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HomeMy WebLinkAboutMembrane Structure Town of Montville Building Deparmment Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231 Building / Trades Permit Permit Number BP2001-96 Permit Date 3126101 Permit Type Building Permit Code R11 Job Street # 11 Job Location ANN AVENUE Map/Lot 109/077-000 Job Description Membrane Structure Owner Contractor Josee Errami /Kim Rubin Kim Rubin Address 11 Ann Avenue Address 11 Ann Avenue City Uncasville State Ct. City Uncasville State Ct. Zip 06382 Telephone 848-9239 Zip 06382 Telephone 848-9239 Lie/Reg Number Lic/Reg Type Exp Date: Use Group U Code 1996 BOCA Type Construction 5B Building Value $0.00 Building Fee $0.00 Plumbing Value $0.00 Plumbing Fee $0.00 Mechanical Value $0.00 Mechanical Fee $0.00 Electrical Value $0.00 Electrical Fee $0.00 Other Value $0.00 Other Fee $0.00 Total Values $0.00 C/O Fee $0.00 Comments: Plan Review Fee $0.00 Temporary Structure Permit - fee waived - State Ed Fee $0.00 Permit must be renewed every 180 days Total Fees $a•~~ Date/ Building Official's Signatur It is the owners res o schedule the followin re uired inspections minimum 24 hours notice re uired : ❑ Footings - prior to pouring concrete ❑ Backfill - footing drains and waterproofing ❑ Fireplace Throat ❑ Concrete Slab, prior to pouring ❑ Fireplace Final ❑ Rough Framing ❑ Chimney - one flue above thimble ❑ Rough Electrical ❑ Firestopping/draftstopping ❑ Electrical Service ❑ Insulation ❑ Rough Plumbing and leak test ❑ Pool bonding ❑ Gas piping - pressure test and installation ❑ Final Inspection ❑ Rough HVAC © Certificate of Occupancy - PRIOR to use or occupancy Town of Montville Permit a Building Department 310 Norwich New London Tpke. Tel. 848-7166 Uncasville, Ct. 06382 Fax 848-7231 Application for Building or Trades Permit BuildinE Permit Trades Permit ❑ New construction ❑ Accessory structure ❑ Plumbing ❑Mechanical ❑ Addition ❑ Demolition ~q" El Electrical Heating ❑ Alteration Other c5 Vle ~I ~ Air conditioning Gas piping Job Location It t Av\v\ Ave, Job Description/Materials ,.--G Owner fl'rru.Y.-~, * Ins 4 Mailing Address (t h v~tIC~- City C n 00.5 cr'i t e- State C 1 Zip N3S-.-)-Tel.9& -Ay e, Contractor W~ ~l t, 001 Mailing Address I 1 AA, - - _ - a City_-- ~ U ~l ! ~ f- State Zip Tel. F D Contractors License/Registration Type & Number Exp. Date New Home Construction Contractors: Have you entered into a contract with the consumer for the proposed work? ❑ Yes ❑ No 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 applicatio for ermi for such work as described above. Owner /Agent Signature le Date 0,& Construction Value Fee Building $ $ Plumbing $ $ Heating $ $ Electrical $ $ Air Conditioning $ $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education Fee $ Total $ $ A STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Pcrmit Affidavit for Property Owners or Sole Proprietors 1 (Conn. Gen. Stat. § 31-286b) Property located at ! 1 Al n A Ve- In the town of ~l c. as V-)- /Ae Name of building permit applicant: ~~~1? (..t V/ ~~ee V ~f -O-V" t- 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 notarized 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 chec I do not intend to act as a general contractor or principal employer. [SiTand s p 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 wil I 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 witli the Workers' Compensation Act (Chapter 568). I understand that pursuant to § 3 1-27 5 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) ZONING PERMIT IT IS THE APPLIcANT'S RESPONSIBILITY TO FURNISH THE FOLLOWING INFORMATION: PROPERTY LOCATION t A MAP It)? LOT -jZ M PROPERTY OWNER Ses; -7 r, 4-L CONTRACTOR CONTRACTOR LICENSE # 7 CONTACT ADDRESS TELEP ON R'Co0 I .2 T-- ZONE" LOT AREA-.k ~9STRUCTURE AREA HEIGHT NATURE OF REQUEST/PROPOSED USE ! emw to'ra4ie- -SAu- e A 1111111119M, OR PROV®fE TWO COPDS OF MLAW DRAWN TO A $CUR OF AT WAMT t' m 4W MNOWDIW WMEHM M OF TN! LOT, TNR MIZE, ARRA,n AND LOCATION OF 013111ING, PROPOM, PROKWAL AID ACCROORT MTRdCTOdII, D WVMATM, SANITART imLcm n= AND WATER SWM.Y, PAM M FACEnW, AND ADOCENT SI M I WTANCWIM OF PROPOSED MTEW11 IVEM FROM PROPEEM MW AND WRBANDM. A PLAN aRIPARED ST A COIIIICCNCIR R2GIVINEED LAND MORV "R MAT RE WOMUM106 UM PROPOSED MR SPRCWM ASH M MNAWL NOT AE A8190I111~ etlWll AN ACT/AL CIMMUMCATE OF COMONAANCR IM 1111811111111100 ST THE COMIM MION OR ITS APP*Na= AGENWY. Office use only YES NIA SKETCH PLAN OR GRADING PLAN ❑ HEALTH DISTRICTNIPCA APPROVAL STATE HIGHWAY PERMIT WETLANDS PERMIT C) HAS A VARIANCE EVER BEEN GRANTED FOR THIS PROPERTY ❑ HAS BOND BEEN FILED 0 FEE ❑ CASH/CHECK # ❑ ZONING PERMIT NUMBER 00/ -I OR ' ❑WA EXPIRATION DATE U2- THE APPLICANT IS RESPONSIBLE FOR AND AGREES TO; 1. ADHERE TO ALL THE APPLICABLE REQUIREMENTS OF THE ZONING REGULATIONS. 2. FURNISH ALL NECESSARY INFORMATION AND DOCUMENTATION TO PROCESS APPLICATION. 3. NOTIFY THE COMMISSION OR ITS APPOINTED AGENT OF ANY ALTERATION IN THE PLANS_ 4. CALL FOR FINAL INSPECTION AND REQUEST CERTIFICATE OF COMPLIANCE BEFORE ISSUANCE OF C. O. APPLICANT' NATURE DATE: ~ DATE 14 DATE COMMISSION AGENT CERTIFICATE OF COMPLIANCE THIS SIGNED PERMIT AUTHORIZES THE APPLICANT TO PROCEED TO THE BUILDING DEPARTMENT FOR ANY REQUIRED PERMITS THE SIGNED CERTIFICATE OF COMPLIANCE IS NEEDED PRIOR TO A CERTIFICATE OF OCCUPANCY BEING ISSUED BY THE BUILDING INSPECTOR CONTACT THE ZONING OFFICER (84841549) AT LEAST 24 HOURS BEFORE CONSTRUCTION BEGINS AND UPON COMPLETION OF PROJECT TO ALLOW ZONING OFFICER TO INSPECT LOCATION. REV. 6129!99