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HomeMy WebLinkAboutSFR Plumbing Town of Montville Building- Popartpient 310 Norwich-New London Tpke.' Tel. 848-3030, Ext 382 Uncasville, CT 06382 Fax. 848-7231 Residential Trades Permit Application Form Permit # -71-1 ,Plum6ing ❑Electrical ❑5Wechanicaf C VU # Meating _Air Conditioning Gas Wiping Singre Tamify ❑ Two-Tamify. ❑ Townhouse Job Address 1 2- A l Boe.> IdA-d ©(Number) (Street) (Umt) Job Description Owner bAy i l Q &c,,,,/ Mailing Address City State Zip Tel Contractor?lu v► i►-e_ me k~nz,,., Mailing Address City i Il ~S State Zip 0,x,77 'z. Tel GO / 0ozz Contractor's License Type & Number &~,-,Y c Exp. Date W I hereby certify that the proposed work will conform to the Basic 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. Owner /Agent Signa 4e~=s _ 4-,,') Date Z / Z l V3 f Construction Value Fee Plumbing 12,00,P,` $ $ Mechanical $ $ Electrical $ $ Work commencing before the issuance of a permit $ Plan Review $ State Education $ Total i'z, $ *visedXovem6er1, 2004 PLUMBING & PIPING UNLINIPTE'D CONTRACTOR P1 JAMES E DRISCOLL 360 RAYMOND HILL ROAD UNCASVILLE, CT 06382 LIC. / -RE -G NO. EFFECTIVE E-XPIRE S 204088 11J0005 `10/31/2006 SIGNEDyMe~~??// i Town df Montville Building Department 310 Norwich-New London Tpke. Uncasville, CT 06382 Tel. 860-848-3030, Ext. 382 Fax. 860-848-7231 CONSTRUCTION PERMIT APPROVAL Property Address Job Description The applicant is responsible for obtaining all of the required approvals checked off on this form. No building permit will be issued until all of the required signatures have been obtained. Required Department Permit Issuance Approval Approval Tax Collector /a--- "Ap Signratarc. (,late Comments: ❑ WPCA, Administrative Comments: ❑ WPCA, Technical ; igl.aitffe date Comments: ❑ Planning & Zoning Sigtaatare/ date Comments: ❑ Health Department Signature/ date Comments: ❑ Department of Public Works Comments: ❑ State Dept. of Transportation Sigiiature/ date Comments: ❑ Fire Marshal 8i.gnature;` date Comments: 1§visedAugst 5, 2005