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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: 82008-0614 Date: 24-Dec-08 Map/Lot: 109/074-000 Owner ID: 96000
(Project Location: 16 ANN AVENUE Unit:
]lob Description: Framed in Porch & Finished
Owner Name: Cathy Chen Tenant Name: N/A
Careof:
16 Ann Ave
Uncasville CT 06382- Telephone:
Contractor Name: Home Owner Telephone:
DBA: Lic/Reg Type:
Lic/Reg No: 0
Exp Date:
Construction Value Permit Fees Construction Information
Building Value: $1,200.00. Building Fee: $32.00 Use Group: IRC
Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 2005 State Building Code
Mechanical Value: $0.00 Mechanical Fee: $0.00
Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: IRC
'Total Value: $1,200.00 Penalty Fee: $0.00 Permit Code: R4
C of 0 Fee: $0.00 Comments:
Plan Review Fee: $0.00
State Ed Fee: $0.22
Total Fee Paid: $32.22
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 ❑ R Plumbing and leak test
❑ Deck Piers ❑ 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
❑ Framing ❑ R HVAC
❑ Masonry Fireplace Throat or Chimney Thimble ❑ Gas Piping and leak test
❑ Fireblocking -Draftstopping PE IO RE UIRED UP COM LETI N
❑ Insulation ❑l 'ficat of roval
rtifi f Occupancy
J GGZ
Building Official's Approval:
Town of Montville
Building Department
310 Norwich-New London Tpke.
Tel. 860-848-3030, F)ct 382 Uncasville, CT 06382 Fax. 860-848-7231
RESIDENTIAL PERMIT APPLICATION FORM Permit No.: ro
Type of Work Occupancy Type Permit T e
0 New Construction Single Famlly Buiiding
❑ Addition ❑ Two-Family Plumbing
Witeration ❑ Townhouse 0 Mechanical
❑ Accessory Structure ❑ Electrical CRS#:
Property Address: 16 (Number) (Street) (Unit)
Job Description: G losA ukKzAl Qgmai~ ,ate fr.Lm e l -t,-t 96c'c, e
Owner. C Pct ~j Ctt A,~
Address: 6
l 44 C AS V i L L E State: C Zip Code: D X30 - Telephone ( ) - a
Applicant: C G
DBA:
Address: GN
City: State: cT Zip Code: D610 Telephone ( r~~ } _2 SS - 0417
Contractors - Complete the Following:
License Type: License No.: Expiration Date:
I hereby certify that the proposed work will conform to the State Building Code and all other codes as adopted by the State of Connecticut and the Town
of Montville and further attest that the oroposed wor* is aufodked by the owner in fee and that i am aulhor&ed to make aopfication for a
permit for such work as described above.
0 By checking this box, l will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Code,
instead of the electrical requirements in chapters 33 through 42 of the Residential Code. J
Owner /Agent Signatu i ~ Date:. 1244
Construction Value Permit Fees
Building Value. ~c p Building Fee:
Plumbing Value: Plumbing Fee:
Mechanical Value: Mechanical Fee:
Electrical Value: Electrical Fee:
Total Value: Penalty Fee:
C of 0 Fee:
Plan Review Fee:
State Ed Fee:
Total Fee:
'[ngrrst z.T. 2007
Town of Montville
Building Department
File Receipt
Date: 05-Dec-08
Receipt No: 4125
Received From: Cathy Chen
Job Address: 16 Ann Avenue
Fees Collected State Educational Training Fee
Cash: $0.00
Cash: $0.00
Check: $32.22
Check: $0.22
Check No: 687
Short/Over: $0.00
Construction Value: $1,200.00
Demolition Value: $0.00
Received By Carmen Roberts
Address: 16 Ann Avenue
ITEM OTY $/UNIT TOTAL
Building Plumbing Mechanical Electrical
BUILDING AREA
New Construction SF $ 113.03 $ - $ _
Basement, Finished SF $ 22.96 $ - $ _
Basement, Unfinished SF $ 12.40 $ - $ _
Crawl Sapce SF $ 9.30 $ -
Interior Renovations SF $ 35.09 $ - $ _ $ _
MANUFACTURED HOMES
Ground Anchors SF $ 6.45 $ - $ - $ _
Basement SF $ 12.41 $ - $ _ $ _
