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Home My WebLink AboutAddition - Foundation Only 2003 k o o » N VD E co tu — q 5 k N . = - c s- / O -.5, E 2 & IL) ƒ % 0 § ( q . 0 2 az U k 2 0 / u c ' § CS U § o 0 0 - 0ƒ § U = ? '\S §§ / g / o± \LI R cz. ¢ qo / .7"E q C - CH "a ■ �m .. 2a - /g cd CI o o W 2 ƒ / 0 0 •\ J « 0 % >1 .§ 2 U / N Q 00 cn k / R 0 k k 0 < . 2 2 \ to 0 ]33 N., >, = O o A m ck 03 k c In d Uu 7 U 2 2 2 / 7 k ' \ / i.4 c 2 � / A H \ d 2 U 0 q ' Town of Montville Building Department 848-3030, Ext 82 ONE & TWO FAMILY CONSTRUCTION PERMIT SIGN-OFF S EET V026 41 1 / -1/) - Pr perty Address Job Description: (21,24- . 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,Ext.882 /!Val t � ,R.S. G dy�4-l�� ❑ Permit#: 15��e rpQ ❑ Not Applicable Sere is Sys. % Date ❑ Permit#: ❑ Not Applicable Private Well Date WPCA DEPART ENT 848-3030,Ext.881 ❑ Permit#: ❑ Not Applicable yn icipal Sewer Date il - 0 Permit# ❑ Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 /1 - p Permit#: ❑ Not Applicable Director Date PLANNING : ZONING DEPARTMENT 848-3030,Ext.81 It ! � r''' - �0� ,: - /i/o +1:a 6�Permit#: a1 .E❑ Not Applicable Zoning Date C2--- ❑ Permit#: ❑ Not Applicable In and-Wetlands Date Town of Montville Building Department Date j /44/p Field Inspection Notice Permit#na(ppd _.37‘ Job Location 40,y /4,10 CZ /1/ fed- , Approved Type of Inspection e/. 1 Not Approved - Please call for re-inspection when the following corrections have been completed: piT//3"1- 29"QvIrz-t4y1 /i.l �/Jse�r�rsnJ�' t { � k Building Official Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ext.82 Electrical Permit Permit Number: E2002-363 Permit Date: 05-Nov-02 Permit Code R5 Job Location: 426 RAYMOND HILL ROAD UNIT: MAP/LOT: 032/003-000 Job Description: Electrical&Electric Service Owner Contractor William R Allen Barber Electric P.0. Box 14 542 Route 163 Unit: Bozrah,Ct.06334 Uncasville,CT 06382 Telephone: 887-9889 Lic/Reg Type: El Use Group R4 Lic/Reg Number: 121802 Code 1995 CABO Exp Date: 9/30/03 Construction 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: $0.00 Electrical Fee: $0.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $0.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 Included on Building Permit State Ed Fee: $0.00 Total Fees: $0.00 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 ❑ F• ireplace Throat ❑ Concrete Slab-Prior to pouring ❑ F• ireplace Final ❑ Rough Framing ❑ Chimney-One flue above thimble Rough Electrical ❑ Firestopping/draftstopping © Electrical Service ❑ Insulation ❑ Rough Plumbing and Leak Test ❑ Final Inspection ❑ Gas Piping and Pressure Test ■ ertificate •-a "Prior 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 Application for Commercial Trades Permit Tfum6ing ,;� Electrical E]Mechanical 2{eating Air Conditioning Gas ❑Other Job Location .4a(0 -R Aim x,11 Job Description/Materials L 1 (L N G 4O(Z /�E(a) f--U) v S G N ►r��11 C—C Owner W Mailing Address City n,j p t L 1� c i_�, State �.T, Zip Tel / / Contractor TZ Le-c-rp t_ Z Mailing Address { -0 . o . ( City (2-1 - 1-4 State Zip ©6 33t Tel /?g 7 / —`� �"i Contractor's License/Registration