COMPLETE THIS FORM AND CLICK "SUBMIT"
*ALL FIELDS MUST BE COMPLETE IN ORDER TO FOR INSPECTION TO BE SCHEDULED*
Date Request Submitted:
*
/
Month
/
Day
Year
Submission date cannot be changed.
Building Permit Number:
*
Example: B25-1234 (Enter N/A if None)
Property Information
Name of Business To Be Inspected:
*
(Enter "Residential" for Multifamily Homes, Apartments, etc.)
Street Number, Street Name, Suite #:
*
City, State, Zip Code:
*
State of Connecticut Occupancy Classification:
*
Please Select
Assembly
Business
Day Care
Education
Health Care
Industrial
Medical/Dental
Mercantile
Mercantile w/ Commercial Kitchen
Residential - Apartment Building
Storage
Select the State of Connecticut Occupancy Classification from the drop-down list
Specifics of inspection requested:
*
Include as much information as possible regarding what needs to be inspected.
Person(s) Requesting Inspection
Property Representative, Business, or Contractor:
*
Please Select
Property Representative
Business Owner
Contracto
Contact Name:
*
Contact Name
Contact Phone:
*
Enter Numbers Only
Contact Email:
*
Confirmation Email
Confirm email
Submit
Should be Empty: