HomeMy WebLinkAboutSFR Electrical Town of Montville
Building Department
310 Norwich-New London Tpke . , Uncasville, Ct . 06382 Tel . 848-7166
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APPLICATIONIO�� FOR BUILDING PERMIT OR TRADES PERMIT, Please" fill rout completely
Owner : ,y/'//111(� e S gJ/L19 S Mailing Address : Av txx _3Qk 3
City: /Z1=b) State : C/ Zip Code CDIMO Tel a(1j-g7Si
Job Location: 40 / r--k"h4 41D// Map/Block/Lot : C9O2 _ 66
Contractor : Z de(5 6 eC-6eir (fL C - Mailing Address : Po goX E77
City : b70Fe- State : C 7 Zip Code: 0.0,3 3rel :
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Stick Built : Modular Home : Manufactured Home: Commercial :
Addition: Garage: Car Port : Shed : Remodeling : Roofing : _
Siding : - Fireplace : Chimney : Windows :, � Pool : Demolition :
Plumbing : Heating : __ Electrical : L� qir Conditioning : Gas :
Patio : _ Porch : Deck : Retaining Wall : New : Repair/Replacement :
Job Discription/Materials used:
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Size : Type of Heat : Off
Fireplace:
4o. of Stories : No . Rooms : Bree�.�::ay : _
1o . Baths : Garage : Use :
I hereby certify that the proposed work will conform to the Basic
Wilding Code and all other Codes as adopted by the State of Connecticut , and
:he Town of Montville and further attest that the proposed work is authorized
_ur the owner in fee and that I--am authorized to make application for a permit
or such work as described above.
wner/Agent Signature 9'ti Kerdtt,6 Date
f signed by Contractor , type of license/registration & No: E/0/95a_
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Building Denartm nt 11•,0 ,).,
Construct _on_ Value Fee
Building
Plumbing
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Heating
Electrical
Air Cond . •
Other
Certificate of Occupancy
Plan Review
Total
Cash/Check