HomeMy WebLinkAbout2015 - 8x12 Shed Town of Montville
Building Department
310 Norwich-New London Tpke.
TeL 860-848-3030, Ext 382
Uncasville, CT 06382
Fax. 860-848-7231
RESIDENTIAL PERMIT APPLICATION FORM
Permit No.:
Type o_�rk Occupancy Type Permit Type
&New Construction El Single Family
Q Addition ❑Two-Family El BPuilding
ElAlteration ❑ ming
❑Townhouse Mechanical❑
I]Accessory Structure ❑Electrical CRS#:
Job Address: ib PYtt.e
(Number)
(Street)
(Unit)
Job Description: j,, /
C.L . ,^;car?/-
Owner: U g . 0_v1 e Le_l evi(t tr--e-._
Address: at r+l-C2 TT 17_
City: 01 l7 j L/—
State: e Zip Code: UE 3 U
Telephone: &p c{r 7 Gt(7
Contractor: k Lot-pev F .
DBA:
Address: 2((0 w --f?"(-- Z')
City: l= L--1-1 (ZEN L
v State: Zip Code: (_ D Z
Telephone: ?f>O 511-7( Ly _ License Type:YP License No.: Expiration Date:
I hereby certify that the proposed work will conform to the State 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.
X By checking this box, I will follow the requirements of the 2005 NEC as the alternative compliance per section E3301.2.1 of the Residential Code,
instead of the electrical requirements in chapters 33 through 42 of the Residential Code.
. i /._..
Owner/Agent Signature: / .L �
Date:Z j /% e.,_ „c) f
Construction Value
Building Value: �j Permit Fey.
Plumbing Value: Building Fee:
Mechanical Value: Plumbing Fee: l'
Mechanical Fee: �
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Electrical Value: —
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Total Value: Electrical Fee: t t ►
I y/J
Penalty Fee: titallirdr
C of 0 Fee: W t
Plan Review Fee:
State Ed Fee: (. 1/ Ot
Total Fee:
RE'+iserr'cDecemEer31,2005
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Brook Bend
Town of Montville
Building Department
CONSTRUCTION PERMIT APPROVAL
Applicant is responsible for obtaining all of the required approvals. No •ermit will be issued until all the re.uired si•natures are obtained.
Pr -e'rt— � 64 P�4
Property Address
Job Description
Required
Approval Department Permit Issuance Approval
® Tax Collectoru
Signature/date
Comments:
--�� Planning & Zoning /74O /G✓
Signature/date t
Comments:
® Fire Marshal � 42/2O /f/
Signature/date
Comments:
Health Department I , f 2 - '-/S
Required for properties with private septic or well
MWPO'1D z=t-1
Comments:
❑ WPCA, Administrative
Required for properties on sewer Signature/date
Comments:
❑ WPCA, Operations
When Required by WPCA Signature!date
Comments:
(� Department of Public Works
Required when project includes driveway work or certain drainage requirements Signature/date
Comments:
❑ Montville Police Department •
Required for all permits EXCEPT one and two family residential Signature/date
Comments:
❑ State Dept. of Transportation
Re•uired for Structures over 100 000 s..ft or with more than 200 parkin. s•aces-Official co• of STC Certificate of 0•eration re.uired—per
CGS 14-311
Signature/date
Building Department Review Complete
Signature/date
7ZevisedMay 23,2011