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HomeMy WebLinkAboutElectric/Electric Service for SFR Town of Montville Field Inspection Notice Permit Type of Inspection: Location: Delivered to: Issued to: -s APPROVED NOT APPROVED The following orders are hereby issued for their correction: Please call for' s ection when corrections have been completed 86 -848-7166,,' , 1 p= Date: Building Ofric al Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Electrical Permit Permit Number: E2004-0072 Date: 16-Mar-04 Map/Lot: 043/009-020 Owner ID 1756 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. ES 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 an 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 required): ❑ 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 W~ Rough Electrical ❑ Insulation d❑ 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, ~,'S b Building Department Permit 310 Norwich- Now London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form ElPfd ~fectricaf F jMechank4d xeating Air Conditioning Gas 0019 job Location Job Description/Materials Owner `Z Mailing Address City ems SV~~~ .L Stated Zip Tel Contractor SA Mailing Address 's 3Cn'vk City Y~3C~~ State \ Zip 04, 35 Tel 2(21/3? 1a1 a i ' 3 Contractor's License/Registration Type & Number S~\ Q) 'A 5 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 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 Constru lion Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ . Certificate of Occupancy $ Plan Review Fee $ State Education $ Total' $ $ STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: t ~L- SOvJ c .~J~1 In the town of dSJ~<~ ~~L Name of building permit applicant: VJ Please check one: 1. ✓ I am the owner of the above property. 2. I am the sole proprietor of a business. \L 2A. Name of business: 2B. Federal Employer Identification 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 af fidavit 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 ral 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 , 2bQ_ (Notary Public/Commissioner of the Superior Court) Sim ELECTRICAL;` fED-CONTRACTOR JOS~L-PH N NIILLOVITS(IH JR 43 LISBON IYUGHTS LISBON, CT W511 TYPE: E1 EFFECTIVE EXPIRES LIC. / REG N© 10,'01'2003 09/30/2004 104995 SIGNED_ S