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TOWN OF MONTV I LLE'
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Permit No. &IS Y 6 Date
Estimat Cost Fee
Owner ddress Tel ate-
Contrac or 09
Address ~E Tel e Location of Building Zone No.
Additions & Alterations (Including m v ng, de lition, sign erection)
New Building - Type of Cons action
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 ontained are true and correct.
Si9ned Approved
Date Q/ a2 / Building Inspector
Inspections For:
Footings
Framing
Rough Wiring
Electric Service
Rough Heating
Fireplaces
Other Misc.
Final Inspection for C.O.
Approved Rejected Signed