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Home My WebLink AboutBasement - Finish Town of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030, Ext 382 Fax. 860-848-7231 Cathy Chen 16 Ann Avenue Uncasville, CT 06382 RE: Finished basement, Permit # B2005-0787 CERTIFIED MAIL, RETURN RECEIPT REQUESTED This notice is issued in response to your desire to abandon the completion of the finished basement applied for under the above listed permit. Please note that due to the amount and nature of the work that has already been performed and inspected, the permit must remain open at this time. In order for this permit to be suspended all work previously performed, must be removed or the items that required to make the installation code compliant must be completed. If you choose to remove the work previously installed work, a final inspection would be required to confirm the removal, at which time the permit would be suspended. If you choose to continue with the project, please submit to our office the methods that will be used to correct the deficiencies listed on the enclosed inspection report. David M. Jensen Deputy Building Official Cc: File SENDER: ■ Complete items 1, 2, and 3. Also complete A. Signature item 4 if Restricted Delivery is desired. ❑ Agent ■ Print your name and address on the reverse X ❑ Addressee so that we can return the card to you. B. Received byte Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, ~i or on the front if space permits. D. is delivery address different from item 1? ❑ Yes 1. Article Addressed to: If YES, enter delivery address below: ❑ No C~-~-h~ Ghen t(.t Arun" Avenue- LA-In.CG.SVI ie- 01 DCO 3 3. Service Type D.Certified Mail ❑ Express Mail ❑ Registered K Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2 : Artiele Nurtiber 713116 1311113 001114 115 8 8656 (Transfer fro' m'servfce fabo PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540! M Town of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030, Ext 382 Fax. 860-848-7231 Cathy Chen 16 Ann Avenue Uncasville, CT 06382 RE: Finished basement, Permit # B2005-0787 CERTIFIED MAIL, RETURN RECEIPT REQUESTED This notice is issued in response to your desire to abandon the completion of the finished basement applied for under the above listed permit. Please note that due to the amount and nature of the work that has already been performed and inspected, the permit must remain open at this time. In order for this permit to be suspended all work previously performed, must be removed or the items that required to make the installation code compliant must be completed. If you choose to remove the work previously installed work, a final inspection would be required to confirm the removal, at which time the permit would be suspended. If you choose to continue with the project, please submit to our office the methods that will be used to correct the deficiencies listed on the enclosed inspection report. David M. Jensen Deputy Building Official Cc: File 0 4 Field Inspection Notice Town of Montville Building Department January 23, 2009 Address: 16 Ann Ave. Job Description: Finish Basement & install two windows Pen-nit Number(s): B2005-0787 - B2006-0006 Permit Date: 1/31/06 - 2/14/06 Not Approved Approval INSPECTION Date: Deficiencies Special Conditions Date 722106 • PT lumber required for plates in contact with cement Framing 3J6106 VV 2122106 • Plu holes in switch & receptacle boxes 316106 VV R. Elect I 3/16106 VV • Ext rear wall not insulated 3J29/06 VV Insulation . Box beam not insulated . Reverse polarity on all receptacles with ground • facing up a Open ground on receptacle in area of the oil tank and knitting room . Emergency cutoff switch required at the entry to the boiler room • Stair guardrail can not allow passage of a 4' sphere • Ceiling height measures 79°, minimum height is 82' 5/17106 JS (11305.1) 5125106 DJ*" . Ceiling height under the beam is 72'/", minimum Certificate of height required is 78" (R305.1) occupancy • - Open ground on receptacle in area of the oil tank and knitting room, condition still present. e ""Stair guardrail is not constructed to proper height and the hand rail lack the proper space between the railing and wall. • Clearances under beam at door only 72 inches, 78" min. required • Open ground on receptacle in area of the oil tank 8128/06 JS and knitting room, condition still present. • Clearances under beam at door only 72 inches, 78" min. required NOTE: Owner sent a letter saying that the project has been abandoned - 5/6/08 CC