HomeMy WebLinkAbout10x16 Shed 2016 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 of Work Occupancy Type Permit Type
❑New Construction g Single Family a Building
Al Addition El Two-Family El Plumbing
❑Alteration
❑Townhouse ❑ Mechanical
0 Accessory Structure 0 Electrical CRS#:
Property Address: /6 5 6'44c ,t 2/ cr aq 4 C 7
(Number) (Street) (Unit)
Job Description: /0X/W O(r ;c, 577 n
Owner: 0-2.to I .9 aet 5•5-t/f
Address:
/'� /Ca 5 �AU !/ 63/4 ,
City: Q? c�q/ State: e / Zip Code:C--c.' 7 7v Telephone(T"' ) ) y.3) - �6 ,
Applicant: (1).,, f /9 /
5-5,
DBA: vf
Address: ->/4z : i2 614
/1 07 /y -
City. Ceil C1aK State:C / Zip Code: 6- 3 /0 Telephone(0pO ) y_ )_ ?6,9-/
Contractors - Complete the Following:
License Type: 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.
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.
Owner/Agent Signature: jZ%��iC�J 4 , �!� �j-hi l
Ci����'' Date: D 7 -/C..:, 1
Construction Value Permit Fees
BuildingValue: \ 1
Building Fee: A
PlumbingValue: r s t� of
Plumbing Fee: . � " / 1 �
Mechanical Value: Mechanical Fee: �J
Electrical Value: Electrical Fee: �!!!I/
Total Value: Penalty Fee: • Y" 1
CofOFee: tit, Lj��� V/
.1
ij
Plan Review Fee: �� �/
State Ed Fee:
Total Fee:
Revised August 23,2037
A
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Town of Montville
Building Department
CONSTRUCTION PERMIT APPROVAL
/6 S 6-3/Uri/ •62ht—r- CIA&f t C ./. 4w 3 /0
Property Address
/G X /(o 6,47€ / S/J7G .
Job Description
Required
Department
Approval Permit Issuance Approval
Hi/ Tax Collector
21/
Comments:
Signature/date
Fire Marshal
Signature/date
Comments:
❑ Planning &Zoning . __ ,_r _
uired for all •ermits exce•t A.7V e,' `gnature/date
• mbinq,Electrical,Mechanical,_Roofi •,S . •,Windows&Doors
f Health Department
47///
uired for properties with private septic or well Signature/date
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:
❑ Copy of State Dept. of Transportation Certificate
Required for Structures over 100,000 sq.ft.or with more than 200 parking spaces-Official copy of STC Certificate of Operation required—per
CGS 14-311
Signature/date
Building Department Final Inspection
QevLced Marrh23,2015
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