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MFH and Deck 2003 A 1 IP Town of Montville Building Department Date crs/ /l3/ 0 Field Inspection Notice Permit #1_,,;2003. - j Job Locate Q Q_ //(,l Ap6L.)/ ZDr— , Approved Type of Inspection A' -..e.: v'tl f C e Not Approved - Please call for re-inspection when the following corrections have been completed: I 77,— Building 2 Cr) 0 N 0 $ \ . cn _ 3 y R § - " in 0 \ / \ - k 7 usCD - O > ° ,� H 2 - g C S3 2 , a . . � % g o E o q as U 2 71 J CU « k ,49 W / ? ƒ K ° ; 4 2 et A § \ 0 titi mI. 2 G 'li 0 C) E c o Cl "0 U ° c c VO Emml Z § & 2 / o g •ccnw u 1. u & § 2 U .. IL) 2q � { _ .2 2 00 ,, q , / to ? E-. aci c4 \ : q m p c \ / q N k © •- ] q -5 pp k CI CD o 7 - ƒ < o d d 2 k \ kiii � \ ® ) § ? \ 2 2 k = 2 R ` .3 \ N k d § § -C 2 2 \ kcm. 9 2 { 3 E-4 m = o 2 Q U U O : &pi v :' l!" 'N„: �/ , - � � » /, CI Town of Montville i j uilding Department Date /a 0 / © 3 Field Inspection Notice Permit #142.6,2 r /pQ' Job Location V 9ke2,- IA 10 GO I. pproved Type of Inspection •/Z, .AP --,itiff . I } Not Approved - Please call for re-inspection when the following corrections have been completed: i I i 1 i Building Official Town of Montville �� Building Department Date .4 ift / Field Inspection Notice J IF Permit # .� Job Location4. , I I Approved PP Type of InspectionAi '' Not A _ pproved Please call for re-inspection when the following corrections have been completed: c-af" !C 0/C- .4 ati• 0 BIEW,A IMIrelaria / # 0 , 64.4 41r r ,wir , Build' :iiia tial Town of Montville Building Department Date_4(0_9(3 /j3 Field Inspection Notice Permit # Job Location � f 4 Ir 4 I I Approved Type of Inspection F-9-- of Approved - Please call for re-inspection when the following corrections have been completed: 47 /2/-/i/317`/E-9 ���- B mg • is.- al Town of Montville (;) A/ 3 Building Department Date / f/ 0.5 Field Inspection Notice Permit # Job Loc ion / N sic, Pte) Approved Type of Inspection GA 5 II Not Approved - Please call for re-inspection when the e tollowmg corrections have been completed: r ALJ/ 444/7(- --- 3 ' /' ;, kjmiod-, BuilgOfficial 4�j 410 Town of Montville 0 l Building Department Date �j / '7 / 03 Field Inspection Notice Permit # Job Location 9 Afrue064.3 I I Approved Type of Inspection fiO/C E,C kEPIA1(617,--/t)7" INot Approved - Please call for re-inspection when the following corrections have been completed: /y / 1 /9 /00 0(--) 4 i 1 " Bui1dingc!7 i • Town of Montville Building Department Date c/a / e 3 Field Inspection Notice Permit tp003— 7 1 Job Location Pr daitt.pproved Type of Inspection c.. e.c74-- )01 e r IS' II Not Approved - Please call for re-inspection when the following corrections have been completed: 1 1 1 i / Building Official Town of Montville Building Department 848-3030,Ext 82 ONE&TWO FAMILY CERTIFICATE OF OCCUPANCY SIGN-OFF SHEET 1e7,t /1) (c) „— Property Addrssss Job Description: %✓ "/ I42 e The owner/agent shall be responsible for the completion of the form, no certificate of occupancy will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030-339 Approved ❑ Permit#: ❑ Not Applicable Septic System Date Approved ❑ Permit#: ❑ Not Applicable Private Well Date WPCA DEPARTMENT 848-3030,Ext.376 Approved Ab+ ❑ Permit#: D Not Applicable Municipal Sewer Date House Trap ❑ Outside ❑ Inside Approved ❑ Permit# ❑ Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 Approved ❑ Permit#: ❑ Not Applicable Director Date PLANNING& ZONING DEPARTMENT 848-3030.Ext.379 744a4 / In-Compliance 4. 