HomeMy WebLinkAboutSiding
Town of Montville
BUILDING DEPARTMENT
310 Norwich-New London Turnpike
Uncasville, CT 06382
(860) 848-3030, Ext. 382
Building Permit
Permit Number: 82003-0420 Date: 28-Jul-03 Map/Lot: 109/071-000 Owner ID 3000
Job Location: 4 ANN AY.ENUE _ Unit
Job Description: Siding
Owner: Contractor:
Mario and Emily Montalbini Tom Harnish
358 Plant Street
6 Ann Ave Groton Ct. 06340-
Uncasville CT 06382 Telephone: (860) 449-0286
Lic/Reg Type/No. HIC 509887 Exp Date: 30-Nov-03
Tenant:
Self
Telephone:
Construction Values Permit Fees Construction Information
Building Value: $6,900.00 Building Fee: $52.00 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: R4
Other Value: $0.00 Other Fee: $0.00 Comments:
Total Value: $6,900.00 CO Fee: $10.00
Plan Review Fee: $0.00
State Ed Fee: $1.42
Total Fees: $63.42
It is the owners responsibility to schedule the following inspections (minimum 48 hogs notice repLi reds
❑ 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 F Final Inspection
❑ Rough plumbing and leak test ❑ Certificate of Occupany
❑ Gas piping and test
Building Official's Signature: 41-
Town of Montville
Building Department Permit #
42 _5
71
310 Norwich New London Tpke.
Tel. 848-3030, Ext 382 UncAsville, CT 06382
Fax. 848-7231
One & Two Family. Building Permit Application Form
El 9~fw Construction Adfiitzon ~,atlon E]Accessory Structure
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Job Location /V&-,Zs Z
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Job Description/Materials
U
O*ner , ~1 /3 l ✓~i i'~ Mailing Address
t3'! ~~i / l l State
Ci d Zip 3 ' Tel
Contractor ►JJ Mailing Address.
City ~2~70 State2~ _p Q~ ~~,J Tel
Contractor's License/Registration Type & Number-: ~ Exp. Date fl
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 attes at the proposed work is authorized by the owner in fee
and that I am authorized to make application for a permit for s ch ork as described above.
-Owvner /Agent Signature. Date
Construction Value Fee
Building
Plumbing
-
Mechanical $
Electrical $ $
Other $ $
Certificate of Occupancy $
Plan Review Fee $
State Education . n 00
Total $ c3''~C~ $ > <
(See *verse sink for a4ttond requircwtenu)
Town of Montville Building Department Receipt
No. 76
Date
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From:
Job Address: ~-•°",}k'.~ ~
i
Amount Cash i Check Check #
(circle one)
Pe
Received b~ rmit
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du I INN No I !ME
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HOME. r'V~'PC)~'F.bs ENT CON RACTOR
TH~T~2AS E HARNISH
i PLANT ST
, I ~.t StLc DELING
L REG NQ EFFECTIVE_ EXPIRES
50988 3:~~ ~7 k 12 11!30/2003
!SIGNED sry
STATE OF CONNECTICUT
WORIORS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn. Gen. Stat. § 31-286b)
Property located at: /~Zvlv
In the town of O l
lo"
Name of building permit applicant:
Please check one:
1. 1 aw`ihe owner of the above property.
2. 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 "swom
affidavit... stating that he will require proof of workers' compensation ins ce for all those employed on the
job site in accordance with,this chapter."
Please check ;
1. I do not intend to act as a gene c ntractor or princ' al e ployer.
[Sign and stop here]
Signature of a7ageneral 2. 1 intend to act 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 parwership-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)