HomeMy WebLinkAboutNew SFR - Heat & A/C
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville, CT 06382
(860) 848-3030, Ext. 382
Mechanical Permit
Permit Number: M2004-0097 Date: 30-Apr-04 Map/Lot: 043/009-022 Owner ID 1760
Job Location: 18 A j5D S WAY Unit
Job Description: Hydro Air/w A/C
Owner: Contractor:
RTT Development William Rheaume
1295 Route 32
35 Blais Road Uncasville Ct. 06382-
Uncasville CT 06382 Telephone: (860) 848-2647
Lic/Reg Type/No. S1 303676 Exp Date: 31-Aug-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 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
❑ Rough Electrical ❑ Insulation
❑ Electrical Service CRS 0 ❑ Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signatur .
Town of Montville
Building Department
310 Norwich-New London Tpke.
Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231
Residential Trades Permit Application Form
Permit # g4e,~0 . 0 061-7
❑PCumbing ❑ECectricaC echanicaC
C u # Weating
Conditioning
Gas Wiping
❑ Single 'Family 4❑ Two-,Family ❑ Townhouse
Job Address 0 4rkStd LJ
(Number) (Street) (Unit)
Job Description _Sc 1 01 ra G~ C!~ g (/l cokoITO-(
Owner / L l C c ~Uj 1 S Mailing Address 5 1 S '
State Zip el /Z,;, 0 / 9 7~
S
Contractor /
Jc~l / Mailing Address
City Cod Lx- ff<,, State C7 Zip ( Tel / z~,14 / ~-f
Contractor's License Type & Number 3 3 ~ 7 Exp. Date/ab/AL 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 to make application for a permit for such work as described above.
Owner /Agent Signature Date 136 /nC/
Construction Value Fee
Plumbing $ $
Mechanical $ $
Electrical $ $
Plan Review Fee $
State Education $
Total $ $
(Complete reverse side)
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at:
In the town of
Name of building permit applicant:
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)
- - - - - - - - - - - - - - - - - -
Pursuant t o§ 3 1-286b, " a p roperty o wner o r s ole proprietor [ who] i ntends t o a ct a s a g eneral c ontractor o r
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 check one:
1. I do not intend to act as a general contractor or principal employer.
[Sign and stop here]
Signature of applicant
2. 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,
subcontractor, o r o ther w orker b efore h e/she e ngages i n 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)
r .
HEATING, PRII N6 8e COOLING VN'LMMD CONTRACTOR
WILLIAM L RI-IEAUTAE
11.9 MOXLEY ROAD
UNCAS\'ILLE, CF 06382
TYPE: S l
IL 10 C~ N0. EFFECTIVE EXPIRES
3 3b76 g9fi11/2003 . „ 09/31/2004
StitC~iF~f~: .
.
National tndemmtl, Co.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLI.C
INFORMATION PAGE RE
Coverage is provided in Agency: 96018
Evergreen, National Indemnity Company The Pawson Gro
(Car_ie.r Code: 203.62) 5 South Mairi S
Branford, CT0
Carrier Policy 00
Carrier Prior Policy: 00
1. The Insured: Rheaume'Heatllg LLC Dba
Uncasville Oil Type-of Business:
Mailing-Address: `65 Maple Avenue Fein:
Uncasville, CT 06382 Risk ID:
Other workplaces not shown above:
NO-OTHER WORKPLACES FOR THIS POLICY
2. Tlie policy period is from -12:01 a.m. on 6/02/2000 to 12:.01 a.m. on_
at the.insured's mailing. address.
3. A.. Workers Compensation Insurance: Part'One of the policy applies to t
Compensation Law of the states listed here:. CT
B. Employers Liability Insurance: Part.Two of the policy applies to'wo
state-listed in Item 3.A. The limits of our liability under'Part T
Bodily Injury by Accident $ - 100.•000 each acciden
Bod-Lly Injury by Disease $ 500.000 policy limit
Bodily Injury by Disease $ 100.000 each employe
C. Other States. Insurance: Part 3 of the policy applies to all states,
WA. WV, WY and. the states. designated in 3A
s D. This policy includes these endorsements and schedules:
WC600000A(04/92) W0000311A(08/91) WC000406(08/84) WC000414(07/90)
41C060303B(04/96) WC060401(0.7/96)
4.. the premium for this policy will be determined by our Manuals of Rules;
Classifications, Rates and Rating Plans. All 'information required belo'
to verification and change by audit.
Gla."ifications Code Premium Basis Rate Per.
Nc . Total Estimated $100 of. z,
Annual Remuneration 'Remuneratior~-
SEE SCHEDULE OF OPERATIONS
T4fal Estimated Annual Premium 7,154.00