2 7 63 Et Permit#: 263-CVz ❑ Not Applicable Zoning ate In-Compliance 0 Permit#: ❑ Not Applicable Inland-Wetlands Date *visa 6/28/2002 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Electrical Permit Permit Number: E2003-0124 Date: 27-May-03 Map/Lot: 016/029-TOO Owner ID 122505 Job Location: • : s ► • , • :_ Unit Job Description: Electric Service for Manufactured Home Owner: Contractor: Thomas A Mcdonald John Morton 85 Green Hill Road 9 Rainbow Dr Madison Ct. 06443- Uncasville CT 06382 Telephone: (203) 245-3644 Lic/Reg Type/No. El 101835 Exp Date: 30-Sep-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 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: $900.00 Electrical Fee: $10.00 Permit Code: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $900.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.14 Total Fees: $10.14 It is the owners responsibility to schedule the following inspections(minimum 48 hours notice required); ❑ 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 ❑ Insulation ❑d Electrical Service ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: ,A e/es 02)-9 yl/ Town of Montville wow Building Department Permit#/_ 0�W3 —/� 310 Norwich-New London Tpke. (( Tel. 848-3030,Ext 82 Uncasville,CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form ['Plumbing 5Electricaf ['Mechanical' 5leating Air Conditioning Gas Piping ['Other Job Location kti 61 w tUr. Job Description/Materials Z(15 ( aOD 4 op Se oe r/e c- tv Owner 3-e.4)Sr,✓s :74/C, Mailing Address 'v ' City 501,4 114 Y?ti State £ Zip D''ytc? Tel Contractor So 1/4/ Vi-/0, 7d.-1 Mailing Address 35— 6'/`e¢N /(c(( City A'14d , sc) u State C"7— Zip 0&yJ Te1203 /"z Kr/ 7G Y y Contractor's License/Registration Type&Number 47 ' rU/ Exp.Date O? / fc / 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 ✓c l i Z / v_5 Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ 70000 u, $ /L' c% Other Certificate of Occupancy $ Plan Review Fee $ State Education -/Y1 Total $ 2C =$ / ) illIMMINIMINIONOMMINIMININIIIIIIIIIIIIIIIIIIIII Town of Montville Building Department Receipt Date No. 5 =�_/��-- From: -3?)/-1/3 ( TcTvi Job Address: C Cash Check Check # 8(� , Amount $—L= (circic one) Permit#j_:,2 ____3 -_� Received by 0 ci Z r m n 0 o C CA I `n °n xy T � (A � "6 0 ' -, CD m til Otr � N � zz - 0 0 m n x py d 3 Z 7.4R z.-. 0-3 ("'. n o X z sn ::.1 � I � 3 ay ►a m o cn © w I 1 1 II ;% lkor STATE OF CONNECTICUT vol WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: In the town of Name of building permit applicant: Please check one: 1. 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 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. /v I do not intend to act as a general contractor or principal employer. [Sign'; • top he/ T Si: ture 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. 