lic/Reg Type Exp Date: Use Group R4 Code 1995 CABO Type Construction 5B Building Value $1,890.00 Building Fee $10.00 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 Values $1,890.00 CIO Fee $10.00 Comments: Plan Review Fee $0.00 State Ed Fee $0.30 T• -1 Fees $20.30 Building Official's Signature ��2,�� -41111111. -'�-G,- Date JO/ �Jl cV/r It is the owners responsibility o schedule the following required spections (minimum 24 hours notice required): Footings-prior to pouring concrete 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 ❑ Pool bonding ❑ Gas piping -pressure test and installation v' Final Inspection 117 Rough HVAC Certificate of Occupancy -PRIOR to use or occupanc Town of Montville Permit #44,&2‘24.: 5- Building _Building Department 310 Norwich-New London Tpke. Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231 Application for Building or Trades Permit Building Permit Trades Permit U New Construction U Accessory Structure ❑Action U�DemoCztzon ❑��m�� ❑9Kec(ranical U Alteration U Other f\i - ;H t►L' ��L ❑ECectrzcal 9feating Air Conditioning Gas Piping Job Location = % 2`t h C�� a- r Job Description/Materials F, e� t<S S ,� I05 it-4 Owner h1 t c k t ra< 1.2 Pi Ti� U C-I11-L Mailing Address 3`-) ZCuk ( 2.7- City .iCity 0 I`) C-P151;1 Ili °v 3 State C l Zip Tel 06:-)/ 6/ SS 2 Contractor ("f-�ti 4 ' Mailing Address City State Zip Tel / / Contractor's License/Registration Type&Number Exp. Date New Home Construction Contractors: Have you entered into a contract with a consumer for the proposed new home?U Yes [j No 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. ( i) Owner/Agent Signature fir- z,.� ( \v� Date l (' / / Construction Value Fee Building Plumbing $ % ��CJ $ /[j Mechanical $ $ Electrical $ $ Other $ Certificate of Occupancy $ Plan Review Fee $ / State Education Total d _______,...........mmemommemiummomurimmmilimmmomun f Town of Montville Building Department Receipt No. 01150 ft* ii From: --) dor Jr . ly...''' rJob Address: 4 te:..... • ....... / \ ......4. . ....4. (;) Amount $ 2; Se2_ Cash (—Check Check # (l.ir • ' Received by /4- -• aAiir' ,,, 0 jib -, .....-.., Permit ------------------------- Permit Fee Calculation Spreadsheet MISCELLANEOUS PERMIT CALCULATION Pools&Spas Above Ground Round EA $ 3.000.00 $ Above Ground Oval EA $ 5,000.00 $ In-Ground EA $ 18,00000 $ Heater EA $ 3,300.00 $ Hot Tub EA $ 5,000.00 $ Roofing Strip&Reroof 9 SQ 210.00 $ 1,890 C; Overlay SQ 175.00 $ Sheds With Electric SF $ 2500 No Electric SF 2500 Deck SF $ 15.00 Porch SF 23.00 $ TOTAL BUILDING CONSTRUCTION COST $ 1,890.00 PERMIT FEE Building $ 10.00 Mechanical $ - Electrical $ - $ - CO Fee $ $ 10.W Plan Review - State Ed Fee ;, $ 030 Total Fees $ 20.30 Based on 2000 Average Construction Cost 10/3/01 STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at 3 ' 11—a,v( lC th L U In the town of X Y v u, it e er v6 /� Name of building permit applicant: Y r kcc- HA F LR.-/Tei/C) ALL Please check one: 1. 7 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 notarized 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 check one: 1. I do not intend to act as a general contractor or principal employer. [Sign and stop here] lsc/(/`-ifiAP Signature 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 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)