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Home My WebLink AboutRe-Roof Porch 2002 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ext.82 Building Permit Permit Number: B2002-327 Permit Date: 20-Jun-02 Permit Code R4 Job Location: 170 RAYMOND HILL ROAD UNIT: MAP/LOT: 085/005-000 Job Description: re-roof front porch Owner Contractor IRENE H DESAULNIER Irene Desaulnier 170 Raymond Hill Road 170 RAYMOND HILL ROAD Unit: Uncasville,Ct.06370 UNCASVILLE CT 06382 Telephone: 848-3823 Lic/Reg Type: Use Group R4 Lic/Reg Number: 0 Code 1995 CABO Exp Date: Construction Type 5B Construction Values Permit Fees Building Value: $500.00 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 Value: $500.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.08 Total Fees: $10.08 It is the owners responsibility to schedule the following required inspections(minimum 48 hours notice reauested): ❑ 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 ❑ Electrical Service ❑ Insulation ❑ Rough Plumbing and Leak Test D Final Inspection ❑ Gas Piping and Pressure Test ❑ Certifi --- . sccu!a • -Prior to use or occupancy Building Official's Signature: / , �/ • Town of Montville 4 Building Department Permit# zovz 5 z7 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 AdditionAlteration 0 Accessory Structure OOther /e2- roof 4 ,,,,,4 Job Location 767 Hyl 1 ,`_ K. Job Description/Materials, / vio. / Owner f P_ /j 1 ZSa v�,o' Mailing Address /70 y�cc�, V reel City MI CR S V i/(C_ State C/ Zip .03 2 Tel S'60 / 84g/ 3 g'2.3 Contractor ei, Mailing Address City State Zip Tel / / 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. / i, Owner/Agent Signature C-( . . • . Date 6 / /t/ Construction Value Fee Building $ �or.— $ /vim Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ a r aT Total $ -cri" $ /o..rig I p Town of Montville Building Department Receipt I 0 Date G /2_9_1 o z No. 01847 From: Job Address: 1111 Amount $---/0 . a?- 4111) Check Check # FReceived by J. "-------0-..-4..—...... ---- -- Permit #_. 7_06-z--32,---) f f 4 STATE OF CONNECTICUT WORKERS'COMPENSATION COMMISSION Bui!din: Permit Affidavit for Pro Owners or Sole Pro rietors (Conn.Gen.Stat§31-286b) Property located at ir In the town of a Ca S Name of building permit applicant Please check o I.JZI am the owner of the abovero P perly. 2. I am the sole proprietor of a business. -2A.Name of business 2B.Federal Employer.Identification Number Pursuant.. §31-286..•.........................................•-••---._._....---- aractt to r or a property owner or sole proprietor --•- (icate intends to act as ea sgeneral insurance or a"swoPrnnotarized may provide either a certificate of workers'compensation affidavit... stating that he will requirecompensation insurance for all those employed on the job site inac rdcproofof with this » workers' Please check on • � 1. do not intend to act as a general co [Sign and stop herb} n •ctor or principal employer. Signature of applicant 2. I intend to act as a general contractor or rinci provide a certificate of workers'compensationp �employer.Applicant mast either below. insurance or sign the affidavit Affidavit ................ I hereby swear and attest that I will require contractor,subcontractor,or other worker before h f of sh��compensation insurance for every accordance with the Workers'Compensation Act(ChapterSaga in work on the above property in I understand that 568). pursuantto§31-275 C.G.S.,officers of a partnership may elect to be excluded from coveragecorporation and partners in a District Office;and that a sole g by filing a waiver with the appropriate files his intent to accept Proprietor of a business is not required to have coverage he seep coverage. Signature of applicant Subscribed and sworn to before me this day of 200 - (Notary Public/Commissioner of the Superior Court)