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) • Irr'' Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 (860)848-3030, Ext. 382 Plumbing Permit Permit Number: P2003-0051 Date: 20-May-03 Map/Lot: 016/029-TOO Owner ID 122505 Job Location: 9 RAINBOW DRIVE Unit Job Description: plumbing for new Mfg.home Owner: Contractor: Thomas A Mcdonald Efficient Plumbing P.0. Box 68 9 Rainbow Dr Montville, Ct. 06353- Uncasville CT 06382 Telephone: (860)464-6678 Lic/Reg Type/No. P1 204880 Exp Date: 31-Oct-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 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: $0.00 CO Fee: $0.00 Included on Building Permit Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fees: $0.00 It is the owners responsibility to schedule the following inspections(minimum 48 hours notice required); ❑ 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 ❑ Insulation ❑ Electrical Service ❑ Final Inspection V Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Buil in / 4 d g Official's Signature: ` /7 /LGt� Town of Montville Building Depa:tment Permit#Po?t,f) 3 -.7 7 310 Norwich-New London Tpke. Tel. 848-3030,Ext 382 Uncasville,CT 06382 Fax. 848-7231 One&Two Family h +ënit Application Form w Construction ID motion 0 Alteration J accessory Structure Other Job Location f \ A t • Job Description/Materials ? o Owner Feus f-s W S Mailing Address r9L/6 E��STv�,sL �� 0`( City_45a vc��� \v StateC-- -t Zip Ol LAVI Tel itc( ) / x`13/ O 2FS Contractor IGr v`-'1 PLvv.-- 01-,--.6 Mailing Address ?6 = C V< <( City 1` I u+rTV ILA-t, State G'- Zip 0(c'33 Tel / (c1/ (o(o W Contractor's License/Registration Type&Number ? "`/ Exp. Date (.° / 3 ( / 0-4) I hereby certifythat the proposed work will conform rm 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 SignatureDate S / ( / G 3 Construc n Value Fee • • Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ (See*verse side for adiational requirements) STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION PLUMBING&PIPING UNLIMITED CONTRACTOR l CRIB F KERFUS PO BOX 402 MONTVILLE,CT 06353 TYPE: P1 LIC./REG NO. EFFECTIVE EXPIRES 204530 ,, 11/01/2002 10/31/2003 SIGNED 9 )"'Ll • Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860)848-3030, Ext. 382 Mechanical Permit Permit Number: M2003-0084 Date: 18-Jun-03 Map/Lot: 016/029-TOO Owner ID 122505 Job Location: 9 RAINBOW DRIVE Unit Job Description: gas tank, &gas piping Owner: Contractor: Thomas A Mcdonald Spicer Gas • 36 Thames Street 9 Rainbow Dr Groton Ct. 06340- Uncasville CT 06382 Telephone: (860)445-2436 Lic/Reg Type/No. G1 308503 Exp Date: 31-Aug-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $600.00 Mechanical Fee: $10.00 Construction Type: 5B Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $600.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.10 Total Fees: $10.10 It is the owners responsibility to schedule the following inspections(minimum 48 hours notice required); ❑ 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 ❑ Insulation ❑ Electrical Service ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑d Gas piping and test Building Official's Signature: Town of Montville P Rdd 3' -6, -e./ Building Department 310 Norwich-New London Tpke. Uncasville, Ct. 06382 Tel. 848-7166 Fax 848-7231 Application for Building or Trades Permit t v..c, Mailing Address ,-q(e R60(5 lam-•-e S4 Owner Q�,��SGc.�,c 5 � City cO( ln. V , State c-( , Zip 063 Y)--Tel.Y6Q -?Q3 - b)- l Job Location q ;/i.•-Jac 7)(. Map/Block-Lot / - Contractor (`C°p� 6a,S Mailing Address 3(,, TI .4A-e5 51 City YOf- !Ovti t. State C4 Zip O6 310Tel.'40 - -Gic(3� � Type of Permit f New Single Family ❑New Two Family ❑ Addition ❑ Commercial ❑ Industrial 1 I Alteration ❑ Garage ❑ Carport ❑ Shed ❑ Roofing n Air Conditioning I 1 Plumbing ❑ Heating ❑Electrical 2Tas Retaining Wall (t Deck ❑ Pool ❑ Patio ❑ Porch Demolition ❑ Siding ❑ Windows ❑ Fireplace ❑ Chimney / o‘ f>o 1 a((o `7 1 F� e>4.