Type&Number 4— / /2.1 k"OZ Exp.Date 9 / 3 a / d3 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 p- - t f. such work as described above. // Owner/Agent Signature Date 1e" / 20 / o 2— Construction —Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ 9sa C. t1/19) Other $ r Certificate of Occupancy Plan Review Fee 4 State Education ; Total $ r STATE OF CONNECTICUT DEp t R 11E:A T OF CO:A S(11ER PROTEC710.A ELECTRICAL UNLIMITED CONTRACTOR SCOTT S BARBER • 178 FITCHVILLE RD 13OZRAH,CT 06334 TYPE: El LIC/REG NO. EFFECTIVE EXPIRES SIGNED12180.7Di/ 0/01/2002 09/30/2003 C�" 0 Town of Montville 0 Building Department Date // / // D Field Inspection Notice Permit eia,„0,...„, E 6 44 ' Job Location N � // il-qia y Approved Type of Inspection /-;' Not Approved - Please call for re-inspection when the following corrections have been completed: / j` yj ,- Building Official j Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ext.82 Mechanical Permit Permit Number: M2002-203 Permit Date: 24-Oct-02 Permit Code R5 3ob Location: 426 RAYMOND HILL ROAD UNIT: MAP/LOT: 032/003-000 Job Description: Heating Owner Contractor William R Allen PlumFire Mechanical,LLC P.O. Box 536 542 Route 163 Unit: Uncasville,Ct.06382 Uncasville,CT 06382 Telephone: 848-0022 Lic/Reg Type: S1 Use Group R4 Lic/Reg Number: 393132 Code 1995 CABO Construction Type 5B Exp Date: 8/31/03 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: $0.00 Electrical Fee: $0.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $0.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 —Included on Building Permit _ State Ed Fee: $0.00 Total Fees: $0.00 It is the owners responsibility to schedule the following required inspections(minimum 48 hours notice requested); ❑ Footing-Prior to pouring concrete El 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 ❑ Final Inspection ❑ Gas Piping and Pressure Test 11 ;ertificate . . .• 'r'; to use or occupancy Building Official's Signature: Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ext.82 Plumbing Permit Permit Number: P2002-140 Permit Date: 24-Oct-02 Permit Code R5 Job Location: 426 RAYMOND HILL ROAD UNIT: MAP/LOT: 032/003-000 Job Description: plumbing Owner Contractor William R Allen PlumFire Mechanical,LLC P.0. Box 536 542 Route 163 Unit: Uncasville,Ct.06382 Uncasville,CT 06382 Telephone: 848-0022 Lic/Reg Type: P1 Use Group R4 Uc/Reg Number: 204088 Code 1995 CABO Construction Type 5B Exp Date: 10/31/03 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: $0.00 Electrical Fee: $0.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $0.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 —Included on Building Permit State Ed Fee: $0.00 Total Fees: $0.00 it is the owners responsibility to schedule the following required inspections(minimum 48 hours notice requested)z ❑ 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 ❑ Final nspection ❑ Gas Piping and Pressure Test 17 -rtificat: if Occup. /'.r to use or occupancy Building Official's Signature: 1 Town of Montville /°a©©a //� Building Department Permit#/4/07 °00?