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TOWN OF MONTV I LL
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Permit No. Date
✓ r~
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Estimated Cost ~L Fee /
Owner ( %"l t~ Address / w,4-Ae- Tel e. Contractor ✓,~l f Address ✓6, 99 1,6 Tele. :~;Sl'-312
Location of Building 42,Zone No.
Additions & Alterations (Including moving, demolition, sign erection) ov-en
1/7
New Building - Type of Construction
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 contained are true and correct.
Signed Gtr Approved
Date Building Inspector
Inspections For:
Footings
Framing
Rough Wiring
Electric Service
Rough Heating
Fireplaces
Other Misc.
Final Inspection for C.O.
Approved eo~) Rejected Signed
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