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Home My WebLink AboutSFR " OWN OF. MONTV I LLE BUILDING DEPARTMENT APPLICATION FOR BUILDING PERMIT Permit No. Date ` Estimated Cost Fee D Owner fV c1cxa L co Address a~'u ~ 0 e1 e. ' Contractor, V Address "Tel e. a ~5 Location of Building Zone No. Additions & Alterations (Including moving, demolition, sign erection) i /V r New Building - Type of Construction ` Size 'type of Heat Fireplace No,, of Stories No. Rooms Breezeway No.. Baths / Garage 1(14 A -D~ 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 grt Approved Date Building Inspector Inspections For: Footings Framing Rough Wiring Electric Service Rough Heating Fireplaces Other Misc. Final Inspection for C.O. Approved -Rejected_ Signed P60 Vt t ~ h~V I pA~F6`d, ~ 'fo d ~5 4 ~f E ,K"1 IZI 0 v k ga i~ P f fi f ~Date Recei,' at PFS 3 ADDITIONAL OR MODIFIED MODEL ACCEPTANCE This form is to be used only when the manufacturer is seeking acceptance of an additional model, modified model or model name change which uses a previously accepted building system. Previous PFS Building System Acceptance Model Name Manufacturer's Name Plant(s) at which model will be produced Check Two: MOBILE M NON-MOBILE. D NEW MODEL ~ MODIFICATION TECHNICAL DATA (Submit 2 copies of this form and all data). Submit 3 copies for Mobiles). Floor Plan Showing: Conforms Yes No Building Size Room Sizes Light & Ventilation Exit Requirements Electrical Outlet Spacing & Smoke Detector Shearwall Location (When applicable) Heat Loss Calculations: Include furnace size and model Electrical Load Calculations: Electrica:. service size and location Submit model to the following states: Description of lfodification - - * Submitted by Date 5 FOR PFS USE FEB 4 '8b Reviewed and Approved By Date Remarks THIS FORM SHALL BE FILLED OUT COMPLETELY WITH EACH MODEL ACCEPTANCE OR -j MODIFICATION, PRIOR TO SUBMITTAL TO PFS. x This certifies that the attached building plan meets the Federal Mobile Hame Construction and Safety Standard it-. f•~rce at this in (mob ile.s;on1y) PFS Form M R-74 Revised *9/30/83* cc: CT. ZONING PL- . SIT: # EXP IRAT 1UN DATE- SUBMITTED DATE Ppplicant Af:;';~ ~ Property owner -f_~r s ; •i ~r• 4 !.i f(~=E., /~,h~._._ t` t,,,,.,,,;_~`;'z~. c i ~ f ~f ~j>l to Applicant's Address/Telephone Nurber~-~ - l-e- Property location including Assessor's Map and Lot nurbersSubdiv itceision44 4.> ~zc Name Building i-!eight Lot Area Zone -r- t livable - Total. Floor area of Structures after_~v_elopment s Sign Area if APP Nature of Request/Proposed Use: -r'~~.~.,~:;,f'~~~,>~,G<• This application, and two copies thereof, including plans drawn to a le of at leeaa~ =Y 4stshow`innes, driveways ,f t_r lot, the size, area, and location on the lot of existing, proposed, principal ~c~r) erty sanitary facilities and water supply, parking facilities, and adjacent streets. Distances of structures from prop500 incIn the luded. case'of lines and centerlines of public roads must also ieindicate. Any otherlre9uJ-ationslforrspecific(usesrrrus cubic yards) dimensions of fill area and cubic yards must b also be mTlied with. A plan prepared by a Connecticut Registered Land Surveyor may be required. The applicant guarantees that all the applicable requirements of'the Zoning Regulations will be adhered to. In add!11i,o, int.ed a t of any alteration in the plans. Application for the applicant agrees to notify the Carm ission or its appo San the use of which shall not be auttiurizc;~ a Certificate of Use and Conpliance for the use specified above is hereby made, until an actual Certificate of Use and Corpliance is issued by the Comnission or its appointed agent. This permit authorizes the plicant t;'proceed to the Building Departrment for any requisite permits. 