Crawl Space SF $ 9.31 $ - $ _ $ _
AMENITIES
Kitchen EA $ _ $ _ $
Full Bathroom EA $ _ $ _
Half-Bathroom EA $ _ $ _
GARAGE
Attached SF $ 54.35 $ - $ _
Detached SF $ 69.53 $ - $ _
Under SF $ 10.03 $ - $ _
Carport SF $ 19.89 $ -
MECHANICAL
Warm-Air n YIN $ _
Hot Water n Y/N $ _
Electric n Y/N $ _
Air Conditioning n Y/N $ -
ELECTRICAL SERVICE
Upgrade Amps $ _
Overhead, new Amps $ _
Underground, new Amps $ _
Subpanel EA $ 599.50 $ _
Gen Set EA $ 3,850.00 $ _
SOLID FUEL BURNING APPLIANCES
Prefab Metal Fireplace EA $ 6,497.70 $ -
Masonryw/lfireplace EA $ 7,096.65 $ -
Masonry w/2 fireplaces EA $ 11,095.70 $ -
Wood Stove, free standing EA $ 2,692.25 $ -
Woodstoveinsert EA $ 1,859.77 $ -
DECKS, PORCHES, SUNROOMS
Deck SF $ 43.07 $ -
Porch SF $ 149.38 $
Sunroom SF $ 176.90 $ - $
POOLS & HOT TUBS
Hot Tub EA $ 8,016.25 $ - $ _
Inground Pool EA $ 21,373.44 $ - $ _
Above Ground Round EA $ 5,099.46 $ - $ _
Above Ground Oval EA $ 6,019.75 $ - $ _
Pool Heater EA $ 8,984.25 $ -
Inflatable Type Pool EA $ 1,550.00 $ -
SHEDS
w/o electrical SF $ 20.35 $ -
w/electrical SF $ 20.35 $ - $ _
RENOVATIONS
Roofing, Overlay SF $ 3.00 $ -
Roofing, Strip & reroof SF $ 4.00 $ -
Roof Sheathing SF $ 1.31 $ -
Siding _ SF $ 3.50 $ -
Windows EA $ 500.00 $ -
Skylights EA $ 1,051.10 $ -
Doom, Exterior EA $ 601.50 $ -
Oil Tank, 275 Gallon EA $ _
Oil Tank, 550 Gallon EA $ _
MISCELLANEOUS CALCULATIONS $ 1,200.00
TOTALS $ 1,200.00 $ - $ $ _
PERMIT FEE CALCULATIONS
Construction Value Fee
Building $ 1,200.00 $ 16.00
Plumbing y $ _ $ _
Mechanical y $ $ _
Electrical y $ _ $ _
Working before Permit Issuance y $ 16.00
Certificate of Occupancy Fee $ _
Plan Review Fee $ _
State Education Fee $ 0.22
TOTALS $ 1,200.00 $ 32.22
Figures are based on the 2006 RS Means Residential Cost Data
State of Connecticut =
Workers' Compensation Commission -
Please TYPE or PRINT IN INK
gr
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 . Building
Permit
Name of Applicant for Building Permit ~~T 7r77 Cif oU
Property located at r &V fT'
in the City !Town of / ` ~'/1J 7~1C
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:
U-11 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
o Town of Montville
Building Department
310 Norwich-New London Tpke.
Tel. 860-848-3030, Ext 382 Uncasville, CT 06382 Fax. 860-848-7231
CONSTRUCTION PERMIT APPROVAL
Applicant is responsible for obtaining all of the required approvals. No permit will be issued until all the required signatures are obtained.
(o Ann -A1c
Property Address
oj'sh
Job Description
- Required for all permits At least one required for all permits ❑ - Required as indicated below
Required Department Permit Issuance Approval
Approval
® Tax Collector a1 sl d g
v Signature/ date
Comments:
® Planning & Zoning
_ Signature/ date
Comments:
® Fire Marshal
Signature/ date
Comments: L ( t' I:
® Health Department
Required for properties with septic systems - Not required for Plumbing. Electrical. Mechanical Roofing, Siding Windows & Doors
Signature/ date
Comments:
V WPCA, Administrative
Required for properties gn sewer
Signature/ date
Comments:
❑ WPCA, Operations
When Required by WPCA Signature/ date
Comments:
❑ Department of Public Works
Required when oroiect includes driveway work or certain drainage requirements Signature/ date
Comments:
❑ State Dept of Transportation
Required for Structures over 100,000 sg ft or with more than 200 parking spaces Official copy of STC Certificate of Operation required per
CGS 14-311
Signature/ date
Building Department Review Complete
Signature/ date
RFvrsuf. CW=6Vr5, 2008