HomeMy WebLinkAboutElectric/Electric Service for SFR
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville, CT 06382
(860) 848-3030, Ext. 382
Electrical Permit
Permit Number: E2004-0065 Date: 16-Mar-04 Map/Lot: 043/009-021 Owner ID 1761
Job Location: 20 ALLISON'S 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. E1 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: $0.00
It is the owners responsibility to schedule the following inspections (minimum 48 hours notice required):
❑ Footing - Prior to pouring concrete ❑ Rough HVAC
❑ Backfill - Footing drains and waterproofing ❑ Fireplace.Throat
❑ Concrete Slab - Prior to pouring concrete ❑ Chimney - One flue above thimble
❑ Rough Framing ❑ Firestopping/draftstopping
Rough Electrical ❑ Insulation
Electrical Service CRS 317508 ❑ Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature:
Town of Montville,
Building Department Permit #
310 Norwich-New London Tpke.
Tel. 84$-3030, Ext 82 Uncasville, CT .06382 Fax. 848-7231
One & Two Family Trades Permit Application Form
FlPfumding ~fectrecaf nMedwdcaf
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Air Cmtilitioning
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❑omer
Job Locationl;~' Q \ SCE'- 1~-A
Job Description/Materials
Owner \ Mailing Address
State~_ Zip Tel 1 I
Contractor \Z-\ IC,~~ Mailing Address
City L.•~ ~ C,~ State_! Zip 0423S , Tel ~/3?, 6,/ 1 5
Cont ractor's License/Registration Type & Number Exp. Date / 6 / 0 4
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 $ $
i -
I I
ELECTRICAL U= IMMR-CONTIRACTOR
JOS,FpHN MlLLOVI1'SCH JR
43 LISBON IIfIGI3'TS
i LISBO-N. CT 06351
TYPE. E I
EF" FEAT EXPIRES
LIC. / REG NQe= ,1 UU3 09/30/2004
104995 10, 01,
f rr
SIGNED
Y
STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at:'-~~ SOvJ
In the town of >
Name of building permit applicant:
Please chec 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 2,0 1'J L I
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 with1his chapter."
Please checYone:
1. Z I 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 gen 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)