17 Conrom ion Ag~ Lion/Dale / Applicant - - - - - - - - - - - - - - - - - C r- - - - - PLAN (Attach if Necessary) / J S C art 6-L'-~ l o~ ,ooo~ f 416, 0 S. \ _ v -o, • 2 Q 1 o~`rod d, 111 ~d 2 , - ;t CONSUMER PROTECTION WELL DRILLING' BOARD ~ STATE OF CONNECTICUT PERMIT NUMBER CPR-8 REV. 11-82 DEPARTMENT OF CONSUMER P ROT `ION 130490 WELL DRILLING PERMIT 165 CAPITOL AVE., HARTFORD, CONNECTICUT 06,106 4vAj L I.ON OF WELL (Town) (Street) 7Tot Number) DATE OWNER OF WELL INDIVIDUAL BUILDER OTHER (Specify) OWNER'S ADDRESS BUSINESS TEST Est. No. of PROPOSED DOMESTIC ESTABLISHMENT FAQ' LJ WELL People being USE OF served. WELL CI SUPUBLIC AIR PPLY E] INDUSTRIAL CONDITIONING El (Specify) SKETCH OF WELL LOCATION - Locate well with respect- to a, least two roods, showing distance from ,terse pan arid front of lot Loca!lon of lot to at least two roads Well location on lot and to house (if present) 01;7 Indicate North It Loll 16 Nil A ,d "7 10 ANN Av_ ApproxEmote number of feel from well to nearest source of possible contamination f The undersigned is aware shot upon completion of the well, a "Well Comp!etton Repor'" containing construct ~n°defatls and informationrequired under Section 25131 of the 1969 Supplement to the General Statutes most - be sent to the ovine,, the Board and the Water R- ~rceys omission bn the form provided by the - Board. This permit is not valid until all information is filled in and it has been ounier R s~nV a4,%-r of ;W e rA~ APPLE (S' iraturt APPLICANT'S ADDRESS gg aux 303 REGISTRATION NO. R ► TQG77 BY (Town He h Officer or gent) ° - DATE APPROVED.,g REJECTED REMARKS t., DIRECTOR OF HEALTH WELL COMPLETION REPORT STATE OF CONNECTICUT Do NOT fill in CPR-9 REV. 11-e4 DEPARTMENT OF CONSUMERPROTEL JN STATE WELL NO. WELL DRILLING BOARD 165 CAPITOL AVE. OTHER NO. HARTFORD, CONNECTICUT 06106 NAME ADDRESS OWNER ss s i t. 'z T F'+q o.s awt rt tt4o. 8 Street) . ' (Town) (Lot Number) LOCATION OF WELL BUSINESS TEST WELL I PROPOSED DOMESTIC ESTABLISHMENT FARM USE OF OTHER WELL ❑ SUPPLY ❑ INDUSTRIAL 0 CONDITIONING F(Specify) CABLE , . OTHER DRILLING COMPRESSED PERCUSSION PERCUSSION (Specify) EQUIPMENT D ROTARY AR LENGTH DIAMETER (inches) WEIGHT PER FOOT IV H WAS CASING GROUTED? NO CASING ~,fee t) 7 . THREADED ~ WELDED YES [ NO ~ YES DETAILS ci HOURS YIELD (GPM) YIELD TEST El BAILED 11PUMPED Fx-]COMPRESSED AIR MEASURE FROM LAND SURFACE-STATIC (Specify feet) DURING YIELD TEST- (feet) WATER De=]=feetobelovv Completed Wellin Land surface: LEVEL r LENGTH OPEN TO AQUIFER (feet) MAKE SCREEN DETAILS SLOT SIZE DIAMETER (inches) IF GRAVEL Diameter of well including GRAVEL SIZE (inches) FROM (feet) TO (feet PACKED: grovel pock (inches): Sketch exact location of well with distances, to at least DEPTH FROM LAND SURFACE FORMATION DESCRIPTION FEET TO FEET two permanent landmorks. ti ~ 'A-5 tF v' If yield was tested at different depths during drilling, list below i FEET GALLONS PER MINUTE i j Y 5 'iP 1 ]j I - t DATE, WELL t„pMPLE ED PERMIT NO. REGISTRATION NO. DATE C,Ffi2EPORTWELL DRILLER x LOCAL DIRECTOR OF HEALTH Qe 9~ LAND EcoScience Laboratory 490 Main Street Norwich, Connecticut 06360 (203) 889-8104 12 vs::::{« I.i.-},_•»y _ {•-e Y. . i. .i. F i { r.. _ s v 5 e t i i ~:i C' j. -f Y . 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