Page 1 of 1 Rev. Date: 1/18/06 r b~ SECTION SEND ER:'COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1, 2, and 3. Also complete A. Signatur7~ item 4 if Restricted Delivery is desired. C~ ❑ Agent ■ Print your name and address on the reverse X 4 ❑ Addressee so that we can return the card to you, B. Receiv d by (Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, k_ I,{ 2~4 or on the front if space permits. R D. Is delivery addr&s different from item 1? ❑ Yes 1. Article Addressed to: if YES, enter delivery address below: ❑ No C,,-EhY Ch c n ICe Awn i4Vf-r1ue Lkn CQ.SV t c/ LI 3. Service Type .Certified Mail ❑ Express Mail ❑ Registered ML Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number ?006 010 0 0004 115 8 9981 (Transfer from service labeQ PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 rl =0 / • r E 117 q•xio ut ti Ll aa:, v..ast r 9 Postage r t } Certified Fee C3 1~ Return Receipt Fee U , O C3 (Endorsement Required) C3 Restricted Delivery Fee p (Endorsement Required) ~ - r3 -total Postage & Fees $ \ C3 Sent To O Chen- ° - - r Street, Apt No.; Ave- or PO Box No. y1,~ 1 P+4 State l L~ cq- O 3 Cathy Chen 16 Ann Ave Uncasville, CT 06382 April 29, 2008 Town of Montville Building Department Attn: Charles Corell 310 Norwich - New London Tpke Uncasville, CT 06382 Dear Mr. Corell: Please be informed that I have given up on the idea of finishing up my basement, for now. Ever since the building inspector found a major deficiency I realized that I did not have the time or the money to correct the ceiling head room. To fix the head room issue would require cutting off a section of one of the main beans supporting the main floor. This would compromise the structural integrity of the house. To fix this problem would require the hiring a structural engineer to draft plans on getting around this issue and then a qualified contractor to do the actual work. For me to comply with the building standards set by the city and finish my basement would require a large cash disbursement which I cannot afford at this time. Given these facts, I have decided to leave the basement as is until such a time as I can afford to effect those changes at which time I would contact the city for new building permits. Until then, my basement will continue to be used as storage space. Best regards, Cathy Chen Town of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030, Ext. 382 Fax. 860-848-7231 4/16/08 Cathy Chen 16 Ann Avenue Uncasville Ct 06382 Dear Cathy During a resent review of our files it was established that permit # B 2005 - 0787 dated January 31 2006 and permit #B2006 - 0006 for finishing a basement has not been closed out because when the final inspection was done deficiencies were found. If these deficiencies have been corrected please contact our office to schedule another inspection. Please respond to the building department within ten days or this issue will be turned over to the state housing prosecutor Please be informed that the use ofthis finished space without the required inspections and issuance of a Certificate of occupancy would constitute a violation under the Connecticut Building Code. Respectfully yours Charles Corell Building Inspector cc: File Town of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030, Ext. 382 Fax. 860-848-7231 11/29/07 Cathy Chen 16 Ann Avenue Uncasville Ct 06382 Dear Cathy During a resent review of our files it was established that permit # B 2005 - 0787 dated January 31 2006 and permit #B2006 - 0006 for finishing a basement has not been closed out because when the final inspection was done deficiencies were found. If these deficiencies have been corrected please contact our office to schedule another inspection. Please be informed that the use of this finished space without the required inspections and issuance of a Certificate of occupancy would constitute a violation under the Connecticut Building Code. Respectfully yours Charles Corell Building Inspector cc: File Field Inspection Notice Town of Montville Building Department May 6, 2008 Address: 16 Ann Ave. Jot> Description: Finish Basement i& install two windows Permit Number(s): B2005-0787 - B2006-0006 Permit Date: 1/31/06 - 2114106 INSPECTION Not Approved Approval Date: Deficiencies Special Conditions Date Framing 2122106 • PT lumber required for plates in contact with cement 316106 VV R. Elect 2122106 • Plu holes in switch & receptacle boxes 316/06 VV 3/16/06 VV • Ext rear wall not insulated • Insulation . Box beam not insulated 3129106 VV • Reverse