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TOWN OF MONTVILLE
Building Department
848-7166
APPROVED BUILDING PERMIT OR TRADES PERMIT
Far 180 Days
Permit No: 10426-H Approval Date: 10/13/92 Expiration Date: 4/13/93
Estimated Cost: 4,400.00 Fees: 28.00 PRF: C.O:
Owner: Peter Keramidas Address: 10 Azealea Lane Tel:
Job Location: 10 Azealea Lane Code: 06
Contractor: S.L.S. Heating Address: P.O. Box 424,Wtfd. Tel: 447-8709
Stick Built: x MModular,Home: Manufactured Home: Commercial:
Addition: Garage: Car Port: Shed: Remodeling: Roofing:
Siding: Fireplace: Chimney: Windows: Pool: Demolition:
Plumbing: Heating: x Electrical: Air Conditioning: Gas:
Patio: Porch: Deck: New: Repair/Replacement: x
Type of material used/discription: remove electric heat and install gas fired
boiler and baseray heat - w/power vent
Size: 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. - i' _
Applicant's Signature: Date:
type of 1' ense/regist a n & No:
If signed by Contractor,
Building Official's Signature: ate:
Date of Health Dept. Approval:
Date of Zoning Approval:
THIS IS TO INFORM YOU THAT UNDER THE CONNECTICUT AMENDMENT OF THE
BUILDING CODE, SECTION 119.1 A CERTIFICATE OF OCCUPANCY IS REQUIRED PRIOR TO
ANY USE OF THE STRUCTURE.
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~e TOWN OF MONTVILLE
Building Department
p lication for a Permit C
Tel:
Address:
Owner:
Job Location: Tel:
Contractor:
Address: Tel: Home: Manufactured Home:
commercial:
Stick Built: Roofing: Car Port: Shed: Remodeling:
Addition: Garage:
_ Pool: _ Demolition:
Windows:
Siding: _ Fireplace: _ Chimney:
Air Conditioning: Gas:
Plumbing: _ Heating: Electrical:
New: Repair/Replacement:
Patio : Porch : Deck ~GfZ-®W
fi
Type of Material to be used/job description:
~t7?'o P7
Type of Heat: ~S Fireplace:
Size: Breezeway:
No. Rooms:
No.of Stories:
Use:
Garage:
No. Baths: