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Home My WebLink AboutShed Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Building Permit Permit Number: B2003-0148 Date: 24-Apr-03 Map/Lot: 131/045-000 Owner ID 2503 Sob Location: ANDERSE_N_L/AKE_ Unit Job Description: Shed 10'x 10' Owner: Contractor: Ruriko I Rogers and Margaret R Dixon Margaret R. Dixon 8 Anderson Lane 8 Andersen Lane Oakdale Ct. 06370- Oakdale CT 06370 Telephone: (860 304-1376 Lic/Reg Type/No. 0 Exp Date: Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $2,625.00 Building Fee: $16.00 Use Group: R4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1995 CABO Mechanical Value: $0.00 Mechanical Fee: $0.00 Construction Type: 56 Electrical Value: $0.00 Electrical Fee: $0.00 Permit Code: R9 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $2,625.00 CO Fee: $10.00 Plan Review Fee: $1.60 State Ed Fee: $0.42 Total Fees: $28.02 It is the owners responsibility to schedule the following in p ions (minimum 48 hours notice reauired): i ❑ 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 ❑ Final Inspection ❑ Rough plumbing and leak test ❑Q Certificate of Occupany ❑ Gas piping and test Building Official's Signature: Town of Montville ~j Building Department Permit # , 7 310 Norwich-New London Tpke. Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Building Permit Application Form _ F ~ New Construction Addition F-1 Afteration R Accessory Structure. Other Job Location Job Description/Materials o-Y, Owner Mailing Address City CA\(,A,. State Zip Tel Contractor Mailing Address City State Zip Tel Contractor's License/Registration Type & Number 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. r Owner /Agent Signature Date Construction Value Fee Building $ $ Plumbing $ Mechanical $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ $ (See Reverse side for a&&itionaf requirements) Town of ''Y`-ontville Building Departmr- t Receipt No.; 4 Date From: `k a-ZI Job Address: Cash Check Check # Amount (circle one) Permit # ~2 Received by Permit Fee Calculation Spreadsheet MISCELLANEOUS PERMIT CALCULATION Pools & Spas Above Ground Round EA $ 3,150.00 $ Above Ground Oval EA $ 5,250.00 $ In-Ground EA $ 18,900.00 $ Heater EA $ 3,465.00 $ Hot Tub EA $ 5,250.00 $ Roofing Strip & Reroof SQ $ 207.20 $ Overlay SQ $ 127.05 $ Plywood SQ $ 101.85 $ Sheds too SF $ 26.25 $ 2,625.00 Electrical Service 100 Amp EA $ 816.43 $ 200 Amp EA $ 1,519.19 $ 400 Amp EA $ 6,039.29 $ Breezeway/Decks Open SF $ 22.31 $ Enclosed SF $ 94.76 $ Porches Open SF $ 62.69 $ Enclosed : SF $ 123.90 $ - TOTAL BUILDING CONSTRUCTION COST $ 2,625.00 PERMIT FEE Building $ 2,625 $ 16.00 Electrical $ $ CO Fee $ 10.00 Plan Review $ 1.60 State Ed Fee $ 2,625 $ 0.42 Total Fees $ 28.02 Based on 2003 RS Means Residential Cost Data 4/23/03 STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: Y'"~ ✓ 1 ~~3 In the town of Ql~ l LL- Name of building permit applicant:" of&c~ 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 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 ch yl one: 1. I do not intend to act as a general contractor or principal employer. [ ign and stop here Signature o 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, 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) Town of Montville Building Department 848-3030, Ext 382 ONE & TWO FAMILY CONSTRUCTION PERMIT SIGN-OFF SHEET Property Address Job Description: l\j S=3 L_L_. `S' H The owner/agent shall be responsible for the completion of the form, no certificate of occupancy will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030-339 Approved ❑ Permit ❑ Not Applicable Septic System Date Approved ❑ Permit ❑ Not Applicable Private Well Date WPCA DEPARTMENT 848-3030, Ext 376 Approved ❑ Permit 1V Not Applicable unicipal Sewer Date House Trap ❑ Outside ❑ Inside Approved ❑ Permit # ❑ Not Applicable Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 Approved ❑ Permit ❑ Not Applicable Director Date PLANNING & ZONING DEPARTMENT 848-3030. Ext. 379 In-Compliance &74f__1 _ ❑ Permit Not Applicable nmg Date 7>F In-Compliance _ ❑ Permit Not Applicable Inlan - tlands Date