polarity on all receptacles with ground • facing up • Open ground on receptacle in area of the oil tank and knitting room • Emergency cutoff switch required at the entry to the boiler room • Stair guardrail can not allow passage of a 4° sphere • Ceiling height measures 79", minimum height is 82" 5117106 JS (R305.1) 5125106 DJ- . Ceiling height under the beam is 72 1/2", minimum Certificate of height required is 78° (R305.1) occupancy • " Open ground on receptacle in area of the oil tank and knitting room, condition still present. . -Stair guardrail is not constructed to proper height and the hand rail lack the proper space between the railing and wall. • Clearances under beam at door only 72 inches, 78" min. required • Open ground on receptacle in area of the oil tank 8128106 JS and knitting room, condition still present. • Clearances under beam at door only 72 inches, 78° min. required NOTE: Owner sent a letter saying that the project has been abandoned - 5/6/08 CC Rev. Date: 1/18/06 Page 1 of 1 TOWN OF MONTVILLE Building Department 310 NORWICH-NEW LONDON TURNPIKE UNCASVILLE, CT 06382-2599 TEL. (860) 848-3030 X382 FAX. (860) 848-7231 BUILDING PERMIT Permit Number: B2005-0787 Date: 31-Jan-06 Map/Lot: 109/074-000 Owner ID: 96000 Project Location: 16 ANN AVENUE Unit: Job Description: finish basement Owner Name: Cathy Chen Tenant Name: N/A Careof: 16 Ann Ave Uncasville CT 06382- Telephone: ~`,ntractor Name: Property Owner Telephone: (203)918-8117 DBA: Lic/Reg Type: Lic/Reg No: 0 Exp Date: Construction Value Permit Fees Construction Information Building Value: $28,910.00 Building Fee: $232.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code Mechanical Value: $1,326.00 Mechanical Fee: $16.00 w/2004 Amendment . Electrical Value: $2,674.00 Electrical Fee: $24.00 Construction Type: 5B Total Value: $32,910.00 Penalty Fee: $0.00 Permit Code: R4 C of O Fee: $10.00 Comments: Plan Review Fee: $27.20 State Ed Fee: $5.27 Total Fee Paid: $314.47 It shall be the owners repsonsibility.to schedule the following inspections a minimum of 2 business days in advance: Field set of approved construction documents shall be available onsite during all inspections. BUILDING PERMIT INSPECTIONS PLUMBING, MECHANICAL, ELECTRICAL PERMIT INSPECTIONS ❑ Footing - Prior to pouring concrete F R Plumbing and leak test ❑ Deck Piers 0 R Electrical ❑ Backfill - Footing drains and waterproofing Elec Trench - with conduit installed ❑ Concrete Slab - Prior to pouring concrete ❑ Pool Bonding ❑ Anchor Bolts - with sill plate and prior to floor framing ❑ Electrical Service CRS No: 0 W Framing ❑V R HVAC ❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test / Fireblocking Draftstopping INSPECTION REQUIRED UPON COMPLETIo ❑V Insulation ❑ Certif ate of Approval rtificate of Occupancy Building Official's Approval: P(AXI p l I I t, ~Vv_ 3 3 w ell 6 a r 1(711 ~ 41-7 77 RECEIVED _ F EH 1 5 2006 ~X~E,( 'I t BUILDING DEPT. 3 ~ ~ }9 F T(-4 f f it I - r ` 1 r h i i ~ 1 I ~ 9='' ° ~ ~ { ~ ~"d ~ I' i~ ~ ~ r $ ` Town of Montville Building Department Residential Plan Review Form Date: AJ Z. cnc, 6 Job Address: YU- Job Description: //rJlf{ 13.n.SFr1-t0!!M The following information must be included on both sets of plans or accompanying documents (two sets are required) (C.G.S. 29-252a.) This list is offered as a guideline only. It is not meant to be all-inclusive for every permit application, nor is it meant to take the place of the building code. Your application is being reiected for the following reason(s) that are checked-off or commented on: Supporting Documentation Grading is to slope away from the building, Windows & Doors Building permit application not completed provide more details Door and window sizes -.!A= ARR cam $ Deck/porch not shown Emergency escape & rescue opening required in Plan must be the same as submitted and approved the basement or two code compliant stairs Permit fee to be calculated by the Zoning Department and Uncas Health, (if Worker's comp. Affidavit or worker' comp. (8310.1) Insurance required a licable Indicate required light (8% of floor area per room) Copy Contractor's registration or license Retaining Walls and ventilation (4% of floor area per room) for Construction permit sign-off sheet with approvals Plans required each habitable room or space required Documents required to be stamped and signed by a Indicate safety glazing in areas required such as: Provide all documentation to show compliance CT registered Professional Engineer doors, windows, tub & shower enclosures, etc. with