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HomeMy WebLinkAboutNew Half Bathroom 2002 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030,Ext.82 Building Permit Permit Number: B2002-562 Permit Date: 26-Sep-2002 Permit Code R4 Job Location: 200 RAYMOND HILL ROAD UNIT: MAP/LOT: 087/001-00B Job Description: install 1/2 bath Owner Contractor _ Stacey Terrial&Michael Frank Pittisinger Michael Pittisinger 200 Raymond Hill Road 200 Raymond Hill Road Unit: Uncasville,Ct.06382 Uncasville,CT 06382 Telephone: 848-8405 Use Group R4 Lic/Reg Type: Code 1995 CABG Lic/Reg Number: 0 Construction Type 5B Exp Date: Construction Values Permit Fees Building Value: $200.00 Building Fee: $10.00 Plumbing Value: $200.00 Plumbing Fee: $10.00 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: $400.00 C/O Fee: $10.00 Comments: Plan Review Fee: $1.00 1 State Ed Fee: $0.06 Total Fees: $31.06 It is the owners responsibility to schedule the following required inspections(minimum 48 hours notice requested); ❑ 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 ❑ Fin. Inspection ❑ Gas Piping and Pressure Test l'.' Certificat- s . '. - • for to use or occupancy Building Official's Signature: Town of Montville Building Department Permit# 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 AdditionACteration 0 Accessory Structure ElOther Job Location app PAyri?o J p 1:1,// R n CASU /1rCr (361-32 Job Description/Materials /C'/YJ?, G F A C/OSE T— TO A //2_ L/3Th' Owner ?t R TAct/kJ GE 2 Mailing Address P.9/m o N D /1,// Rt) City (JA)C A q Vt l/E. State CT Zip 06,3?,,9_ Tel p'(0o / $'Y8 / 4 o s Contractor �A'L l= 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. Owner/Agent Signature ceDate / / /?o c. Construction Value Fee Building $ 2 o�-- $ / �^ Plumbing $ a .Op $ /c Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ re-- Plan Review Fee $ / State Education $ © 0 6 Total $ y u,-- $ 3/.06 Town of Montville Building Department Receipt 1 Date 9 / / r / 0 Z No. 02179 From: Job Address: 2-0o j2yyrr-u„d !1/ Ll n_J OD Amount $ g / . p-6 ( Cash Check Check # IReceived by Permit # -- STATE OF CONNECTICUT WOR 'COMPENSATION COMMISSION Buildin Permit Affidavit for Pro e Owners or Sole Pro rietors (Conn.Gen.Stat.§31-286b) Property located at • C ox.)p / p In the town of C Name of building permit applicant: Please check onn 1.1 1/ram the owner of the above property. 2. I am the sole proprietor of a business_ -2A.Name of business • 2B.Federal Employer Identification Number Pursuantto§31286b,"................................•---...-......... ....._...._.._. Pursuant t or prim property owner or sole proprietor[who]intends to a.._gen r•_-.._. principal employer*may provide either a certificate of workers'compensation a Baal insurance or a"sworn notarized affidavit... peasatioa compensation insurance for all stating that he will-require proof of worker' 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 em I er. [Sign and stop here] P oy Signature of applicant 2- intend to as act a genera contractor provide a a ia g of workers' or principal employer.Applicant must either below: compensation insurance or sign the affidavit ................... Affidavit ............ I hereby swear and attest that I will require proof of workers'com contractor,subcontractor,or other worker before he/she engages in n workon insurance for every accordance with the Worker'Compensation Act(Chapter 568). on the above property in I understand that pursuant to§31-275 C.G.S.,officers of a corporation and partnership may elect to-be excluded from coverage by filing a in partners District Office;and that a sole proprietor of a business is not waiver with the v r ge uuIcxs he files his intent to accept coverage, required to havecoverageunI if_ /S1it Si 4 turc of applicant R Subscribed and sworn to before me this day of 200_ (Notary Public/Commissioner of the Superior Cenral ace gR pie);0 /Ii 0 R ( A) FLoo( 1 2 \\c r i ?tit f V BEA). Oft Rem • bEo t ri 6i Roon1 Town of Montville ` Building Department 848-3030, Ext 82 ONE & TWO FAMILY CONSTRUCTION PERMIT SIGN-OFF SHEET ,dao RAAnio_klb /1,1/ R D oiuc%►.cV i I/E CT 06 3 > Property Address Job Description: C/ iti GC A e/o SST 77: 4 /,4- l3i /,' a N D FLco1L 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. HEALTDISTRICT 848-3030,Ext. 882 £i...1 Li.- 9-3o-02_ ❑ Permit#: El Not Applicable Septic S stem Date ❑ Permit#: ❑ Not Applicable Private Well Date WPCA DEPARTMENT 848-3030,Ext.881 ❑ Permit#: ' Not Applicable Municipal Sewer Date ❑ Permit# dii Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 ❑ Permit#: ��i� 'j Not Applicable Director Date PLANNING&ZONING DEPARTMENT 848-3030,Ext.81 alizem 6,1 4 C'!(l t'/0 z ❑ Permit#: E] Not Ap licable oning Date ( i n lei'" Cylki) aaa-7 6 Ci r1g;.-2-i Cl(Y(G 2 ❑ Permit#: 4 Not Applicable InlatWWetlands Date