ROOFING BUILDING PERMIT APPLICATION
CITY OF MERIDEN Phone (203) 630-4091
142 EAST MAIN STREET Fax (203) 630-4093
MERIDEN, CT 06450
RESIDENTIAL ROOFING: ____ COMMERCIAL ROOFING: ____
ADDRESS OF PROJECT: ________________________________________________________________
OWNER OF PROPERTY: _______________________________ PHONE: _________________________
OWNERS ADDRESS: ___________________________________________________________________
CONTRACTORS NAME: _______________________________ PHONE: __________________________
CONTRACTORS ADDRESS: ______________________________________________________________
CONTRACTORS LICENSE NUMBER: _____________________ EST COST: _________________________
APPLICIANTS EMAIL: __________________________________________________________________
DESCRIPTION OF WORK: _______________________________________________________________
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NUMBER OF SQUARES: ________ EXISTING (1 LAYER): ________ STRIPPING: __________
CHECK APPLICABLE: HOUSE: _______ GARAGE: ________ SHED: ______ COMMERCIAL: __________
FLAT ROOF: ____ PITCHED: ____ FELT PAPER (lbs): ______ LOCATION OF ICE/WATER SHIELD: ________
SHEATHING APPLIED: ______ CONTRACTOR: YES ___ NO ___ HOMEOWNER: YES ____ NO_____
HAS PROJECT STARTED: YES _____ NO ____?
A COPY OF WORKMANS COMPENSTAION INSURANCE POLICY INCLUDED: YES ___ NO ___
IF “NO” PLEASE SUPPLY STATE ALTERNATIVE WORKERS COMPENSTATION FORM 7A or 7B.
I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner of record to make this
application as an authorized agent and we agree to conform to all the requirements of the laws and codes of the State of Connecticut.
APPLICANT NAME: _______________________ SIGN: _______________________ DATE: __________
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FOR OFFICE USE ONLY BELOW THIS LINE
PERMIT TO: ___________________________________________________________________________
ESTIMATED COST: ______________________________ PERMIT FEE: ______________________
(COMMERCIAL ONLY.) ____________
BUILDING APPROVAL: ______________________ DATE: ____________________
ZONING APPROVAL: _______________________ DATE: ____________________
TAX COLLECTOR: __________________________ DATE: ____________________
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