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Home My WebLink AboutElectrical 2002 Town of Montville Building Department Date 7 1,10 I oZ Field Inspection Notice Permit # Job Location Z ad e A 5"',lig fr.+!, y/i t 120 Approved Type of Inspection G—mac lj- -V'c1'' Not Approved - Please call for re-inspection when the following corrections have been completed: i /7/ Building Official Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,Cr 06382 860-848-3030,Ext.82 Electrical Permit Permit Number: E2002-177 Permit Date: 15-Jul-02 Permit Code R5 3ob Location 200 RAYMOND HILL ROAD UNIT: MAP/LOT: 087/001-00B Job Description: Electric Service Owner Contractor STACEY TERRIAL PARKER William Robarge 94 Cow Hill Road 310 ANTHONY RD APT L Unit: Mystic,Ct.06355 NEW LONDON CT 06320 Telephone: 872-6072 Use Group R4 Lic/Reg Type: El Lic/Reg Number: 123489 Code 1995 CABO Exp Date: 9/30/02 Constriction Type 5B Construction Values Permit Fees Building Value: $0.00 Building Fee: $0.00 Plumbing Value: $0.00 Plumbing Fee: $0.00 Mechanical Value: $0.00 Mechanical Fee: $0.00 Electrical Value: $600.00 Electrical Fee: $10.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $600.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.10 Total Fees: $10.10 it is the owners responsibility to schedule the following reauired inspections(minimum 48 hours notice reauested): • Footing-Prior to pouring concrete ❑ Rough HVAC ▪ B• ackfill-Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab-Prior to pouring ❑ Fireplace Final • R• ough Framing ❑ Chimney-One flue above thimble ▪ Rough Electrical ❑ Firestopping/draftsstopping k Electrical Service ❑ Insulation ❑ Rough Plumbing and Leak Test ❑ F' .1 Inspection Gas Piping and Pressure Test Certifi -of... .; .rior to use or occupancy Building Official's Signature: i Town of Montville Building Department Permit # ` 177 310 Norwich-New London Tpke. Tel. 848-7166,Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form ❑(Pfum6ing Efectricaf fl!fecfaanicaf Jfeating Air Conditioning 0 Other Gas Piping Job Location ZO ,A_g \A vtco-d!s� Job Description/Materials a 6 C} c re V 1 C u psi 24\6 '� Owner Vv" S 1 "� L< Mailing Address S61-142-6-- C ity 61-mCity State Zip 6 6 3V Z Tel o O / dY13 / (No r Contractor (AJ�1��+►„�`nObVA-0 Mailing Address 4 (-1 &6L.,) P. pp.� City �4 1 C State 6+ Zip 6 s S Tel Oa / s-7zi 667e Contractor's License/Registration Type&Number I/ /Z 3(/0 f Exp. Date 9 / 3 0 / 6 2 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 7 / 3 a Z Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ a C Other Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ 6C 6 , av $ , /U Town of Montville Building Department Receipt Date 7 / _/ p cam. No. L 1900 :- 02 From: a),,,,i( i1 Job Address: (79 e:)C EWA CAmount $ /Q. /4, Cash c7Chcck Check # 6--, / (Cultic one Received by -P6O a^l?l kr=/, a/.1�%' .I r. _ i/� Permit ## STATE OF CONNECTICUT WORKERS'COMPENSATION COMMISSION Buildin: Permit Affidavit for Pro.e Owners or Sole Pro tietors (Conn.Gen. Stat. §31-286b) Property located at 2 C O 2 fvutA I �, In the town of Gtr}S'kit Name of building permit applicant Please check one: 1. I am the owner of the above property. 2. am the sole proprietor of a business. -2A.Name of business 2B.Federal Employer Identification Number ............................. ................ Pursuant to§31-286b "a ••........................... ....................... contractor or property owner or sole proprietor[who]intends ...... ......... Principal employer"may provide either a to act as aa general insurance or a"sworn notarized affidavit... stating that he will of workers'compensation compensation insurance for all those employed on the job site in proof of workers accordance with this chapter." Please check pne: 1. `-/ do not intend to act as a general contractor or principal employer. [Sign and stop here Y c Signature of applicant 2. I intend to act as a g enf workers comor pensation or principal employer.Applicant must either provide a certificate below. insurance or sign the affidavit ........................ ...• -... . . . Affidavit I hereby swear and attest that I .... contractor,subcontractor, will require proof of workers'compensation bcontractor,or other worker before he/she engages ��for every in work n 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 co partnership may elect to be� excluded corporation and partners in a Distict Office- from coverage by filing a waiver with the and that a sole proprietor of a business is not appropriate files his intent to accept coverage. to have coverage unless he Signature of applicant Subscribed and sworn to before me this 3 day of 200_2: (Notary 00Z- (Notary Public/Commissioner of the Superior Court) 0 1 \ *ori 11 WC. I ti'No. EXPIRES Ia i'� I ,gip j