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HomeMy WebLinkAbout2004 - Shed Town of Montville` Building Department Date: Field Inspection Notice Permit ~~f~ Address: Not Comments/Corrections Required - re-inspection required: Inspection Approved,. Approved ❑ Footing ❑ ❑ Backfill ❑ ❑ Concrete Slab ❑ ❑ Framing ❑ ❑ ❑ Rough Elec ❑ ❑ ❑ Elec Service ❑ ❑ Rough HVAC ❑ ❑ ❑ Rough Plumbing ❑ ❑ ❑ Gas Line ❑ ❑ ❑ Fireplace Throat ❑ ❑ Chimney ❑ ❑ ❑ Fire/Draftstopping ❑ ❑ ❑ Insulation ❑ ❑ E ❑ Final Inspection ❑ ❑ i ❑ Cof0 - ❑ 57 11.2jC_ Inspector's Signature j 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: 82004-0445 Date: 26-Jul-04 Map/Lot: 096/102-000 Owner ID: 120000 Project Location: 32 BALDWIN COURT Unit: Job Description: Shed 10'x 12' Owner Name: John -3 and Susan E Lombardo Tenant Name: N/A Careof: 32 Baldwin Court Uncasville CT 06382- Telephone: Contractor Name: Property Owner Telephone: DBA: Lic/Reg Type: Lic/Reg No: 0 Exp Date: Construction Value Permit Fees Construction Information Building Value: $3,000.00 Building Fee: $24.00 Use Group: R-4 Plumbing Value: $0.00 Plumbing Fee: $0.00 Code: 1999 State Building Code Mechanical Value: $0.00 Mechanical Fee: $0.00 Electrical Value: $0.00 Electrical Fee: $0.00 Construction Type: 5B Total Value: $3,000.00 Penalty Fee: $0.00 Permit Code: R9 C of 0 Fee: $10.00 Comments: Plan Review Fee: $0.00 State Ed Fee: $0.48 Total Fee: $34.48 It shall be the owners rensonsibility 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. ❑ Footing - Prior to pouring concrete ❑ R Plumbing and leak test ❑ Backfill - Footing drains and waterproofing ❑ R Electrical ❑ Concrete Slab - Prior to pouring concrete ❑ Elec Trench - with conduit installed ❑ Framing ❑ Electrical Service CRS No: 0 ❑ Fireplace Throat - One flue above throat ❑ R HVAC ❑ Chimney- One flue above thimble ❑ Gas Piping and leak test ❑ Firestop Draftstopping ❑ Final Inspection ❑ Insulation © Certificate of Occupancy Building Official's Approval: n Town `of Montville P~~uilding Department 310 Norwich-New. London Tpke. Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential Building Permit Application Form - Permit # New Construction Addition Alteration Accessory Structure Single Family E] Two-family Townhouse Job Address 3 2 'gQL D )AI I fit C'T (Number) (Street) (Unit) Job Description .11 O Xe 12 5 f1'ep Owner J0HW 9P Sos,4j,,i Lofw3yDo Mailing Address 32 gALDrill?1\1 City W40,4SV I CG 6 State ST Zip 06382 Tel 3~O Contractor 6-f LF" Mailing Address S 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.- Date d 7 :/o,4 Construction Value Fee ® 7 ~ Building $ $ Plumbing $~T $ Mechanical $ $ Electrical $ $ Certificate of Occupancy $~2 Plan Review Fee $ State Education $ Total $ (See gZgverse side for adtional requirements) Town of Montville, Building Department Receipt DateNo.o.' 4 From: ! Job Address: Amount Cash CC-hock Check # P Received by Permit # Q Q ~1 STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for PMpgl!y Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: '32 BALI W1W CT In the town of MON T V I LLE. Name of building permit applicant: JOHN & SUSAN Loivt 1?7A JZ V0 Please c eck 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 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 c one: 1. I do not intend to act as a general contractor or principal employer. [Si acid stop here] & V 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 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 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) l Town'of Montville Building Department 848-3030, Ext 382 RESIDENTIAL CONSTRUCTION PERMIT SIGN-OFF SHEET 32 3ALt Wl" G Property Address Job Description: 10 r1 __X F 'F-T- 5H f_ p The applicant is responsible for the completion of the form, no permit will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030, Ext. 339 Approved No Permit ❑ Permit ❑ Required Septic System Date Approved No Permit ❑ Permit ❑ Required Private Well Date WPCA DEPARTMENT 848-3030, Ext 376 Approved No Permit ❑ Permit Required unicipal Sewe6 Date Building Trap ❑ Outside ❑ Inside Approved No Permit ❑ Permit # ❑ Required Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 Approved No Permit ❑ Permit ❑ Required Director Date XPLANNING & ZONING DEPARTMENT 848-3030, Ext. 379 tt Approved No Permit Permit ❑ Required oning Date Approved No Permit ❑ Permit Required Inland-Wetlands Date M ~ r 3 J IIII { t ~°:r 1 1 9 i t z 74, IZQ- I 24' ~ 4' d z ; f r - } t, S €j f