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Home My WebLink About2001 - Electric Service Town of Montville Field Inspection Notice Permit # T e of Inspection: Location: yP Delivered to: Issued to: ' NOT APPROVED LAPA~PKOVE The The following orders are hereby issued for their correction: Please call for in when corrections have been com I ted 860-848-7166 G By Building Official Date: Town of Montville Building Department Phone: 848-7166 310 Norwich New London Tpke Fax: 848-7231 Building / Trades Permit Permit Number EL2001-63 Permit Date 2/26/01 Permit Type Electrical Permit Code 35 Job Street # 63 Job Location BEECHWOOD ROAD Map/Lot 081/068-000 Job Description Electrical Service Owner Contractor Dak Casagranda Stern Electric Address 63 Beechwood Road Address 43 Senkow Avenue City Oakdale State Ct. City Groton State Ct. Zip 06370 Telephone 848-1994 Zip 06340 Telephone 445-5207 Lic/Reg Number 123469 Uc/Reg Type E1 Exp Date: 10/31/01 Use Group R4 Code 1995 CABO 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 $300.00 Electrical Fee $10.00 Other Value $0.00 Other Fee $0.00 Total Values $300.00 C/O Fee $0.00 Comments: Plan Review Fee $0.00 paid cash - replace entrance cable and meter State Pd Fee $0.04 socket only Total Fees ~-$10.04 Building Official's Sign atur Date -Z- k Z:-? / C It is the owners resnons ility to schedule the followina required inspections (minimum 24 hours notice require ❑ Footings - prior to pouring concrete ❑ Fireplace Throat ❑ Backfill - footing drains and waterproofing ❑ Fireplace Final ❑ Rough Framing ❑ Chimney - one flue above thimble ❑ Rough Electrical ❑ Firestopping/draftstopping B Electrical Service ❑ Insulation ❑ Rough Plumbing and leak zest ❑ Pool bonding ❑ Gas piping - pressure test and installation ❑ Final Inspection ❑ Rough HVAC ❑ Certificate of Occupancy - PRIOR to use or occupancy Town of Montville Permit # 6a~~ 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 ❑,PIfuunbing ❑Mechanical ❑ Addition ❑ Demolition Electrical Heating ❑ Alteration ❑ Other Air conditioning Gas piping Job Location 6S Job Description/Materials -5✓~,~~ r%~'~ ~~'-~ef`~ ~"~Ll~ Owner Mailing Address~~ r ~db27 City State Zip 11 22Te1.-- zf Contractor Mailing Address City ~~a a~~✓ State Zip QeffI,a Tel. &e Contractors License/Registration Type & Number>~ Exp. Date /moo / New Home Construction Contractors: Have you entered into a contract with the consumer for the proposed work? ❑ Yes [o 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. ~ .2 t2 Owner /Agent Si atur Date / / Construction Value Fee Building $ $ Plumbing $ $ Heating $ $ Electrical $ n $ -Zd Air Conditioning $ Other $ $ Certificate of Occupancy $ Plan Review Fee $ State Education Fee $ y Total $ n of Montville Building Department Receipt Tow Date 1 From: Job Address: Chick Check # _ Amount ] Y~ 4 circlcu~c) Permit #~`r~ Sa; Received by s" s. M b STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn. Gen. Stat. § 31-286b) Property located at In the town of ae Name of building permit applicant: Please check one: 1. _ I am the owner of the above property. 2. __jZI am the sole proprietor of a business. 2A. Name of business ~5°ir~-~,•/ r'~~=~~~'~~G 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 check one: 1. ~ I do not intend to act as a general contractor or principal employer. [Sign and stop here] Sign ture app icant 2. _ 1 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)