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Home My WebLink AboutSiding Town of Montville Building Department Fax: 848-7231 Phone: 848-7166 310 Norwich New London Tpke Building I Trades Permit Permit Number BP2001-534 Permit Date - 9/7101 PermitType Buildinq PermitCode R4 MaplLot 106/049-000 Job Street # 35 Job Location CEDAR LANE Job Description Siding Owner Contractor David Courville David Courville ~ Address 35 Cedar Lane ~ Address 35 Cedar Lane State Ct. City Uncasville State Ct. City Uncasville Telephone 848-0594 Zip 06382 Telephone 848-0594 Z~P 06382 LiclReg Number LiclReg Type _ Exp Date: Code 1995 CABO Type Construction 5B Use Group R4 _ Building Value $3,800.00 Building Fee $22.00 $0.00 Plumbing Fee $0.00 Plumbing Value Mechanical Value $0.00 Mechanical Fee $0.00 $0.00 Electrical Fee $0.00 Electrical Value $0.00 Other Fee $0.00 Other Value Total Values ~ $3,800.00 CIO Fee $10.00 Comments: Plan Review Fee $0.00 State Ed Fee $0.61 ;ions tal Fees 61 Date~ Building Official's Signature It is the owners res onsibili to schedule the followin re uctions s minimum 24 hours notice re uired : J Footings - prior to pouring concrete C7 Backfill - footing drains and waterproofing ❑ Fireplace Throat ~]Concrete Slab, prior to pouring ❑ Fireplace Final [7 Rough Framing ❑ Chimney - one flue above thimble ❑ Rough Electrical U Firestoppingldraftstopping -Electrical Service E Insulation E-Rough Plumbing and leak test i_-1 Pool bonding ❑ Gas piping - pressure test and installation Fvf Final Inspection Rough HVAC E Certificate of Occupancy - PRIOR to use or occupanc Town of Montville Pernut # Building Department 310 Norwich-New London Tpke. Tel. 848-7166 Uncasville, CT 06382 Fax. 848-7231 Application for Building or Trades Permit Buildin?- Permit Trades Permit ~1'lum6ing ❑~fecFanicaC ❑ New Construction ❑ Accessory Structure ~ ❑~~ct~f _-I('~ting ~ A~tivn ❑~DemoCtian ir ~'onitioning ~ ACteration [ZOtfer /f1C~J 5►~,.~t~ Gas 41Ptn9 Job Location (\Cc ns V i ~ A= C~ 1ob Description/Materials e Iw = A o Owner ' /(x;ti ~ ~u ('(11 f I e Mailing Address ~ ck C L-i 6 e State-C T_ Zip 0(o ~~Zs Tel $(a) CitY()iP1(~OSjjj j)'-- - Contractor Mailing Address CiState Zip Tel Contractor's LicenselRegistration Type & Number Exp. Date New Home Coastruction Contractors: Have you entered into a contract with a consumer for the proposed new home? E] Yes E] No 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. Date Owner /Agent Signature Coastruction Value Fee 01 11 $ , Building Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ ✓ Plan Review Fee $ State Education $ Total $ 6 artment IZeceip Town of Montville Building Dep ; t No. ~ D ate IV' ; d~~~ From: ' -,v . ;Job Address: ~ Chcck # Cas~i~ Check P• ~ AIT10U[lt irclconcl I Permit Izece►vea hy r ~ STATE OF CONNECTICUT WpRKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at ~.,5 e~e'Jaf (~fai e In the town of f kil(L, Name of buiiding permit applicant: /)Au► Please check one: 1. _ZI am the owner of the above property. • 2. I am the sole proprietor of a business. 2A_ Name of business 2B. Federa( Employer ldentification 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' com pensation insurance for all those employed on the job site in accordance with this chapter." ptease 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 engages in work on 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 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 applicant Subscribed and sworn to before me this day of 1200- (Notary Public/ Commissioner of ihe Superior Court)