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Home My WebLink AboutPlumbing - SFR Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Plumbing Permit Permit Number: P2003-0005 Date: 16-Jan-03 Map/Lot: 037/002-044 Owner ID 2505 Job Location: 12 AN.DF$,5f.N, LANE Unit Job Description: plumbing Owner: Contractor: Cyr Construction Inc Jack Cipriano Plumbing & Heating 14 Old Fitch Hill Road 135 Providence Street Uncasville Ct. 06382- Taftville CT 06380 Telephone: (860) 848-3208 Lic/Reg Type/No. P1 203959 Exp Date: 31-Oct-03 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 resaonsibility to schedule the following inspections (minimum 48 hours notice reguiredl: ❑ 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 ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: 5 Town of Montville ` Building Department Permit #Q p 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form Pfumding [:]EfectricaC ❑Mechanicaf Heating Air Conditioning -Gas Oping Other Job Location ;4J 1) e rSC) A) 641V-e_ Job Description/Materials fro k x L513a pf K LIPL451' 12) 2C- OwnerCVr{_ rfo Mailing Address ~c7t)p 1,Lj'ce- A-, ~ City llState C Zip Pat Tel 6C~ Contractor Mailing Address Iq bit) City 0rw 143 U i I (`@ State Ct Zip NOW- Tel ` &0 / ? 6 / D 0 q Contractor's License/Registration Type & Number Pw 2 03 95I Exp. Date /`6 / 31 / 3 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 prop se rk is authorized by the owner in fee and that I am authorized to make application for a permit for such work s d ed ove. r_r ~o Owner /Agent Signature n Date__/ & Construction Value Fee Building $ ~ (Vd / $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ . State Education $ Total $ $ i _ r _ , - , f:, CIPRIANO PLUMBING & HEATING 14 OLD FITCH HILL RD. UNCASVILLE, CT. 06382 (860) 848-4221 I AUTHARIZE JACK CIPRIANO TO ACT AS MY AGENT TO SECURE ANY AND ALL PERMITS. LOCATION LOT 44 12 ANDERSON LANE. OAKDALE CT. P JA K CIP ANO I tir de STATE OF C *fl3CnCW WORXMS' C0MPBNSATI0Nt0I4WSST(yN BuiIdin Permit Ailidavit for Pro Gen. Stat. 4r+►ners or Sole pro rielors § 31-286b) Property-located at j2 CSI sv 2 In the town of Q Name of building hermit applicant: i CIVO Please check one: 1. I am the owner of the above property. 2. I am the sole tOpcietor of a business, _2A. Name of business 2B. Federal F.rnpIoye Identification Number (FE1N~_ . Pursuant to § 31----- ...............r.--..-..,_...-.._--.-•-•--•_..--..-.._--•---•--r a loya- owner or sof contractor orprineipaI emptoye~ may provide either. ~ o1 mods to act as a general inwrance.or a "sworn notarized affidavit... statin ccrtifmt a ofworkers• compensation ggj compensation insurance for alt those employed n the Johe will require proof b site in accordance with rice this Please check one: I • I -do not intend to act as a general contractor or principal cm. [Sign and stop herd ployer. Signature of applicant - 2. I intend to act as a en provide. a a al contractor or principal employer. Applicant must either below certificate e ofworkus" compensation insurance-or sign the affrdavk i......r ♦..........Y ♦ dy. 14eCby.swear and.attest that I Will require r contractor subcontractor proof of workers' c(mpenntion insurance for, very or Other worker before he/she en $0 arc with the Workers' ComppMtion Act (Chapter-569). 6g), is work ort the above pro" in I undo d that purmwtto § 31.-275 C.G.S., officers ofa fmtnership may elect to-be exec fiV. coven won and partners in a `District Office; -and that a sole P by Mot a waiver with the vpr~ fita'his intent.to accept co~,eraP"detor of a business is not WT ired.to lave a=ge Unless he Signatum ofapplic=t Subsen'berd and sworn to before me this day 200 :(NotaryPubW niWOnerofthe Superior Caul) .