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HomeMy WebLinkAbout2003 - SFR Town of Montville Building Department - Certificate of Occupancy for Single Family Residence t 1 at 4 ADAMO AVENUE SE~fThis is to certify that the construction described conforms substantially to the requirements of the State of Connecticut Building Code as per Section 29-265 of the Connecticut General Statutes and Zoning Regulations as adopted by the Town of Montville and is hereby approved for use and occupancy. Permit Number: B2003-0094 Special Conditions: Map/Lot: 131/027-000 Use Group: R4 Code: 1995 CABO Construction Type: 5B Owner: CJT Development LLC 59 Mirey Dam Road Middlebury CT 06762 Tuesda October 07 2003 Building Official: CO Issued: Town of Montville Building Department e 848-3030, Ext 82 y ONE & TV 70 FAMILY CERTIFICATE OF OCCUPANCY SIGN-OFF SHEET b uy . /~b n jl~ c r, Property Addr ss Job Description: S 'l The owner/agent shall be responsible for the completion of the form, no certificate of occupancy will be issued until all signatures below have been obtained. HEALTH DISTRICT 81-48-3030-339 Approved ❑ Permit Not Applicable Septic ys em Date Approved ?-0? -6-3 ❑ Permit 22Q ❑ Not Applicable Private/Well Date WPCA DEPARTMENT 848-3030, Ext. 376 ' Approved ❑ Permit ❑ Not Applicable Municipal Sewer Date House Trap ❑ Outside ❑ Inside Approved Municipal W ter Date El Permit # ❑ Not Applicable DEPARTMENT OF PUB IC WORKS 848-7473 s & I Approved Y' 7-6-3 ❑ Permit Not Ap licable Date PLA F NNING & ZONING "DEPARTMENT 848-3030. Ext. 379 In-Compliance Zoning Date El Permit ❑ Not Applicable In-Compliance ❑ Permit ❑ Not Applicable Inland-Wetlands Date *viad 6/281WO Town of Montville a Building Department 848-3030, Ext 82 ONE & TWO FAMILY CERTIFICATE OF OCCUPANCY SIGN-OFF SHEET w2ei: /W /I - Prope y ddress Job Description: The owner/agent shall be responsible for the completion of the form, no certificate of occupancy will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030-339 Approved ❑ Permit ❑ Not Applicable Septic Sys em Date Approved ❑ Permit ❑ Not Applicable Private Well Date WPCA DEPARTMENT 848-3030, Ext. 376 Approved ❑ Permit ❑ Not Applicable Municipal Sewer Date House Trap ❑ Outside ❑ Inside Approved Municipal ater Date El Permit # ❑ Not Applicable DEPARTMENT OF P LIC WORKS 848-7473 Approved ❑ Permit ❑ Not Applicable Director Date PLANNING & ZONING DEPARTMENT 848-3030. Ext. 379 In-Compliance Pq. Permit ZOO-3'07 ❑ Not Applicable Zoning Date In-Compliance ❑ Permit Not Applicable Inland-Wetlands Date Xpised 6/28/2 2 Town of Montville", I . Building' Department Date Field Inspection Nonce Permit ' f Job Locatio Approved Type of Inspection Not Approv d - Please call for re-inspection when the following corrections have been completed: is< l Buil Official Town of Montville Building Department Date Field Inspection Notice Permit # . Job Location of Inspection e Type NOt ApprOV d - Please call for re-inspection the following corrections have been completed: j ,r when u_ Building Official r Town of Montville U Building Department Date Field Inspection Notice Permit # ash C/ .010 Job Location A roved Type of Inspection PP Not APPI'OV d - Please call for re-inspection when the following corrections have been completed: ; Building Official Town of Montville Building Department f/ Field Inspection Notice Permit # Date / f ~ k. Job Location F a t' t~kApproved Type of Inspection 'k i. , F] Not Approv d - Please call for re-inspection when the following corrections have en completed: F; Building Official Town of Montville i Building Department y Field Inspection Notice Permit Date y/ I 1 Job Location Y$ x. (Approved Type of Inspection I -Please call for re-inspection when the following corrections have been completed: Not Approved ❑ i E:[ u i 'r Building Official r. Town of Montville Building, Department Date / I Field Inspection Notice Permit # Job Location tom-- ' ,i ` . Approved Type of Inspection 5< en completed: Not Approved - Please call for re-inspection when the following corrections have be E ~i .'a Building Official Town df Montville Building Department Date Inspection Notice Permit Field 1..