the 2003 International Energy Conservation Foundation Plan Indicate bedroom egress windows (5.7 sf net clear Code (www.energycodes.gov) Plans required opening, 24" clear opening height, 20" clear Street address of project on all drawings and Dimensions opening width) documents required Wall thickness Egress window sill height Field set of approved plans need to be picked up Footing sizes Window and door header sizes from our office Column footings - size Window well details Two sets of construction documents required, this Frost protection not indicated or insufficient Garage includes engineering data, calculations, and other Foundation- indicate the assumed soil conditions Plans required documentation that the system has been designed for or provide Minimum 5/8" Type X gypsum board separation Documents are copyright protected, provide engineering data. If presumptive soil conditions (on garage side) to all living spaces - all original copyright plans or a letter from the cannot be met, provide soil bearing engineering combustible support framing to be covered with designer authorizing the duplication of the plans. data minimum 5/8" Type X gypsum board if it supports Wind Limitations Design Criteria Concrete strength- foundation, floors, exterior habitable rooms Submit supporting data to show conformance with porches, walks, slabs Openings between the garage and residence the wind limitations (3 second gust @ 115 mph) Vapor barrier between sub-grade and concrete required to have a minimum 1 3/8" solid wood Design publication needs to be identified (WFCM, basement floor required door, 13/8" solid core steel door, 1 3/8" chapter 3, WFCM, chapter 2, ASCE 7-2002) Floor thickness and control joint location honeycomb core steel door, or 20 minute rated Documents required to be stamped and signed by a Lally column size, attachment and spacing door from the garage to the house and its basement CT registered Professional Engineer Waterproofing details or attic Documents required to be stamped and signed by a Fireplace/chimney base Indicate self-closing devices on all doors from CT registered Professional Engineer if based on Concrete piers and anchor details garage to the house and its basement or attic ASCE 7-02 or WFCM chapter 2 Foundation drainage Indicate slope for garage floor _ Shearwalls not identified or insufficient Beam pockets - minimum clearances Elevations _ Ridge connection not identified or insufficient Engineered foundation plan required Plans required Roof-to-wall connection not identified or Type of siding insufficient Crawl Spaces Type of roofing Wall-to-wall connection not identified or Crawl space data - clearance to joists, slab Finish grades insufficient thickness (if provided), vapor barrier Building heights _ Wall-to-sill connection not identified or Crawl space ventilation, location, type and size Dimension height of chimney above roof insufficient Crawls ace access location and size Roof pitches _ Provide engineering data for the piers to resist Elevations to match site din gravity, lateral, shear and uplift loads, stamped and Floor plan(s) signed by a CT licensed design professional Plans required Building Section(s) & Details Hold-down devices, location and type not Construction documents shall be of sufficient Plans required identified or insufficient clarity to indicate the location, nature and extent of Floor-to-floor heights Foundation anchor spacing not identified or the work proposed (RI06.1.1) Flashing detail - windows and doors - type, insufficient Construction documents are to match the material Construction documents do not match the orientation on the site plan reversed plans are not Additional sections and details required engineering data submitted acceptable, a full plan review can not be Fire-resistance rating details required for exterior Cold-formed steel framing shall be designed in performed with the submitted documentation wall(s) accordance with COFS/PM-2001 edition Construction documents are incomplete or un- Wall/ceiling fireblockin detail Site plan clear, a full plan review can not be performed with Stairs the submitted documentation Stair not shown on basement plan Plans required Basement floor plan required Riser height not indicated Plan does not match building plans Second floor plan required Tread depth not indicated Finish floor elevation Dimensions Property lines not provided Finish floor elevation Nosing required for closed risers Distance from property line to structure Kitchen layout