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Home My WebLink AboutElectric/Electric Service Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Electrical Permit Permit Number: E2003-0020 Date: 22-Jan-03 Map/Lot: 037/002-044 Owner ID 2505 Job Location: 12 ~1 DERSEN LWE Unit Job Description: Electrical & Electric Service Owner: Contractor: Cyr Construction Inc Wayne R. Thompson, Jr. 31 Lisbon Heights 135 Providence Street Lisbon Ct. 06351- Taftville CT 06380 Telephone: (860) 859-6601 Lic/Reg Type/No. El 181667 Exp Date: 30-Sep-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 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 W Rough Electrical ❑ Insulation 0 Electrical Service ❑ Final Inspection ❑ Rough plumbing and leak test ❑ Certificate of Occupany ❑ Gas piping and test Building Official's Signature: i Town of Montville Building Department Permit # a 60 3 310 Norwich-New London Tpke. Tel. 848-3030, Ext 82 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Trades Permit Application Form QPlumding ZEkctrical nMechanicat Heating Air Co;;4tioning Gas Piping n Other Job Location Job Description/Materials n~~ Owner t-,,45 A~-,% G' 1 Mailing Address ce `T -T State C7- Zip Tel 5-6 U CitY a- f Contractor G Mailing Address 31 6t. ~ i 5 City L` S G e 1 State CT Zip 0~1 315'1 Tel 9G 1/ 3 74131'11?--- Contractor's License/Registration Type & Number l' ! S'/ Ga 7 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. Owner /Agent Signature Date 1 C l . 3 Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ q, $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education $ Total $ $ STATE OF CONNGCI'I= WORK IS' COWINSATION b0&tMISSION a3uildin Permit Amdavit for Prope Owners-or Sole proprietors (Conn. Gen. Stat. §3 1 286b) Property .located-at /a f n)e- -se I In the town, of _(11 (e Name of building permit applicant: Please check one: I. I am the owner of the above property. 2. X I am the sole. proprietor of a business. -2A. Name of business 213_ Federal Employer IdentificationNumber Pursuant to 3 1-286b, "a • owner or sole proprietor [who] intends to a#_ property a general contractor or principal employee" may provide either a cutificate ofworke& compensation iasurance.or a "sworn notarized afdaviL stating that he will. require proof of workcre compensation insurance for all those employed on the job skein accordance with this chapter." Please check one: I. K I -do not intend to act -as a general contractor or principal employee [Sign and stop heml Si tune of applican 2_ I intend to act as a general contractor or principal employer. Applicant must either provide. a certificate of workers' compensation iasumce-or sign the affidavit below. A.tYtdayit I hereby swear and-attest that I'Will require proof of workers" compeq=tion contractor, subcontractor, or odw worker before hclshe cnAga work on k the insurance for every accoWancc with the Workers' Compensation Act (Chapter 5W . I Mdmtand'that pursuant to § 31-275 C.G.S., officers of it corporation and partnership may tied to-be exckuled from correraga partner, is a •Distiicx Offices and that a sofa by Ong a waiver with the appropriate files his. intent to accept covgetor of a bastness is trot roqukal.to have coverage unless he Si lure o Sub='W and sworn to befam erne his 17 day of ~ 200 3 . (Notary Pubes Conunissioner.of the superior Court) w.y MIL MMM,(f I=, ELECTRICAL UNLITYRTED CONTRACTOR WAYNE R THOMPSON JR 31 LISBON HGTS LISBON, CT 06351 TYPE: El LIC.✓REG NO. EFFECTIVE EXPIRES . I j 181667 10/01/2402 09/30/200 ± ! .i 'SIGNED i