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Home My WebLink About2003 - Combine Two Existing Decks . f "'i tl Town of Montville BUILDING DEPARTMENT 310 Norwich-New London Turnpike Uncasville, CT 06382 (860) 848-3030, Ext. 382 Building Permit Permit Number: B2003-0471 Date: 26-Aug-03 Map/Lot: 081/073-000 Owner ID 7021 Job Location: 43 ECHW~OD ROAD Unit Job Description: move existing deck into 2 decks Owner: Contractor: Sandra Christina Lawrence Lumbert 43 Beechwood Road 43 Beechwood Road Oakdale Ct. 06370- Oakdale CT 06370 Telephone: (860) 848-3090 Lic/Reg Type/No. 0 Exp Date: Tenant: Self Telephone: Construction Values Permit Fees Construction Information Building Value: $1,000.00 Building Fee: $10.00 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: R10 Other Value: $0.00 Other Fee: $0.00 Comments: Total Value: $1,000.00 CO Fee: $10.00 Plan Review Fee: $1.00 State Ed Fee: $0.16 Total Fees: $21.16 It is the owners resnonsibillity to schedule the following insp ion (minimum 48 hours notice required): ❑ 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 ❑ Final Inspection ❑ Rough plumbing and leak test Certificate of Occupany ❑ Gas piping and test Building Official's Signature: Town of Montville Building Department _ Permit # 310 Norwich-New London Tpke. Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 One & Two Family Building Permit Application Form New Construction ~ Addition FlAlteration n Accessory Structure E]Other Job Location g5,~70 Job Description/Material Owner Mailing Address -1113 Z,066114100,r State 47'_ Zip Oe!!;3 0 Tel K0 / 019 / 307 0 Contractor 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. Owner /Agent Signature ~~-cam G Date/ U~ / Construction Value Fee Building $~i% $ Plumbing $ $ Mechanical $ $ Electrical $ $ Other $ $ Certificate of Occupancy $ _ Plan Review Fee $ State Education $ Total $ - (See Reverse side for additiowl requirements) F Town of r - -intville Building, DepartmF Receipt No. f Date t From: 44 f { Job Address:` rCash ,,/Check Amount Check # (circie onc) # Permit 7/l Received by E STATE OF CONNECTICUT y WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at: ~13 OzY70 In the town of ~M~-2W Z Name of building permit applicant: Please check one: 1. P' 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 (FEN 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 check one: 1. ,4 I do not intend to act as a general contractor or principal employer. [Sign and st 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 will require proof of workers' compensation insurance for every contractor, subcontractor, or other worker before he/she engages ' work on the above property in accordance with the Workers' Com ensation Act (Chapter 568). I understand that purs to § 31-275 C.G.S., officers of a corporation an artners in a partnership may elect to be excluded from coverage filing a waiver with the appropriate District O ; and that a sole proprietor of a business is not requir to have c ge unl files his intent to accept covera Signature of applicant Subscribed and sworn to before me this day of , 200_. (Notary Public/Commissioner he Superior Court) g Town of Montville Building Department 848-3030, Ext 382 ONE & TWO FAMILY CONSTRUCTION PERMIT SIGN-OFF SHEET Property Address Job Description: gpar~4 The owner/agent shall be responsible for the completion of the form, no certificate of occupancy will be issued until all signatures below have been obtained. HEALTH DISTRICT 848-3030-339 Approved Not Permit ❑ Permit ❑ Required Septic System Date Approved Not Permit ❑ Permit ❑ Required Private Well Date WPCA DEPARTMENT 848-3030, Ext 376 l Approved Not Permit [d~ ❑ Permit Required ,f-~MX4,-~ - unicipal Sewer Date House Trap ❑ Outside ❑ Inside Approved Not Permit ❑ Permit # ❑ Required Municipal Water Date DEPARTMENT OF PUBLIC WORKS 848-7473 Approved Not Permit ❑ Permit ❑ Required Director Date PLANNING & ZONING DEPARTMENT 848-3030. Ext. 379 Approved Not Permit ❑ Permit #:C~~ -ZS J~ ❑ Required Zoning Date Approved Not Permit ❑ Permit ❑ Required Inland-Wetlands Date ax - _ - - - - i f~ # c j ,ti `atey~,~ J ; u`r• cr. ~M / `lI1 Y A~ i .~r ~ 1sNY y • ~ 1. a .x L ...Y A O vS + Y f