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TOWN OF MONTV I LLt'
BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Permi t No. Date
Estimated Cost Fee
Owner Address Tele. D.3
Zt4-~
Contractor U Address Tele.,
jAi-
Location of Buil V*ngQ - o? n No.
Additions & Alterations (Intl ding moving, demolition, sign erection)
ew Buildi Type of Construction G~Size Type of Heat
i~ 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
Building Inspector
Date------- - -
Inspections For:
Footings
Framing
Rough Wiring
Electric Service
Rough Heating
Fireplaces
Other Misc.
Final Inspection for C.O.
Approved Rejected Signed_