- c2 310 Norwich-New London Tpke. Tel. 848-3030,Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form Plumbing electrical ttchanicat ( 9feating Air Conditioning Gas Piping Other Job Location 4 2 to RA`1M0 I ht i 1 i g04 I> Job Description/Materials Owner IA)+ k- ff !lets) Mailing Address 5 I 7 Q.4- 3Z City 0j ../L 1 N'i l State 64.. Zip 06'-7C Tel / / ' Contractor IUMr;( ft?(L WA/1C4,y/1 QJ Mailing Address ?,a &OX .53/0 City U N tAW,11 L State L'�- Zip obi Z Tel bnv / gvg- / DDZZ Contractor's License/Registration Type&Number P- I l ZociPU Exp. Date 1 CI / 1 / 03 - 1 li3`i' 17,7 10 /31 )D 1D� 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 A/)'N� L ., _....0111C41 /11 (1 Date ) / /g / D7 Construction Value Fee Building $ $ Plumbing $ l i DOD $ Mechanical $ ',O)J $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ 1 Ili 00° $ Air *l STATE OF CONNECTICUT WORKERS'COMPENSATION 00MMISSION BuiIdin Permit Affidavit for Pro Owners or Sole Pro riotous (Conn.Gen.Stat.§31-286b) Property located at (o A`rvloN. • ( K.oA In the town of Name of building 8 permit applicant: ..)at14&-; b4 4-2C DLL Please check one: I. 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 Numbs(DEIN) Pursuant to§31-286b,"a property owner or sole proprietor ...._ta..._..n_._...... contractor or principal employe"may provide either a [who]intendswoto act as a general insurance or a"sworn notarizedcertificate of workers'compensation affidavit... stating that he willpoworkers compensation insurance for all those employed on the job site inrdance,�� this " PIease 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 provide principal.a certificate of workers' COQ in cam employer.Applicant must either below. surance or sign the affidavit ........ .................................... I Affdayit _... herebyswear and attest that I will require proof of workers'cos contractor,subcontractor,or other worker before he/she engages compensation on insurance above for perry accordance with the Workers'Compensation Act(Chapter m work the above property in I understand that �' pursuantto§31-275 C.G.S. officers of a p ship may elect to be occluded from coveragecorporationaiverand partners in a District Offc6 and that a sole by filing a�� with the appropriate tiles his intent to accept coveraetor of a bgeusiness is not to have coverage unless he Signa/ ofapp `Subscribed and sworn to before me this day of .200 {Notary Public/Commissioner of then Superior Court) FROM CURT IN I NSL ANCE AC,ENCY FAX'NO. : 8608482207 Oct. 18 2002 09:48AM PI. PATE IMM/O0iTYYY) AC C , CERTIFICATE OF LIABILITY INSURANCE 10/18/2001 860)348-2201 FAX ($60 048-2207 THIS CERTIFICATE 78 ISSUED AS A MATTER OF INFORMATION irtin Insurance AgeAcy, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 20 Route 032, Box 317 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR n0 Route e, Box ,ALTER THE COVERAGE AFFOR0 O 8Y TME PO CJES 8 1. ' Margie Tracey INSURERS AFFORDING COVERAGE NAIC# J DjiNArse fsairencaI ILC INSIJIMRP Interstate Fire and Casualty Ins Co P 0 Sox 50E 'INSURERS: Westport Insurance Company Unmoving, CT 06382 ligsurtot G: _-__ mut*u 0: 1NSURP-R E: QVVRAGES THE POLICIES OF P4SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTMIT'I•I$TANDLN' ANY REOUIREMENT,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 CONDITIONSOF SUG45 POLICIES.AG REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE oat INSURANCE POLICY NUMBER PP 4 Y.. ;U -.. >dcr ,Ta.O�N "j.:?, - fi . ,;1Z114 Li411T5 ryiMERAL LIABILITY CLP6214 27 t ./05 - 06/08 003 MCH ocCuRnuNce s 1 000 000 COMMERCIAL GENERAL LIABILITY • GE •_ •ENTE $ 100 000 _.