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BUILDING INSPECTION Y..KLB REPORT
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IST: P:;CTIONSi: (DURING CONSTRUCTION)
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INSPECTIONS: (FOR OCCUPANCY)
PLUMBING
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HEATING
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OTHER
FORM NO, BIMO 70-100-5
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TOWN OF MONTVILLE
Department of Public Works
Application for Building Permit
Application & Permit No. . . . . 707 , , , . , , , , , , Date . / �� /
0 /7 3
Estimated Cost .q/400, - Fee
Owner . . . ..i. . . . . . . . . .1. 9.i./0„ . . Address 3 6 f0, ///j- 6.7- 7c
Contractor
. . . ,' Address g.e.5
‘64
Architect Address 444 6g 64-----
Location of Building . .
Zone No. .'
Additions & Alterations (including moving or demolition an gn erection) ,
Newer — Type of Construction
Size /CO X 2 S (S;J71e;,/62-07-42) Type of Heat
No. of Stories /
Fireplace
No. of Rooms
Breezeway
No. of Baths Garage
Proposed Use /51`l77,/ 'L ✓ ezo y�
I hereby certify that the proposed construction will conform to the applicable zoning regulations of the
Town of Mo t.7lle gnd the Basic B ilding Cod of the State of Connecticu
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TSi ed ���: Approved � �
ate -.-17 a Building Inspecto �# -
Form No. BIMO 70-100-1