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TOWN OF MON TV I LLE'
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
_
Permit No. J~J 6 Date 2/-& Z2
00
Estimated Cost ~ DD• oU Fee -7g" ~
Owner Address 2a, r Tel e. -~3
Contractor Address Tele.
Location of Building Zone No.
Additions & Alterations (Including moving, demolition, sign erection)
New Building - Type of Construction
Size Type of Heat Fireplace
No. of Stories No. Rooms Breezeway
No. Baths Garage Use
I hereby certify that 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 statements herein contained are true and correct.
Signed s Approved '
Date Building Inspector = r ~t
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Inspections For:
Footings
Framing
Rough Wiring
Electric Service
Rough Heating
Fireplaces
Other Misc. JA~ A lc~
Final Inspection for C.O.
Approved Rejected Signed