~ Job Location pproved Type of Inspection Not Approved - Please call for re-inspection when the following corrections have been completed: Buildin Official w_ y^-, Town of Montville Building Department 310 Norwich New London Tpke. Uncasville, CT 06382 Tel. 860-848-3(30, Ext. 82 Fax. 860848-7231 December 11, 2)02 CH Development LLC 59 Mirey Dam Road Middlebury, C 06762 RE: 4 Adanu) Avenue We have received a building permit application for the above referenced property. In accordance with Connecticut General Statute 29-263, your application is being rejected for the following reason(s): No zoning xoval on construction approval sign-off sheet No copy of New Home Contractor Registration No MEC c ck analysis 4. Engineering data required for roof trusses Engineering data required for LVL's Fee due $1 02.00 We will keep all documents received to date on file and renew your application when you have furnished all the required data. Thank u, x I ~oseph J. S rs Asst. Building Official Cc: ]File Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Building Permit Permit Number: 82003-0094 Date: 27-Mar-03 Map/Lot: 037/002-027 Owner ID 501 Job Location: Unit Job Description: Si le Family Residence Owner: Contractor: CJT Development LL JOCA Development Inc. P. 0. Box 294 59 Mirey Dam Road Middlebury Ct. 06762- Middlebury CT 06762 Telephone: (203) 910-0727 Lic/Reg Type/No. NHC 868 Exp Date: 30-Sep-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $152,458.00 Building Fee: $916.00 Use Group: R4 Plumbing Value: $9,208.00 Plumbing Fee: $58.00 Code: 1995 CABO Mechanical Value: 5,575.00 Mechanical Fee: $34.00 Construction Type: 5B Electrical Value: $10,252.00 Electrical Fee: $64.00 Permit Code: R2 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $177,493.00 CO Fee: $10.00 Plan Review Fee: $91.60 State Ed Fee: $28.40 Total Fees: $1,202.00 It ms the owners responsibility to schedule the following inspections (monomurn 48 hours notice requ"red)i • Footing - Prior top ring concrete F-V Rough HVAC • Backfill - Footing drains and waterproofing ❑ Fireplace Throat Concrete Slab - Prior to pouring concrete ❑ Chimney - One flue above thimble Rough Framing d❑ Firestopping/draftstopping Rough Electrical ❑d Insulation W Electrical Service ❑ Final Inspection Rough plumbing a d leak test Certificate of Occupany © Gas piping and to 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 ET-N-ewConstruction Addition ❑ Afteration ❑ Accessory Structure ❑Other Job Location Job Description/Materials _-c-- t J ► ° ~P ko~Sg- - - Owner N aQJ . L.I , C Mailing Address ~ r l~ ~tA~ IBC City. _ t ` ` , ~ c States Zip / o Tel ~3 / J C~~ Contractor_ I'Lla r~ i G~f~DU Mailing Address ~S~ w`~ ~ 5- 0.J®i)c _ city State Zip _ Tel J3d- Contractor's License/Regi tration Type & Number w Ct c~ra~e~ - _ Exp. Date_ (/_~Q 1d 3 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 t make application for a permit for such work as described above. Owner /Agent Signature 0, Date f/ I l O Z" Construction Value Fee Building $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ - State Education $ Total $ $ Town of pAgntville Building Departme,- Receipt No. 14- Date / From: Job Address: l .Mo VL~` ~ ov Cash. cck Check # Amount $ 1Z 0 (cirdc one) Pern Received by ur^t vt # oil NSW HOME CONSTRUCTION CONTRACTC► '%CA [?EVOLOPMENT fNG I PO BOX 294 t{DDLEBURY, CT 0676 I 75C./REG. NO. EFFECTIVE EXPIRES 86$ 10/01/2001 09/30/200$ SIGN STATE OF CONNECTICUT WORKERS, COWENSAMON 00bSUSSION Eui den Permit Affidavit for Prey Owners or Sole Pro rYetors (Conn. Gear. Stat. § 31-286b) Property looted t L~ 7 C~ a rya o Ave 4id 4/4 In the town of vA k Nanse of building Permit applicant: ar j Please che71arl, n Co, r 1. the owner of the above property. 