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Home My WebLink AboutElectrical Service C Town of Montville Building Department 'j Date _LField Inspection Notice Permit # ~ ~ ~ Job Location ~ fl _ ~AppPOVed Type ofInspection ~%"C `,:~1'.' ~ ~~r ~!"7~'v ` ~~i~~'r r` ~~"~✓%~f ~~a~,I ~d~[ y~ / ❑ Not Approved - Please call for re-inspection when the following corrections have been completed: ~ ~ f I r i ~ ~ i i , % i ~ 4ildBUffiClai ~ i~ ~ ~ I I ~ ~ Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Tumpike Uncasville, CT 06382 860-848-3030, Ext. 82 Electricai Permit Permit Date: 07-Oct-02 Permit Code R5 Permit Number: E2002-316 7ob Location: 35 CEDAR LANE UNIT: MAP/LOT: 106/049-000 Job Description: Electrical Service Owner Contractor Tim Forget Electrical DAVID + STACEY L COURVILLE 510 Parum Road 35 CEDAR LANE Unit: Colchester, Ct. 06415 Telephone: 537-8226 UNCASVILLE CT 06382 Lic/Reg Type: E1 Use Group R4 Lic/Reg Number: 184498 Code 1995 CABO Exp Date: 9/30/03 Construction Type 56 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: $500.00 Electrical Fee: $10.00 Other Value: $0.00 Other Fee: $0.00 Total Value: $500.00 C/0 Fee: $0.00 Comments: Plan Review Fee: $0.00 - State Ed Fee: $0.08 Total Fees: $10.08 h•l;+s +o sctiedule the followina ren uir d insnections (minimum 48 hours notice reauestedl: ❑ 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 ❑d Etectrical Service ❑ Insulation ❑ Rough Plumbing and Leak Test ❑ Final nspection ❑ Gas Piping and Pressure Test ertifi o Occ ncy ' r to use or occupancy Building Official's Signature: Town df Montville ~ Building Department Permit 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form RPlum6ing gElectricaf ❑Mechanicaf Hearing Air Conditiorcing Gas -Pipiv ❑ other Job Location `AA4G vAl ci le- Job Description/Materials 9 80/aGe,"~e,-l 7 Owner.D4V (,r) C~l v C v . ► (cf- Mailing Address ~35_ 10IJe, City State C Zip Q.C39aI- Tel A-0/Y~1Z"E ~41 Z~- Contractor :~l ~rt •P i LE~' Mailing Address ~/0 Y CitY!(-,Q(,-- c' State 61- Zip 4ML/Ir Tel Exp. Date Ll 30 LD 3 Contractor's License/Registration Type & Number 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 pernut for such work as described above. ~ Date LO 0~- Owner /Agent Signature Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occugancy $ Plan Review Fee $ State Education $ Total $ ~-d G' - ecei De artment Town of Monri'ille Building P , N o • ~L > ~ Date ~ : E,: From: ' ',,1 r' h' Jor Address: ~Chcck Chcck # i`~~ ~,AS~l , `C,irclconc) ....r. i . Amount Pernut# ~ . : • ! + L < ( ~ • ~ _..~..,....r,- . . , . Reccived b _ Y 1 ELECT~t~.4L D,CONTRACTOR , { ~ ~~~~flLt.vET ~QIsC~~T~, C,"IT~Q6415 ~ : . ~ n`•` ' : - i LfG.JREG NQ:`.`. SFFEC7'iVEIXPIRES 09l30/2003. , ~ /iaNet~ 1 ~1 • u - STATE (JF CONNECTICUT WORKERS' COMPENSATION f)OMI4IISSION Bnilding Permit AiYidavit for Proptety Owners or SoIe Proprietors (Conn. Gcn. Stat. § 3 i-286b) Property located at ./G{ti In t h e towaof_1yjp x,rt/,` t l Name of building pcnnit aQplicant:0V,. ',-1o PIease check one: - 1. I am thc owna of the above propcrty. , 2. ,V,,,I am thc sok proprictor of a busincss. _2A. Name of beuiness 2B. Federal Employcr ldentification Numba (F'~ . I........_..---.... " ' Pursuant to § 31-2866, "a propa[y owner or sole ctor .wbo] iateuds to act as a geucrat contractor or prinaipal cmployd" may provide cithcr a catcficate of workas' compcnsatioa insurance or a"sworn notuizod affidavit... stating that he wM roqttic+e proof of workcrs' cotapcnsation insuranca for all those employcd on the job site in aocordance with this ebapter." Pleue check oae: 1. j4, I do not intcnd to act as a gcncral contracxor or principal employer. (Sign and stag hcre) I,g~of ~ icaat - 2. _ I intend to act as a gcneral contractor or principat employer. Applicaat mast either . provide. a catificate of workers' compcnsation iasurance or sign the affidavit bclow. A,.fiidavit Iltcreby swcar and. attcst that I will roquirc proof of woricaf compen,satioa iasurance for ovay conCradoc, subcontractor, or otha worka befart hetshc eagagas in work oa the abave property in aocordmce vvith the Workcrf Compensation Ad (Chapter 564 I nadastand that pursuantto § 31275 C.G.S., officus of a cocpocatioa aad parhipm in a parhmship may elcct to-be taccludod from cavuaga by filiiig i wwrs with the aPPIoPriaft Disuad Officr and that a wle proprictor of a buseness is aot roqukod.to have caveragt tmless he files his intent to accxpt covetage, Signature of applieaat Snbscn'bed and sworn to 6efixe me this day of 20q. + _ (Notary Publie/ Comrnissionec of the Supecior Cotnt) -