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HomeMy WebLinkAboutStrip 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 BP2001-669 Permit Date 10/30/01 Permit Type Building Permit Code R4 Job Street# 190 Job Location RAYMOND HILL ROAD Map/Lot 085/007-000 Job Description Roofing -Strip Owner Contractor Charles W. Sizer Charles W. Sizer Address 190 Raymond Hill Road Address 190 Raymond Hill Road City Uncasville State Ct. City Uncasville State Ct. Zip 06382 Telephone 848-3600 Zip 06382 Telephone 848-3600 Lic/Reg Number Lic/Reg Type Exp Date: Use Group R4 Code 1995 CABO Type Construction 5B Building Value $7,700.00 Building Fee $46.00 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 $7,700.00 C/O Fee $0.00 Comments: Plan Review Fee $0.00 State Ed Fee $1.23 Total Fees [ $47.23 1 Building Official's Signatur n Date/t /36 / G It is the owners respo-s'• to schedule the following required inspections(minimum 24 hours notice required): ❑Footings-prior to • • ,/ng concrete ❑ Backfill-footing drains and waterproofing ❑ Fireplace Throat ❑Concrete Slab, prior to pouring ❑ Fireplace Final ❑ Rough Framing ❑ Chimney-one flue above thimble ❑ Rough Electrical ❑ Firesto pping/draftstopping ['Electrical Service ❑ Insulation [Rough Plumbing and leak test ❑ Pool bonding ❑ Gas piping-pressure test and installation © Final Inspection ❑ Rough HVAC ❑ Certificate of Occupancy-PRIOR to use or occupanc r , Town of Montville Permit# Building Department TeL 848-7166 310 Norwich-New London Tpke. Uncasville, CT 06382 Fax. 848-7231 Application for Building or Trades Permit _Building Permit Trades Permit ❑New Construction ❑Accessory Structure Addition n ❑�Democition L Tfuntrying ❑�fecheating Alte _Air Conditioning oPingJob Location ' c-)L v .N D ' L Job Description/Materials o rvr ., 4 t S 4., e yo F : , (es4, w Owner : hie •_ z C Mailing Address 0 City 'yi (1 �c. � ► State C'7 Zip 06 3 2 o Tel Fr Go / &4 Sr / 360 Contractor_______TeLetMailing Address Crty S`4 '� State C.L Zip p6 3 Z Tel Contractor's License/Registration Type&Number Exp. New Rome Construction Contractors: Have you entered into a contract with a consumer for the proposed new home?D Yes Q No I hereby certify that the proposed work will conform to the Basic Building Code and all other State of Connecticut and the Town of Montville and further attest that the proposedcodes authorizeds adopted ownerby then fee and that I am authorized to make application for a work is by the in permit for such work as described above. Owner/Agent Signature r . l Date /v / Z q / 6 / Construction Value Fee Building Plumbing $ 7 7 c $ g6—' Mechanical S $ Electrical $ Other $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ 770o $ /' 3 $ 97.z3 I Town odlontville Building De art t Receipt p ce>lpt 1 ft? Date /o / z / O/ No. 0 1 2 i From: Job Address: 190 iz/- Y-`,10r++7 14/6 L. S Amount $ H) . Z.3 �• Check Check # _ 'y (Circle one) Received by -C-7/1.,,r,--,-. / ------- Permit I# 1521_00, 1—______ _,-(�� ( r • { . STATE OF CONNECTICUT WORKERS'COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole . ..Pro y 11CLOrs (Conn.Gen. Stat.§31-2861)) Property located at In the town of Name of building permit applicant: Please check one: h. 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] Signature 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 en accordance with the Workers'Compensation Act(Chapter 568). ines work on the above property in 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 a-- Subscribed Subscribed and sworn to before me this day of ,200 . (Notary Public/Commissioner of the Superior Court)