€4,i o v- JobDescrition/Materials ��-S�4`�afc`oK Size Type of Heat Use 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. New Home Construction Contractors: Have you entered into a contract with the consumer for the proposed work? ❑ Yes ❑ No - Owner/Agent Signature721,14)(-4Date S / a-3 / .03 Contractors License/Registration Type&Number C I —0030YS03 Exp.Date / 3/ / 03 Construction Value Fee Building $ $ Plumbing $ $ - Heating $ , $ /Z)Electrical $ $ Air Conditioning $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education Fee $ , /c2 Total $ $ / Ot /Z . Town of Montville Building Department Receipt Date 5 / 7 / 0 No. 027 '99 1, From: 4 # - 4a-ge--''- if . Address: 4 ' Job �z�i�� 1 Amount $ / • /(, Cash Check Check # 1 Circic one) ,, � 0 , Permit # ��3'e�c '� Received by •A ;..e, .+_i „,,,, ;,,i /ii o. l PICER 4,45 36 Thames Street, Groton, CT 06340 (860) 445-2436 • 800-448-2028 Fax (860) 445-2313 Date: SA-3/0 3 City/Town/Borough: Thu) (A- ✓= ll e Address: q : Jo0 r , ,u-�-�Qs v � l (e , N. Oc2 ' - This letter authorizes Robert Mitchell to obtain a permit, on my behalf, for: Property Owner: .ret,t. SGtt,'5 iwt. • Address: ;-q( Z 4� (0we �& �o(Al-k: 4� , 4, &6/19 Harold E. Everett- LP Gas Technician Division of Spicer Plus, Inc. • CT Lic. # 00308503 • RI Lic. # 00006311 L Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860)848-3030, Ext. 382 Building Permit Permit Number: B2003-0071 Date: 15-Apr-03 Map/Lot: 016/T29-000 Owner ID 122505 Job Location: 9_ AINBOW DRTVF Unit Job Description: Manufactured Home&Deck Owner: Contractor: Thomas A Mcdonald P&H Construction P.0. Box 164 9 Rainbow Dr Uncasville Ct. 06382- Uncasville CT 06382 Telephone: (860)848-2372 Lic/Reg Type/No. NHC 149 Exp Date: 30-Sep-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $10,854.00 Building Fee: $64.00 Use Group: R4 Plumbing Value: $420.00 Plumbing Fee: $10.00 Code: 1995 CABO Mechanical Value: $5,526.00 Mechanical Fee: $34.00 Construction Type: 56 Electrical Value: $210.00 Electrical Fee: $10.00 Permit Code: R6 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $17,010.00 CO Fee: $10.00 Plan Review Fee: $6.40 State Ed Fee: $2.72 Total Fees: $137.12 It is the owners resoonsibility to schedule the following inspections(minimum 48 hours notice required); El Footing- Prior to pouring concrete ❑ Rough HVAC ❑ Backfill - Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab - Prior to pouring concrete ❑ Chimney-One flue above thimble WI Rough Framing ❑ Firestopping/draftstopping [7 R• ough Electrical ❑ Insulation p i Electrical Service ❑ Final Inspection ❑ R• ough plumbing and leak test 0 Certificate of Occupany ❑ G• as piping and test Building Official's Signature: 2ys Town of Montville Residential Plan Review Date: gina.c.-I Zq'1 �_c'c 5 Job Address: e7 2A, f- Yo W -D'p_/v-: Job Description: J`-1 FG. Het,C 7 p L,�C L.7)-14,--).11 We have received a building permit application for the above referenced property. In accordance with Connecticut General Statute 29-263,your application is being rejected for the following reason(s)that are checked-off or commented on: • Supporting Documentation • Plans are to be drawn to scale including dimensions of rooms and • Floor plan(s) t(LKspaces and all framing information(112.1) Dimensions Building permit application not completed,signed,dated Finish floor elevation Permit fee$ !. 