HomeMy WebLinkAboutHydro Air/AC for SFR L
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Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville, CT 06382
(860) 848-3030, Ext. 382
Mechanical Permit
Permit Number: M2004-0098 Date: 30-Apr-04 Map/Lot: 0431009-021 Owner ID 1761
Job Location: 20 ~LL..ISON'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 W 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 Signature-
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
EIT(umbing ❑Efectricaf F; Zecnicar
CAS # t5fjr eatng
Conditioning
Cjas Wiping
❑ Single Tamily ❑ Two-Family ❑ Townhouse
Job Address
(Number) (Street) (Umt)
Job Description 2U rA4d r0 a (r 's Cj.s ~ C i7i `Y
Owner C 60 I -S Mailing Address
City v - State _ Zip Tel
f//^
Contractor g (/--Mailing Address 12-9 S_ prC1~e
city State Zip U G 3 3 Tel / Y/
Contractor's License Type & Number (3 3 626 Exp. Date" 1,~6_/ P 0
.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/ ,-76 /
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 p roprietor [ 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)
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MA' 3 , ~ & C0 CI IN. UNIM41TED CQONT CT+O
WTLLIAhI L RHEAU-ME
119 AIOXLEY ROAD
TUNCASVILLE, CT 06382
TYPE: S1
46'08yyREC NO. EFFECTIVE EXP1RES
343676. 091.01/2003. :,.-.08/31/2004
National Indeapdt), Co.'
14ORKERS COMPENSATION AND EMPLOYERS" IABILITY INSURANCE POLICY
INFORMATION PAGE RENEWAL AGREEMEN`s
Coverage is provided in Agency: 96018 Pr#: 1
Evergreen 'National Indemnity Company The Pawson Group
(Carrier Code: 20362) 5 South Maifi Street
Branford, CT 06405
Carrier Policy 00300000.1675100
Carrier Prior Policy 003000001675099
1. The Insured: Rheaume Heating LLC Dba
Uncasville Oil Type-of Business: Other .
Mailing-Address °65 Maple Avenue Fein: 061479106
Uncasville, CT 06382 Risk ID:
Other workplaces not shown above:
NO-OTHER WORKPLACES FOR THIS POLICY
2. Tte policy period is from .12:01 a.m. on- 6/02/2000 to 12:01 a.m. on .6/02/2001'
at the.insured's mailing. address.
3. A. Workers Compensation Insurance: Part'One of the policy applies to the Workers
Compensation Law of the states listed here:. CT
B. Employers Liability Insurance: Part.Two of the policy applies to'work in.each'
state. listed in Item 3-A. The limits of our liability under'Part Two are:
Bodily Injury by Accident 100.-000 each accident
Bodily Injury by Disease 500,000 policy limit
Bodily Injury by Disease 100,000 each 'employee
C. Other States. Insurance: Part 3 of the policy applies to all states, except ND, OH,
WA, WV,.WY and.the states. designated in 3A above.
D. This policy includes these endorsements and schedules:
WCOOOOOOA(04/92) W0000311A(08/91) WC000406(O8/84) WC000414(07/90) WC060301(04/t4)
WC060303B(04/96) WC060401(OW /96)
4. The premium for this policy will be determined by our Manuals of Rules-,
Classifications, Rates and Rating Plans. All information required below is subject
to verification and change by audit.
Classifications Code Premium Basis Rate Per. Estimated
No. Total Estimated $100 o£..;.:.: Annual"
Annual Remuneration 'Remuneration:- Premium -
SEE SCHEDULE OF OPERATIONS F
Total Estimated Annual Premium 7,154.00