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Home My WebLink AboutElectric/Electric Service for SFR 3 Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Electrical Permit Permit Number: E2004-0053 Date: 16-Mar-04 Map/Lot: 043/009-018 Owner ID 1753 Job Location: Unit Job Description: Electrical & Electric Service Owner: Contractor: RTT Development Millovitsch Electric 43 Lisbon Heights 35 Blais Road Lisbon Ct. 06351- Uncasville CT 06382 Telephone: (860) 376-2153 Lic/Reg Type/No. El 104995 Exp Date: 30-Sep-04 Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $0.00 Building Fee: $0.00 Use Group: R4 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 Included on Building Permit Plan Review Fee: $0.00 State Ed Fee: $0.00 Total Fees: $0.00 It is the owners responsibility to schedule the following inspections (minimum 48 hours notice reg iu red), ❑ Footing - Prior to pouring concrete ❑ Rough HVAC ❑ Backfill - Footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab - Prior to pouring concrete ❑ Chimney - One flue above thimble ❑ Rough Framing ❑ Firestopping/draftstopping ❑V_ Rough Electrical ❑ Insulation FV Electrical Service CRS 317507 ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: ! Town of Montville ' Building Department Permit # a0 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT-06382 Fax. 848-7231 One & Two Family Trades Permit Application Form EIPlum&v Electrical' f -l Mechankaf 9Meatirtg Air Condit Wing not&r Gas! PM9 lob Location Job Description/Materials Owner 12'KN Mailing Address City e S~~ i~\ Stated Zip Tel Contractor \~~-~~\~~G\~S Mailing Address City ~~3cJ~l State \ . Zip -Tel &6_13?6i a) 5-3 Contractor's License/Registration Type & Numbers Exp. Date/6 10 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 Date~~ _A -A Cons tru tion Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ . Certificate of Occupancy $ Plan Review Fee $ State Education $ Total* $ $ 4L: ` r STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: ~L~~ SOvJ W`~`'L In the town of S C ~J Name of building permit applicant: _0-& IJ V l Please check one: 1. ✓ 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 Number (FEIN) d~ 12~ 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 affidavit... stating that he will require proof of workers' compensation insurance for all those employed on the job site in accordance with,this chapter." Please chec one: 1. 1 do not intend to act as a neral contractor or principal employer. [Sign and stop here] Signature of applic t 2: I intend to act as a en al contractor or principal employer. Applicant must either provide a certificate of workers mpensation 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 , 200-. (Notary Public/Commissioner of the Superior Court) s ELECTRICAL L'Nl l'~OTED-CONTRACTOR JO&. L1 N MILLOVITSCH JR 43 LISBON HEIGHTS LISBC)",, I T06351 'J'APE: El EXPIRES EFFECTIVE LIC. / REG NO 0930/2004 104995 10 01,..003 SIGNED~_.