2.-I arn the sole proprietor of a business. - 2A. Name of business 2B Federal Employer Identification Number Puxsttarxt to 31-2 etib "a prvpcrty owner or sole contractor or prin @ ~n I proprietor (whol intends to act as a gem Pal PP oya` may provide either a certificate ofworkere comp insurance or a 'sworn notarezod affidavit... stating that he will ensation COmpensation i ce for all those employed on thJ e; °ob site require proof of workac a with this erhapter;M PIewe check one: I do not intend to act as a general contractor or principal employer. (Si and stop here) /Sip ature of applie~nt 2. Z-1 1 intend to act as a general contractor or ' c" pal prov ide a certificate ofworker s° tomP employer. Applicant must either below. pensatioa insurance or sign the affidavit I hereby swear and attest that I will require proof of workert emu contractor, subcan cttor. or other worker before he/she ea motion insurance for every accordance with the Workere Cons ! work an the above property is peasatian Act (Chapter 56 I Mderstand that p to § 31-275 C.G.S., officers of a corporation and pastaership may elect to-be excluded from covers by t~rtapp in a District Office; and that a sole filing a waiver with the appropriate files his intent to a of asicacss is gigot r+ecpsin+ed to have coverage; unless he Si Of applicant MEMO ®A L ROBERTS MY COMMISS# p#R S OCT. 3 , 2007 Subscribed and sworn to before Ina this Z 1 'day of C.3Y , 200 Z- y Publid Commisai of the Superior Court) Permit Fee Calculation Spreadsheet RESIDENTIAL PERMIT CALCULATION (2 STORY) House Construction A (E=Economy, A=Average, C=Custom) QTY $/UNIT $/UNIT $/UNIT TOTAL Living Area 2088 SF $ - $ 70.55 $ - $ 147,308.40 Finished Basement SF $ - $ 13.10 $ - $ - Unfinished Basement 1008 SF $ - $ 5.05 $ $ 5,090.40 Plumbing Full Bath 2 EA $ - $ 3,531.00 $ - $ 3,531.00 Half Bath 1 EA $ - $ 2,247.00 $ - $ 21247.00 Garages Attached, 1 car EA $ - $ 8,054.00 $ - $ - Attached, 2 car 1 EA $ - $ 13,676.00 $ - $ 13,676.00 Attached, 3 car EA $ - $ 18,938.00 $ - $ - Detached, 1 car EA $ - $ 10,547.00 $ - $ - Detached, 2 car EA $ - $ 15,809.00 _ $ - $ - Detached, 3 car EA $ $ 21,072.00 $ - $ - Under, 1 car EA $ - $ 1,226.00 $ - $ - Under, 2 car EA $ - $ 1,673.00 $ - $ - Fireplace & Chimney Prefab 1 EA $ - $ 3,480.00 $ - $ 3,480.00 Masonry, exterior EA $ - $ 3,555.00 $ - $ - Masonry, interior EA $ - $ 3,330.00 $ - $ - W/2 fireplaces EA $ - $ 2,520.00 $ - $ - Dormers Gable SF $ - $ 22.00 $ - $ - Shed-SF $ - $ 15.00 $ - $ - Breezeway/Decks Open 144 SF $ - $ 15.00 $ - $ 2,160.00 Enclosed SF $ - $ 82.80 $ - $ - Porches Open SF $ $ 56.45 $ $ Enclosed SF $ - $ 111.55 $ - $ Heating Adjustment 2088 SF $ - $ (2.67) $ - $ (5,574.96) Air Conditioning 2088 SF $ - $ 1.45 $ - $ - Electrical 2088 SF $ - $ (4.91) $ - $ (10,252.08) Plumbing 2088 SF $ - $ (4.41) $ - $ (9,208.08) TOTAL BUILDING CONSTRUCTION COST, LESS MEP $ 152,457.68 Is air conditionin incl ded (Y/N)? $ - PERMIT FEE Building $ 152,458 $ 916.00 Y Plumbing $ 9,208 $ 58.00 Y Mechanical $ 5,575 $ 34.00 Y Electrical $ 10,252 $ 64.00 Other $ - CO Fee $ 10.00 Plan Review $ 91.60 State Ed Fee $ 177,493 $ 28.40 Total Fees $ 1,202.00 Based on 2000 RS Means Square Foot Costs 12/11/02 g Town of Montville f~ Building Department 848-3030, Ext 82 ONE & TWO FAMILY CONSTRUCTION PERMIT SIGN-OFF SHEET L o ~ Aba0,0 AVe Property Address Job Description: hS + kO A C- The owner/agent shall be. responsible for the completion of the form, no certificate of occupancy will be issued until all signatures below have ben obtained. HEALTH DISTRICT 848-3030-882 Approved ❑ Permit Not Applicable Septic System Date Approved ❑ Permit ® Not Applicable Private Well