__I CLAIMS WOE 1 -I OCCUR MEO EXP Wry ono Peron) $ 5,000 PSRSONM,&ACIV INJURY $ 40001 000 I GENERAL AOQREGAT6 $ 1.009,000 GENtL&0GEEG-TE LIMIT., APPLIES PER: PRODUCTS-COMPIO'P AGO % 1,000.000 Poucy sta..."--i LOC _.._ .�•- AUTOYOSU2LIABILITY COMBIN iDSINGLE LIMIT all ANY TO (sa aoadM) $ AU ~ ALL OWNED AUTOS SCHEOULEO AUTOS isuctu r 1nourr+ HIRED AUTOS , - (Rbr person) NON-OWNEO AUTOS I Y I. _ _I PROPERTY DAMAGE S CARAAE LIABILITY (Per occident) ANY AUTO r AUTO ONLY-EAACCitENT $ ' prPl THA}{ E?t ACc a '- --.-, aLRO oNLv: Asp $ Eo�sluNtPxE<,t.A uAeurrY 11 OCCUR 11CLAIMSMAoe eACHoccuRgENce $ AGSFOTATE $ III oeoucnatt s . RETENTION S $ WORKERSc'IIMMasAnoNANa III000013749 00 09 12/2002 09/ ._. A $ EMPLOYERS'r 1urY /2003 , µ"+ � IF R/PA TILIDE UTIVat E.L.eAcH ACCIDENT $ 100,090 N�}�f ralbe ands E.L.DISEASE EA EMPLOY=, $ 600, OPEC{hl PR9VISio1a$beaav OTHER .-- E.l._DISEASE-POLICY mar S 500,1't 1' SVD alg OFL'$�,, .LLC�SGONS rt�aeRn gr_____ 7, pzcYEL 1nOHt♦?ib.m61 I_4. 11/4/0A.> H,'/l ,Qc,,¢,) invA.l" /1 . Then �iQBYD ON? RrOESeEEUGroUBwHAAaao¢oeTa H Tding Department Attenti0n los 310 Route #32 Sur PAA.Uaaa TO eMA SUM NOTICE RMAd-L IMPOSE No OYLIGATION oft LaAEPUtY UfcasviTl e, CT 08382 oP ANY ioNto UPON TJsla alu ,ITS AG!Wrs OR RJ;rlteSENTAnVE$, >AUTHOIEZED iaEPoitsSO l'ATVE ACORD 2.8(2001108) FAX; 848-7231 Carlos _....‘,..,,A � ,.,4 :a ACORO CORPORATION 1988 . STATE OF CONNECTICUT DFP1 RI:111:.AT OF(0\\1 111.R PRO1'FCIIO.A PLUMBING&PIPING UNLIMITED CONTRACTOR JAMES E DRISCOLL 34 GLEN CRAG PL UNCASVILLE,CT 06382 TYPE: P1 LIC.✓REG NO. EFFECTIVE EXPIRES 2040 11/01/2002 10/31/2003 SIGNED t. Alf-411‘1:7' STATE OF CONNECTICUT DFPIRT.111sNT OF CO\:SGJILI?PROTL(7YON HEATING,PIPING&COOLING UNLIMITED CONTRACTOR JAMES E DRISCOLL 34 GLEN CRAG PL 1 UNCAS IILLE,CT 06382 TYPE:', Si LIC./REG NO. EFFECTIVE EXPIRES 393132 07/09/2002 08/31/2003 t ip SIGNED °. . OTG ' Cg 992. ' CC C16 ' g e.l8 ~ g 810 ' TT 7+T ' 2. Te� 90 ^ 803 ' S 90 ' T2.9 ' C 00 ` �2.9 OO ' (7,/g 00 ' Q8g 00 ' 800 ' T 8 00 ' 982. ' 8 �Z ' C,OC ' 9 00 ^ 088 00 ' 088 Ot ^ 3tC ' 3 88 ' 99T ' T / 38 ^ 2.g8 ~ 8 Jz ' t8C ' C OO ^ litT ' T OO ' +/fT ' T O41 ^ B8g ' 3 O8 ' 889 r T8 ' 90g ' t CO - 916 ' T 09 ' 089 0.7 ~ 080 00 ^ g8g 80 ' 1C0 1 2.8 ' 2.09 ' 8 117 ^ ClO ' � 0Z ' 2.01 03 ^ 2.02. Oe - co —i.', 08 ' 999 ' T � T2.. ^ gl9 ' T T8 ^ 02.8 01 ^ ZOC O9 ' e.7OC OO ' O OO ` O , 0C ' gCC ' t 0C ' gC8 ' T 00 ' 8/9 00 ' 899 OB ' G8S 09 ' 8T6 ' O8 ^ CTT ' OT JT ' Ti.!:8 ' 9 00 - 9TT ' T DO ^ BTT ' T O8 ` Qsl ' T 80 ' OC ' T � ------------------------------------------------------------------------- - - - 0l8 Te�ol uoT4e-14-TTJuI JooTJ 6uTfreo sseTO asol TTeM #mc : e�eO asol �eAH n Ar.,'.0.Lff, (p.;:.- 4:!':;`..4-.