2 / L_ Minimum room sizes(304.1) Worker's comp.Affidavit or worker'comp.Insurance Door and window sizes Copy Contractor's registration or license Kitchen layout Construction permit sign-off sheet Bathroom layouts,tub sizes in gallons,space clearances Provide all documentation to show compliance with the Model Stair location(min.width 36")(311.1) Energy Code (1995 MEC). Contact your insulation contractor, Attic access location and size Northeast Smart Living Center (1-800-228-7764) or your local Identify the use of each room building official for information. Total square footage for each level of the structure Street address of project on all drawings and documents Indicate required light (8% of floor area per room) and ventilation Heat loss/gain calculations (4%of floor area per room)for each habitable room or space(303.1.) Indicate safety glazing in areas required such as:doors,windows,tub • Site plan &shower enclosures,etc.(308.4.) Finish floor elevation Indicate bedroom egress windows(5.7 sf net clear opening,24"clear opening height,20"clear opening width)(310.2.1.) Signed by P&Z,Wetlands,Uncas health,WPCA Property lines not provided Egress window maximum sill height 44"(310.2) Distance from property to structure Are basement stairs enclosed/accessible? If so, protect with Structure dimensions minimum'"sheetrock(310.3.) Driveway Designate which door is the required exit(36"minimum,hinged) Topography(existing and proposed) Garage Minimum 5/8"Type X gypsum board separation(on garage side)to Footing drain inverts,outlet and separation Proposed utilitiesall living spaces—all combustible support framing to be covered with Wetlands and flood zone limits and elevations minimum 5/8"Type X gypsum board if it supports habitable rooms (309.2) • Foundation Plan Indicate minimum 1 3/a"solid wood door,1 3/."solid core steel door,1 34" honeycomb core steel door, or 20 minute rated door from the Dimensions garage to the house and its basement or attic(309.1) Wall thickness Indicate self-closing devices on all doors from garage to the house Footing sizes and its basement or attic(309.1) Frost protection required Indicate slope for garage floor(309.3.) Window and door sizes and locations Hatchway Foundation—indicate the assumed soil conditions that the system has • Elevations been designed for or provide engineering data. If presumptive soil Type of siding conditions cannot be met,provide soil bearing engineering data(401) Type of roofing Concrete strength—foundation,floors,exterior porches, walks,slabs Other finishes (402.2) Finish grades Basement—finished of unfinished? Building heights Vapor barrier between sub-grade and concrete basement floor Dimension height of chimney above roof (505.2.3) Roof pitches Minimum height of foundation walls above finished grade(404.1.3) Perimeter insulation,if conditioned space • Building Section(s)&Details Anchor bolts—size and location(403.1.a) Floor-to-floor heights Floor thickness and control joint location(403.1.a) Handrails and guardrails — detail, including height and maximum Lally column size,attachment and spacing(408) opening,handrail cross-section,continuity and required returns Colin footings—size(4)) Show riser height(8'4"max),tread depth(9"min.),and nosing(3/4" Waterproofing details 406 —1 1/4") Rebar if required—wall length,unbalanced fill,or soil conditions will Show minimum headroom in stairways—6'-8"measured from nosing determine