Date WPCA DEPARTMENT 848-30309 Ext. 881 Approved El Not Applicable nicipa ewe Date House Trap ❑ Outside ❑ Inside Approved ❑ Permit # Not Applicable Municipal Water Date DEPARTMENT OF P LIC WORKS 848.7473 Approved Permit ❑ Not Applicable Director Date PLANNING & ZONING DEPARTMENT - 848.3030. Ext. 81 In-Compliance ❑ Permit Not Applicable Zoning Date In-Compliance ❑ Permit ❑ Not Applicable Inland-We lands Date *vised 61l$/2W ,2 ' Town of Montville' Building Department 848-3030, Ext 82 ONE & TWO FAMILY CONSTRUCTION PERMIT SIGN-OFF SKEE'T' V _ Property Address Job Description: The owner/agent shall responsible for the completion of the form, no certificate of occupancy will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030-882 Approved ❑ Permit Not Applicable Septic System Date Approved y 0 Permit ❑ Not Applicable Private Well Date WPCA DEPARTMENT 848-3030, Ext. 881 Approved ❑ Permit ❑ Not Applicable Municipal Sewer Date House Trap ❑ Outside ❑ Inside Approved ❑ Permit # Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS ~ 848.7473 Approved ® Permit ❑ Not Applicable Director Date PLANNING & NIN DEP MENT 848.3030. Ext. 81 In-Compliance Permit Not Applicable Dat In-Compliance ❑ Permit ❑ Not Applicable Inland-We Iands Date Revised 6/Z8i2= Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Electrical Permit Permit Number: E2003-0193 Date: 30-Jun-03 Map/Lot: 131/027-000 Owner ID 501 Job Location Unit Job Description: ou h Wiring and Service for New SFR Owner: Contractor: CJT Development LL A C Electric LLC 43 Valley Drive 59 Mirey Dam Road Naugatuck CT 06770- Middlebury CT 06762 Telephone: 20( 3) 723-2430 Lic/Reg Type/No.-E-1 125018 Exp Date: 30-Sep-03 Tenant: N/A Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $0.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fees: $0.00 It es the owne's responsibility to schedule the following "nspections fm"nwrnurn 48 hours notice requ*red)B ❑ Footing - Prior to ouring concrete ❑ Rough HVAC ❑ Backfill - Footing rains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab - P for to pouring concrete ❑ Chimney - One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping FV Rough Electrical ❑ Insulation R Electrical Service ❑d Final Inspection ❑ Rough plumbing nd leak test ❑ Certificate of Occupany ❑ Gas piping and to Building Official's Sig ature: r Town of Montville A 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 []Plumbing 3(fec f ❑Meckankaf Acating Air Conditioning Gas Piping []Other Job Location Job Description/Materials Owner /7 2) FVIE toP"' Mailing Address -'t4~fYd /fD City /V Pc State & Zip Tel J63 / -P-?Z / J G® Contractor Z/1 ~ C ZZC _ Mailing Address -3 Lam` 111 City ~ b State Zip :P ~tl Tel 2,0 3 / ;7,?3 Contractor's License/Regi tration Type & Number Exp. Date/ / C> 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 t make application for a permit for such work as described above. Owner /Agent Signature- 7 Dated Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ S trtP $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ . State Education $ Total $ t ELECTRICAI, VNLp,11TED CONTRACTOR ARTUR J CA.R,X IRA . 43 VALLEY DR' NAUGA.TUCK, CT06770 'nTE: EI UC./REG NO _ EFFECTIVE. 12$018 10/04 ~QZ IXPIRES 09/30/2003 SIGNED .a Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Plumbing Permit Permit Number: P2003-0079 Date: 25-Jul-03 Map/Lot: 131/027-000 Owner ID 501 Job Location: Unit Job Description: Plumbing Owner: Contractor: CJT Development L -C Barry Soucier 81 Deercrest Drive 59 Mirey Dam Roa Torrington Ct. 06790- Middlebury CT 06762 Telephone: (860) 626-0038 Lic/Reg Type/No. P1 204759 Exp Date: 31-Oct-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $0.