--!:O8� ' T C8 ' TT CC Ql3 ' T Tsl' C11T +ifT ' T �T O8T : 8�� 388 ' T � 8t gUC / 08J 883 ' 3 CC�T �g r�*(7,2.T ClC ' T ^ CT CTT �lT �T� ' T �lT ` 9g 8gF, Cg 90g CO CO' O O C 3TT 088 CTT 3TT �T i0T . 62.� 3C.i: ' .(7, 6l3 62.3 0C EC3 T ____________________________________ ______----------'-------'---- ---- --- - eauu buTATi emnToA JmoTJ d«� buTTTeO d» ] aaeTS TTem 4eN li.H« '4.:4 'bS ^�:I 'n3 ^4.-J ^hS ^4,A 'bS ` �.:1 'bS ' �� 'bS e4eO TeuoTauam T ^ 86 09T0 ' 0T8 ' Cg :: sTe-1 g ^ G O098 ^ 80Z ' g TT X Cl X 8 00 ' 6 W8 MO6 8 8 ' 1T 0000 ~ 981 ' 8 0 ^ 9T X ST X 8 O0 ' 8 lDI/NI(T / T ^ 0T 006 ^ /g8 ' 8 C3 X CT X 8 OO ' l W8 SNIAI-+ y CO' 0�16 ^ 09g ' 9 0 ^ gT X TT X 8 OO ^ 9 C O]8 y -17 ' 2T 0318 ^ 2.0g ' 8 CT X 9 - CT X 8 OO ' g F. GAR � 0112.. ^ g2.9 ' T 6 X l X B OO ^ + 3 H1Ud [ 8 ' 2. 009C ' gCC19 , 9T X 8 X 8 OO ` C HlHa lSUW � t ' 81 0O00 ^ Cll ' OT 0 ^ BT X ST X 8 OO ^ � G-JR lSHW T _ . �� eocieaV28 �:j aao1 Ol8 ezTS wood Jo�ne� emeN moo..! � o 88MW, a�Jeme8 (loC INI8SAll-1-36 ' H : �8 PesFed� H0 314 :ii 8I :AWD�6 : -.10�0g�.:1•u00 ass :: JelesmTo O8 11IH aNOWAua 939 : uoT�eooi (10C NDllU HM: empN V i.:0/ST/OT 0939TT# uoT4pTnoTe3 aaol 4peH 88I A7�Clr5 -�rO��l�d'~Z71‘7OOL:::.:1HS 0 Town of Montville 0 lf` Building Department Date 7 I pZ./ O oField Inspection Notice Permit # 4 NCS �, //4Z, / �� Job Location 'Yv7� /419.9.7 M U pproved Type of Inspection ----:. ....77:712-37, . , ,%'. ( ---,.r)/ I 41 Not Approved - Please call for re-inspection when the following corrections have been completed: I } I i i l f % i ," 6 Building e ' cial t i Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville,CT 06382 860-848-3030, Ext.82 Building Permit Permit Number: B2002-586 Permit Date: 27-Sep-2002 Permit Code R1 Job Location: 426 RAYMOND HILL ROAD UNIT: MAP/LOT: 032/003-000 Job Description: Foundation OnlyAddition Owner Contractor William R Allen W. R.Allen Co. 51 D Route 32 542 Route 163 ; Unit: Quaker Hill,Ct.06375 Uncasville,Cr 382 Telephone: 447-2992 Lic/Reg Type: HIC Use Group R4 Lic/Reg Number: 503385 Code 1995 CABO Exp Date: 11/30/2002 Cuction 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: $0.00 Electrical Fee: $0.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $0.00 C/O Fee: $0.00 Comments: Plan Review Fee: $0.00 —Included on Building Permit State Ed Fee: $0.00 Total Fees: $0.00 jt 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 ❑ inal Inspection ❑ Gas Piping and Pressure Test I Certi e of's - -Prior 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 0 New Constructiondcfition ❑Alteration 0 Accessoty Structure ❑OtTier Job Location 1/424 b 47miRnev//7 4 /2 Job Description/Materials cdc'N�ia-r7 uN ON 1--"1 — /)17,E i ll cAr---' Owner (,04iQ iI4 iiQA./ COi Mailing Address 57 '3 .e.9u,t X a. City Rite 10 State Zip OS 3 71 Tel ?60 /747/o2-9f,2 Contractor W . ,e. „9.1ig. co Mailing Address 3-1 6 /�C2<<.lC 3..Z City u. WJ/ State ef- Zip 6-PC Tel 2b° /7 Y>/.-) '2 Contractor's License/Registration Type&Number /A.! ..I.D3-3 es- Exp. Date // /20 /6.Z 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. /2/71 Owner/Agent Signature Date / / / Q 10111Y4r Cons � .n Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ $