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TOWN OF MONTVILLE
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Permit No. ~a Date Y/A/7~p
Estimated Cost 0000.00 Fee 00
Owner Address ice" g2g~e Dn , Tel e. ' ~ 739a
Contractor Address Tele.
Location of Building Zone No.
Additions & Alterations (Including moving, demolition, sign erection)
New Building - Type of Construction
Size / i ® Type of Heat Fireplace
No. of Stories No. Rooms Breezeway
No. Baths Garage Use
I hereby certify Vat the proposed construction will conform to the applicable zoning reg-
ulations of the Town of Montville and the Basic Building Code of the State of Connecticut ,
and that all state ents herein contained are true and correct.
SignedG Approved
Date xAzz~p Building Inspector &,o
- -
Inspections For.
Footings
Framing
Rough Wiring
Electric Service
Rough Heating
Fireplaces
Other Misc.
r
Final Inspection fo C.O.
Approved Rejected Signed
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ZONING PLANNING
APPROVED AS NOTED
DATE
ey ZONIN%GOFFICER
SIGNED
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