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fees: $0.00 It is the owne s responsibility to schedule the following inspections (minimum 48 hours notice requite" ❑ Footing - Prior to pouring concrete ❑ Rough HVAC ❑ Backfill - Footing rains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab - 'or to pouring concrete ❑ Chimney - One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service ❑ Final Inspection Rough plumbing nd leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: Town of Montville g2 Building Department Permit # 1 C~ 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 F• 848-7231 One & Two Family Trades Permit Application Form qTfumbing ❑Efec [}Mechanicaf Meating Air Co;;4Vm ing Gas piping []Other Job Location Job Description/Materials Owner 3. vJ Mailing Address CityState Zip Tel Contractor i t C~ ter Mailing Address 6 i' l fY Srr~ City State_I-Zip O 6.7qQ Tel <Rr~! CPX,10 Contractor's License/Re stration Type & Number " I DO--il 7S Exp. Date / 0 / R 1 / - U1 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 he Town of Montville and further attest that the proposed work is authorized by the owner in fee and that I am authorized t make application for a permit for such work as described above. / ~Gf I Owner /Agent Signature Date -'7 Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ a rl,L~h~ IN<~ r., ~~IZ~zrr~~~~r~;~I~T~r~COrrrltAC~ro~( I3r~r~IZY I ~OT;C'xr~. I sf DI;'VN S1, D13. TOR1.f , .i.t N, CT 16790 j IYN t LIC. / REG NO EFF E~ TIC E EXPIRES ' 2047 9 _j t/QI'20ca-' ~0 31/200 SIGNED D will I-IE:.TIING, PIPING Sr COOLING LTMrrED CONTRACTOR BARRY J SOUCIER I; 81 DEERCREST DR i TORRII,GTO\T, CT 06790 } i TITE• S3 LlC:✓REG NO. EFFECTIVE t EXPIRES . 3S94.81 G9 Ol120G2 08/31/2003 I` SIGNED Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Mechanical Permit Permit Number: M2003-0130 Date: 25-Jul-03 Map/Lot: 131/027-000 Owner ID 501 Job Location: Unit -4 _AQAkjQ_AYENUE Job Description: Heating Owner: Contractor: CJT Development L LC Barry Soucier 81 Deercrest Drive 59 Mirey Dam Road Torrington Ct. 06790- Middlebury CT 06762 Telephone: (860) 626-0038 Lic/Reg Type/No. S3 389481 Exp Date: 31-Aug-03 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 5B Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R5 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $0.00 CO Fee: $0.00 Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fees: $0.00 It is the owne -s responsibility to schedule the following inspections (mmnimum 48 hours notice requwced); ❑ Footing - Prior to pouring concrete W Rough HVAC ❑ Backfill - Footing rains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab - for to pouring concrete ❑ Chimney - One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑ Rough Electrical ❑ Insulation ❑ Electrical Service ❑ Final Inspection ❑ Rough plumbing nd leak test ❑ Certificate of Occupany ❑ Gas piping and test 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 Trades Permit Application Form nPfumding ❑Efec 171Mechanicaf _-4-Heating -Air Conditioning Gas Piping ❑Other Job Location y Job Description/Materials Owner 4 :i Mailing Address CityState Zip Tel 11 / / Contractor it Mailing Address Dezsr C_ Cityf State C-~ zip 0 67,9Tel ~RGO t)q3% Contractor's License/Registration Type & Number-f- 3> 4M Exp. Date 73 1 I hereby certify that the oposed 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 t make application for a permit for such work as described above. r Owner /Agent Signature Date /.<Z Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ . Certificate of Occupancy $ Plan Review Fee $ . State Education $ Total $ $ f PLUM IN t i'IMICY ~ 3i i i1TI D'CONTRACTO . I SOOc4:a 1 Ti D~ RCRTsz DP li T 0'T, , < T G67Q0'. _ i LIC. / REG NQ EFFE 1 IVE EXPIRES 204759~ 03:r SIGNED IOWA A-08-ammmmna. r ® I HEt',UNG, PIPING COOLING LIMUED COl`*TRACTOR I BARRY J SOUCIER 81 DEERCREST DR TORRINGTON, CT 06790 ! y TYPE: S3 LICS<REG NO. EFFECTIVE 389481 PIRES. 09 01/2002 OS/ EX 08/i 2063 i SIGNED y Plans in File