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T 0 W N OF MONTV I LLF
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Permit No. .3'79 Date 69 zip)
Estimated ost Fee- L-5
Owner 19 Address Tel
10/ 67 j
Contractor Address Tele.
Location of Building Zone No.
Additions & Alterations (Including moving, demolition, sign erection)
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 Approved
Date BCD N: Building Insp or
Inspections For:
Footings
Framing
Rough Wiring
Electric Service
Rough Heating
Fireplaces
Other Misc.
Final Inspection for C.O.
Approved /f Rejected Signed