this. Provide engineering data for complex design. plane to lowest point of ceiling Fireplace/chimney base Stud size andspacing,s ecies and Concrete piers and anchor details—decks thickness, grade(or minimum Pb and E) Foundation drainage—sump,drain to grade,or town storm system; Sheathing material,iatype,style type ` indicate pitch(405.1) y Siding, style—underlayment per mfg. Insulation—R-value,type—including basement walls if applicable Beam pockets—minimum clearances Corner bracing *awl Spaces Flashing detail—windows and doors—type,material Crawl space data-clearance to joists,slab thickness(if provided),barrier(409) 7:73Ventilation(409.1) Access 18"x24"(409.2) t/ Town of Montville Building Department Permit ' O 3 - 7/ 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Building Permit Application Form New Construction 0 Addition ❑Alteration 0 Accessory Structure QOther RCe)ixem c...n.'� Job Location 9 RL:,jJpw ,Di';v . /JnGtsv:plc1 G'r Job Description/Materials /&A 1e MA AGA/te,c() A„�,1 e. 60144; -Ste,7kowt4.,( ) / Owner -Favue".3 ik /�c. Mailing Address r`C• b 2)o1c 6Cg City .5OL-I ;/6k0t State GT Zip 06519 Tel g20 /113 /0.R81 Contractor 62i 14 co S J}u(AkOt A Mailing Address AO. Ig0 y /6 Y City L)AG3SVi t/e) G f State C f Zip OG 36W Tel IMO / &P8' / 23,7A Contractor's License/Registration T e&Number Oo)Y9 Exp. Date 9 3d / 0 3 Ge-ok.se4),\ ggf-ii 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/A ent Signature ,4 /. Date 3 / /9 I O3 Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ Town of montville BuildingD P L. epa rtmt Receipt Date /_,____/ 03 No. 0 2 6 0 5 �---- 1 From: - • i Job Address: tAO Amount $ /3 . /A Cash /Check ) Check # �3 e. ((.ircic one) i Received by 411101r, ,,, i Ale Permit # 4200 Permit Fee Calculation Spreadsheet RESIDENTIAL PERMIT CALCULATION (MANUFACTURED) QTY $/UNIT TOTAL Site Work Slab on Grade 1196 SF $ 6.99 $ 8,360.04 Foundation SF $ 29.70 $ Anchors SF Garages $ 6.69 $ Attached, 1 car EA $ 8,885.10 $ Attached,2 car EA $ 15,113.70 $ Attached,3 car EA $ 20,913.90 $ Detached. 1 car EA S 11,657.10 $ Detached,2 car EA S 17,456.25 $ Detached,3 car EA 23,256.45 $ Breezeway/Decks Open 160 SF 15.59 $ 2,494- Enclosed SF 94.76 $ Porches Open SF 62.69 Enclosed SF 123.90 $ Carport SF 9.85 $ Sheds SF $ 26.25 $ TOTAL BUILDING $ 10,854.44 Electrical New Service EA 5 1,519.19 $ - Tie-in 1 EA 210.00 $ 210.00 Misc.Electrical 0 SF 1.24 $ _ Plumbing New Sewer EA $ 1,250.00 $ _ Sewer Tie-in 1 EA $ 210,00 $ 210.00 New Domestic EA $ 1,200.00 _ Domestic Tie-in 1 EA $ 210.00 $ 21000 Mechanical Oil Heat EA $ 579.76 LP-Gas EA $ 450.00 $ Y IIs air conditioning included(YIN)? $ 5,526 ( PERMIT FEE Building $ 10,854 $ 64.00 Y Plumbing $ 420 $ 10.00 Y Mechanical $ 5,526 $ 34.00 Y Electrical $ 210 $ 10.00 Other $ - CO Fee $ 10.00 Plan Review $ 6.40 State Ed Fee $ 17,010 $ 2.72 Total Fees $ 137.12 Based on 2003 RS Means Residential Cost Data 3/27/03 i 0 . 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M:'�fy.i r..r i f r� .-"-_,— ••-,..)s u JK"✓ t � ',.>....�.• _ n�.k, '4 . b s l fVfS^ a�'_ j I�t / t • i.. s �V : !..qs h e 3 kT gy r : ';'-.-•,•-• '; t *.`•-. ;s:--> '.4.,10.1.."'•'''''7: �+ t tr • i ::-. r ..s • :••1e i=:.:: 'Y 1' 'I..,6:,S/ F:{i a ..r.. .t.;• ';1' •.+.••'a:!1 j�.at. t;e ' ..e.L' .sk �.> -.7.d., • 3 ACORDCERTIFICA 1 E OF LIABILITY INSUkNC OP ID Nx DATE(INMIODrYY) NSE-2 03/17/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mathog S Moniello Cos . , Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 433 South Main Street Ste 116 _ ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Hartford CT 06110-2815 Phone: 860-313-2000 Fax:860-561-2882 INSURERS AFFORDING COVERAGE INSURED INsuRGR A. Pennsylvania Manufacturer's --- INSURER 3: - - ensen's, Inc. --- __—_ ...__ - -- Alan —A an Krieger INSURER C. 246 RP�dstone St.-P$ Box 608 iNSURERD _—_ --_-. • - Southington CT 06489 ------- _ INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITH51ANDINC ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. 0;110 LTR TYPE OF INSURANCE POLICY NUMBER DAT M/DDm)CI PDA MMMFDCm)N GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any onn tiro) 3 _� CLAIMS MADE I. j OCCUR MED EXF(Any ono parson)• 3 PERSONAL 8 ADV INJURY S GENERAL AGGREGATE S-- GENII.AGGREGATE AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ POLICY( l Jdr I LOC • — AUTOMOBILE LIABILITY — COMBINED SINGLE LIMIT ANY AUTO (Eu ciGtidbnt) ALL AUTOS BODILY INJURY SCHEDULED AUTOS (Pur purten) HIRED AUTOS BODILY INJURY NON•OWNED AUTOS (Per accident) §- .•----- ..... _..... .. PROPERTY DAMAGE (Por a,cIdont) GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ - ANY AUTO OTHER THAN to ACC $ AUTO ONLY' AGO $ EXCESS LIABILITY EACH OCCURRENCE l OCCUR [-J CLAIMS MADE AGGREGATE — S DEDUCTIBLE --•_-_-• - $' .� RETENTION WCSTH- AIU- WORKERSCOMPENSATIONAND X TORYILIMITS SER EMPLOYERS'LIABILITY A 200300-41-79-040A 01/01/03 01/01/04 EL.EACHACCIDEr4T 3500000 E.L.018EASE-EA EMPLOYEE $5000 0 0 E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED el'ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER IN ADDITIONAL INSURED;INSURER LETTER:— CANCELLATION MONTV IL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Bfl CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE To THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of Montville IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Building Dept. 310 Norwich-New London Tpke_ REPRESENTATIVES. Uncasville CT 06382 AUTHORIZED REPRESENTATIVE Kathy A. 8ellemare ACORD 25-S(7/97) CACORD CORPORATION 1988 Town of Montville 411 i low Building Department 848-3030, Ext 82 ONE & TWO FAMILY CONSTRUCTION PERMIT SIGN-OFF SHEET 9 en- ,r) D,( - Property Address Job Description: l_S.p( ac__p mcibctO /rcn1 .c keLsQ The owner/agent shall be responsible for the completion of the form, no construction permit will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030-882 ❑ Permit#: • • 4 •pplicable Septic System P. ❑ Permit#: i II Not Applicable Private Well Date WPCA DEPARTMENT 848-3030,Ext.881 S 119 1T),, Permit#: Not Applicable umcipal Sewer Date ' pp ❑ Permit# J Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 ❑ Permit#: 0, Not Applicable Director Date PLANNING&ZONING DEPARTMENT 848-3030,Ext. 81 71414(eld1 at-waLv. 0. 3 / e Zoning at?7.0 5T-- Permit#:(9E2--Ola ❑ Not Applicable --)? _____ ❑ Permit#: is Not Applicable Inland- etlands Date JOB 9 R�,zA d w JENSENS, INC. — 246 Redstone Street SHEET NO. OF P.O. Box 608 SOUTHINGTON, CONNECTICUT 06489 CALCULATED BY DATE (860) 793-0281 1 FAX (860) 793-6909 CHECKED BY DATE SCALE c,),-- 61.x;),erL .uSfrocc 3 3/4 111 I t .1 _ •- •!-- _..� a>( F�cx j0l,sr (i(o"a�Cei-N• : ax - c. A + 00 s d Q. 14 r p JENSENS, INC. JOB / P<i Pk 30+.a i'"s V e 246 Redstone Street SHEET NO. OF P.O. 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