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TOWN OF MONTVILLE
BUILDING DEPARTMENT
310 NORWICH-NEW LONDON TPKE.
UNCASVILLE, CONNECTICUT 06382
. eL 860-848-7166 Fax 860-848-7231 Page: 1
rU1ldI4 g Perm) Printed: 8/16/99
Permit Number: BP1999-245
Approved:
Applicant: Arthur W. Lewis Zoning:
,9 Azalea Lane Addition:
Uncasville, Ct 06382 Block: 030 Lot(s): 076-000
Parcel Number: PARC1999-389 Section:
9 Azalea Ln. Township:
Uncasville, Ct 06382 Range:
Area:
Legal Description:
Builder Tollis Construction
, 28 Vance Street Voice: 860-826-7288
New Britian, Ct 06052 Fax:
Local License: State License: 558437
Fees and Receipts:
Number Description Amount
FEE1999-1350 Building Permit Fee (Auto) $16.00
FEE1999-1351 Trades 2000 $10.00
FEE1999-1352 Plan Review Fee $1.60
FEE1999-1353 State Educational Training Fee $0.38
FEE1999-1354 Certificate of Occupancy Assessory structure $10.00
Fees Total: $37.98
Construction Value: $3,000.00 Structure Use: Residential Start Date: 0/0/00
Purpose: above ground pool w/safety gate End Date: 0/0/00
Floor Areas Impervious Surfaces
Living Space: 0.00 Basement/Storage: 0.00 House: 0.00 Porch/Walk: 0.00
Garage: 0.00 Porches: 0.00 Garage: 0.00 Other: 0.00
Decks: 0.00 Other: 0.00 Driveways: 0.00 Total: 0.00
Total Area: 0.00
Site Area: 0.00 Structure Area: 0.00
Percentage of Site:
Building Officials Signature Date
R PwLondo wn of Montville
uilding Department310 Norwich-N Tpke., Uncasville, Ct. 06382 Tel. 848-7166
APPLICATION FOR BUILDING PERMIT OR TRADES PERMIT, Please fill out completely
Owner: 0,tAt4rz-t_ yw_'e_ ~ Mailing Address: &a~Gc o~~
city: f 4nCaA-'11 per[` Stater Zip Code Tel : 1L74` ~
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Job Location: 11qAaA4 Map/Block/Lot: /'5Z4 cb
Contractor: tS f &5oC-1A6_ 5 Mailing Address : ,;?L)_),j,,Z4 .
City: a~7ho State: 01. Zip Code: ~J_~Tel:%
Stick Built: Modular Home: Manufactured Home: Commercial:
Addition: Garage: Car Port: Shed: Remodeling: Roofing:
Siding: Fireplace: Chimney: Windows: Pool: Demolition:
Plumbing: Heating: Electrical: Air Conditioning: Gas: _
Patio: Porch: Deck: Retaining Wall: New: Repair/Replacement:
Job Discription/Materials used:
Size: _c Type of Heat: Fireplace:
No.of Stories: No. Rooms: Breezeway:
No. Baths: Garage: Use:
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 Signature Date
If signed by Contractor, type of license/registration &-No:
Building Department Use Only
Construction V 1ue Fee
Building
Plumbing
Heating
Electrical'
Air Cond.
Other
Certificate of Occupancy
Plan Review Fee
State Education Fee
Total Fees ~3 7. t
Cash/Check x,09
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ZONING PERMIT
ZONING PERMIT NUMBER OR JON/A EXPIRATION DATE
PROPERTY LOCATION MAP LOT
PROPERTY OWNER
CONTRACTOR C t'%11'~i~v CONTRACTOR LICENSE #
CONTACT ADDRESS tOGe~t.~r [ CGS e TELEPHONE
ZONE / LOT AREA
PERMIT REQUEST Gam, AZ
IT IS THE APPLICANT'S RESPONSIBILITY TO FURNISH THE FOLLOWING INFORMATION:
A SKETCH, OR PROVIDE TWO COPIES OF PLANS DRAWN TO A SCALE OF AT LEAST 1" 40' SHOWING: DIMENSIONS OF
THE LOT, THE SIZE, AREA, AND LOCATION OF EXISTING, PROPOSED, PRINCIPAL AND ACCESSORY STRUCTURES,
DRIVEWAYS, SANITARY FACILITIES AND WATER SUPPLY, PARKING FACILITIES, AND ADJACENT STREETS; DISTANCES OF
PROPOSED STRUCTURES FROM PROPERTY LINES AND WETLANDS. A PLAN PREPARED BY. A CONNECTICUT
REGISTERED LAND SURVEYOR MAY BE REQUIRED. THE PROPOSED USE SPECIFIED ABOVE SHALL NOT BE AUTHORIZED
UNTIL AN ACTUAL CERTIFICATE OF COMPLIANCE IS ISSUED BY THE COMMISSION OR ITS APPOINTED AGENTS.
SKETCH PLAN OR GRADING PLAN ❑YES ❑N/A
HEALTH DISTRICT APPROVAL ❑YES ❑N/A
STATE HIGHWAY PERMIT ❑YES ❑N/A
WETLANDS PERMIT ❑YES ❑N/A
HAS A VARIANCE EVER BEEN GRANTED FOR THIS PROPERTY ❑YES ❑NO
HAS BOND BEEN FILED ❑YES ❑N/A
FEE ❑ CASH Q CHECK # ❑ N/A
THE APPLICANT IS RESPONSIBLE FOR AND AGREES TO:
1. ADHERE TO ALL THE APPLICABLE REQUIREMENTS OF THE ZONING REGULATIONS.
2. FURNISH ALL NECESSARY INFORMATION AND DOCUMENTATION TO PROCESS APPLICATION.
3. NOTIFY THE COMMISSION OR ITS APPOINTED AGENT OF ANY ALTERATION IN THE PLANS.
4. CALL FOR FINAL INSPECTION AND REQUEST CERTIFICATE OF COMPLIANCE BEFORE ISSUANCE OF C. O.
APPLICANTS SIGNATURE DATE: ii / z / ZZ
9 /
COMMISSION AGENT DATE CERTIFICATE OF COMPLIANCE DATE
THIS SIGNED PERMIT AUTHORIZES THE APPLICANT TO PROCEED TO THE BUILDING DEPARTMENT FOR ANY REQUIRED PERMITS
CONTACT THE ZONING OFFICER (848-8549) AT LEAST 24 HOURS BEFORE
CONSTRUCTION BEGINS TO ALLOW ZONING OFFICER TO INSPECT
LOCATION.
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