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Home My WebLink About2002 - Electric Service Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Um2 sville, CT 06382 860-848-3030, Ext. 82 Electrical Permit Permit Number: E2002-219 Permit bate: 08-Aug-02 Permit Code R5 Sob Location 11 ALASKA ROAD UNIT: MAP/LOT. 089/051-000 Job Description: Electrical Se ice Owner Contractor P NAMIN RONALDO KBS Electric 1 Avers Drive 11 ALASKA ROAD Unit: Canterbury, Ct. 06331 OAKDALE CT 06370 Telephone: 546-6658 Lic/Reg Type: El Use Group R4 LiciReg Number: 125397 Code 1995 CABO Fxp pate; 9/30/02 Construction Type SB Construction Valu 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 Either Value; $0.00 Other Fee: $0.00 Total Value: $500.00 C/O fee: $0.00 Comments: Plan Review Fee: $0.00 L State Ed flee: $0.08 Total Fees: $10.08 ❑ Footing - Prior to pouring co ete Rough HVAC ❑ Badcfiil - Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Stab - Prior to pour ing ❑ Fireplace Final ❑ Rough Framing ❑ Chimney - One flue above thimble ❑ Rough Electrical ❑ Firestopping/draftstopping ® Electrical Service ❑ Insulation ❑ Rough Plumbing and Leak ❑ I ion ❑ Gas Piping and Pressure T ificate of occupancy - Prior to use or occupancy Building Official's Signs re: Town of Montville Building Department Permit #E~2 ®en 2 - ~2/? 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form R(Plumbing i~zfectliC6 f F-19Hechanical Meating Conditioning Gas 1 Ting Other Job Location Job Description/Materials c C- 5e Owner Mailing Address I AL&R), City State Zip or ,_37d Tel / / Contractor ° Mailing Address T 9-0 P k,`J0 City Stated Zip (l., .S Tel W~60/ r - S Contractor's License/Regis ation Type & Numbers 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 t 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 ° Date/~ Construction Value Fee Building $ 616 $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ - d Total $ $ l rte' Mont-vine I3uildin ]DepartmReceipt Town of--- 1V[ r. No. gz ; _Ddie g From Job Address- Cash C'hcck Check 4 $ Amount (circlconc) b i FROM :PATIPOMPEI IC 86@ 1546 6E y Fi=t;: NO. :54666~~" Aug. O6 3t0~4 00;3~~'M PZ Rr.r.~b r~11I t i R I Avam Drive Caelta wy C r 06331 l7aifed S1eEtre of',48rkt~ PON OW437-6397 August 06, 2002 Town of Montville Building Department Date Field Inspection Notice Permit # Job Location ki4 z L z: s• Approved Type of Inspection S~/ Not Approv d - Please call for re-inspection when the following corrections have been completed: r - /4c~~~ r Bu' in 0 al T f STATE OF CONNECTICUT WORKERS' COMPENSATION CONMUSSION BuiIdi Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at 11 K In the town of Name of building permit applicant:„ ` h 1 &M W Please check ~e• 1. L/ I am a owner of the above property. 2. _ I am he sole proprietor of a business. _2A. ame of business 2B. Federal Employer Identification. Number ) Pursuant to § 3I-28 b, "a property owner or sole proprietor (who] intends to acct t as as contractor or principal employer' ma a geenerneral may provide either a certificate- of workers compensation insurance or a "sworn notarized affidavit... stating that he will g require proof of workers' compensation i ce for all those employed on the job site in accordance with this chapter." Please check one: 1. _ I do of intend to act as a general contractor or principal employer. [Sign and stop here] Signature of applicant i 2. _1/ 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, subcon ctor, or other worker before heJshe engages in work on the above property in accordance with the Workers! Compensation Act (Chapter 568). I understand that p tto § 31-275 C.G.S., officers ofa corporation and partners in a partnership may cI to-be excluded from coverage by filing a waiver with the appropriate District Office; and at a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. Melinda L Robeft Notary Public Si atomOfapplicant -7 arty commission Expires Oct. 31, 2002 Subscribed and sworn to before me this %-"day of AlOckc, 5 , 200. (Notary Public(Commissioner of the Superior Court)