Handrail required on at least on side of the stair Stair Structure dimensions Bathroom layout and space clearances to be minimum 36" in width above the Driveway handrail height Ceiling heights Handrails and guardrails - detail, including height Topography (existing and proposed) Attic access location and size not indicated or Footing drain inverts, outlet and separation insufficient and maximum opening, handrail cross-section Proposed utilities to be indicated Attic access cannot be in a closet continuity and required returns Delineation of flood hazard areas and design flood Identify the use of each room Show minimum headroom in stairways - measured from nosing plane to lowest point of elevation required (R106.1.3) Private sewage disposal system to be identified on ceiling the plan (R106.2.1) 36" landing required at the bottom of the stairs A =-AIT B _ Oasement x= 2(gof S = Site 1 = Thst Tfoor 2 = Second FCoor 3 = ghird F(oor 9?§ sedOetober24, 2005 Town of Montville t- Building Department Plan Review Form Date: NAM 2=q,-;_,006 Street Address: ~~o eA1~1 tj kym t,~ tla, Job Description: f="ir)/1'4 0 ^ ®:.D A The following information must be included on both sets of plans or accompanying documents (two sets are required) (C.G.S. 29-252a) This list is offered as a guideline only. It is not meant to be all-inclusive for every permit application, nor is it meant to take the place of the building code. Your apolication is being reiected for the following reason(s) that are checked-off or commented on: Documents required to be stamped and signed by a CT registered • Supporting Documentation Professional Engineer Exceeds the threshold limits per C.G.S. 29-276b - An independent Construction documents shall be sufficient clarity to indicate the Structural engineering consultant shall review the structural location, nature and extent of the work proposed construction documents to determine compliance with the Construction documents are to match the orientation on the site plan requirements of the code, reversed plans are not acceptable, a full plan review can not be Statement of Special Inspections required as per section 1705.1 performed with the submitted documentation Plans Construction documents are incomplete or unclear, a full plan review Site Plan(s) required can not be performed with the submitted documentation Architectural plan(s) required Building permit application not completed Mechanical plan(s) required Permit fee $ Electrical plan(s) required Permit fee to be calculated Plumbing plan(s) required Worker's comp. Affidavit or worker' comp. Insurance required Fire protection plan(s) required Copy Contractor's registration or license Construction type not identified Construction permit sign-off sheet with approvals required Use group classification not identified Provide all documentation to show compliance with the 2003 Height & area calculations required International Energy Conservation Code (www.energycodes.gov) Occupant load not provided Street address of project on all drawings and documents required Egress plan shall designate the number of occupants on every floor, Field set of approved plans need to be picked up from our office and in all rooms and spaces along with the minimum number of Two sets of construction documents required, this includes occupants to be accommodated by the exits (1003.0) engineering data, calculations, and other documentation Rooms not identified Documents required to be stamped and signed by a CT registered Architect Comments: Afficial q4visedNovember7, 2005 Town of Montville Building Department 310 Norwich-New London Tpke: Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential Building Permit Application Form Permit # J f~ 7F7 ❑ New Construction ❑ Addition ❑ Alteration ❑ Accessory Structure ® Single Family ❑ Two-Family ❑ Townhouse Job Address I Ally . (Number) (Street) (Unit) Job Description To 17/ Aj):5 # ct=n,6j-T 4vtJ Owner GR~"Ifi~~/ X G Z~ Mailing Address 6 AA/d AL9 City (A 4C f}S 1l d LLZ State G T Zip 0000A Tel 213 / floe/ oe/ 00/j4- Contractor 59LF 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. Separate applications are required for electrical, plumbing, mechanical, etc. Owner /Agent Signature Z Date / 121, / DS Construction Value Fee Building $ $ Plumbing $ $ Mechanical $ $ Electrical $ $ Work commencing before the issuance of a permit $ Certificate of Occupancy $ Plan Review $ State Education $ Total $ $ (See &verse side for add tiona(requirements) Rvised-Tebmary 25 2005 Town of Montville Building Department File Receipt Receipt No: 1003 Date: 25-Jan-06 Received From: Catherine X. Chen Job Address: 16 Ann Ave. Fees Collected State Educational Training Fee Cash: $0.00 Cash: $0.00 Check: $314.54 Check: $5.27 Check No: 0 Construction Value: tU-910.00 Demolition Value: $0.00 Received By David M Jensen I ~'ress: TOTAL ITEM QTY $IUNIT Building plumbing Mechanical Electrical BUILDING AREA $ _ New Construction SF $ 114.17 $ Basement, Finished SF $ 20.87 $ - $ Basemen, Unfinished SF $ 11.28 $ - $ Crawl Sapce SF $ 8.46 $ Interior Renovations 1005 SF $ 28.78 $ 28,909.51 $ 1,325.94 $ 2,673.98 MANUFACTURED HOMES $ _ Ground Anchors SF $ 5.66 $ - $ Basemen SF $ 11.28 $ - $ $ - Crawl Space SF $ 8.46 $ - $ $ AMENITIES _ $ Kitchen FA $ $ _ Full Bathroom EA $ $ _ Half-Bathroom FA $ $ GARAGE Attached SF $ 49.41 $ - Detached SF $ 63.21 $ - $ Under SF $ 9.12 $ $ Carport SF $ 18.08 $ - MECHANICAL _ $ - Warm-Air Il Y/N Hot Water N YIN $ _ Electric N Y/N $ Air Conditioning If Y/N $ - ELECTRICAL SERVICE _ $ _ Upgrade Amps overhead, new - Amps $ Underground, new - Amps $ Subpanel EA $ 545.00 $ Gen Set FA $ 3,500.00 $ SOLID FUEL BURNING APPLIANCES Prefab Metal Fireplace EA $ 5,907.00 $ - Masonry wilfireplace EA $ 6,451.50 $ - Masonry w/2 fireplaces EA $ 10,087.00 $ - Wood Stove, free standing EA $ 2,447.50 $ - Wood stove insert FA $ 1,690.70 $ - DECKS, PORCHES, SUNROOMS Deck SF $ - 39.16 $ - Porch SF $ 135.80 $ - Sunroom SF $ 160.82 $ - $ - POOLS & HOT TUBS Hot Tub EA $ 7,287.50 $ - $ - Inground Pool EA $ 19,430.40 $ - $ Above Ground Round EA $ 5,472.50 $ - $ Above Ground Oval EA $ 4,635.88 $ - $ - Pool Heater FA $ 8,167.50 $ Inflatable Type Pool EA $ 1,542.42 $ - - SHEDS wlo electrical SF $ 18.50 $ - w1electical SF $ 18.50 $ - $ - RENOVATIONS Roofing, Overlay SF $ 3.38 $ - Roofing, Ship & reroof SF $ 3.76 $ - , Roof Sheathing SF $ 1.19 $ Siding SF $ 2.30 $ - Windows EA $ 423.50 $ Skylights EA $ 955.54 $ - Doors, EAerior EA $ 401.50 $ - Oil Tank, 275 Gallon EA $ _ Oil Tank, 550 Gallon EA $ MISCELLANEOUS CALCULATIONS TOTALS $ 28,909.51 3 - $ 1,325.94 $ 2,673.98 PERMIT FEE CALCULATIONS Construction Value Fee Building $ 28,910.00 $ 232.00 Plumbing $ $ Mechanical $ 1,326.00 $ 16.00 Electrical $ 2,674.00 $ 24.00 Working before Permit Issuance $ Certificate of Occupancy Fee $ 10.00 Plan Review Fee $ 27.24 State Education Fee $ 5.27 TOTALS $ 32,910.00 $ 314.47 Figures are based on the 2006 RS Means Residential Cost Data State of Connecticut Workers' Compensation Commission - Please TYPE or PRINT IN INK ' Proof of Workers' Compensation Coverage when Applying for a Building Permit for the Sole Proprietor or Property Owner who WILL NOT act as General Contractor or Principal Employer Applicant for Building Permit Name of Applicant for Building Permit Property located at + ft/U/U 4VE In the City / Town of Vl C S(//~ L C 7 D K-3 9_~ If you are the owner of the above-named property or the sole proprietor of a business doing work on the site of the construction project at the above-named property and you WILL NOT act as the general contractor or principal employer, you are not required to have workers' compensation insurance coverage. CHECK ONE (1) BOX ONLY and complete the following: 'A I am the OWNER of the above-named property. I WILL NOT act as the general contractor or principal employer. Signature of OWNER Applicant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ I am the SOLE PROPRIETOR of a business doing work at the above-named property. I WILL NOT act as the general contractor or principal employer. Name of Business Federal Employer ID# (FEIN) Signature of SOLE PROPRIETOR Applicant .r r Town of Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030, Ext. 382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL Property Address Job Description The applicant is responsible for obtaining all of the required approvals checked off on this form. No building permit will be issued until all of the required signatures have been obtained. Required Department Permit Issuance Approval Approval Tax Collector `";,,-A s s Si.gnaaki die Comments: WPCA, Administrative Sigiia.ture/ date Comments: ❑ WPCA, Technical Sitlnaftffe/ date Comments: Planning & Zoning 1 rr. 9):;;.CZ M J OV1 1 t c~~ L6 Exatu:re/ date ~rt Ac4(L Gy\1~1 h,L 6-Aznef-1k (y-) ~rn1Ca~ Cz,~Ot Comments: ❑ Health Department Signa.tl.ire/ (late Comments: ❑ Department of Public Works Signaturef" date Comments: ❑ State Dept. of Transportation Sigiiawre/ date Comments: ❑ Fire Marshal signature date Comments: 4Z v OdAup& S, 2005