Building Inventory Form

Department of Public Works

Request Form for Land and Building Inventory Changes

and the Assignment of Land and Building Numbers
This form is to be submitted by the DPW Project Manager or Agency Representative requesting additions, deletions or other informational changes to the DPW inventory of State owned land and buildings, and for the assignment of new land and building numbers.
New building numbers are assigned when the building is acquired or construction is substantially complete. Please submit a separate form for each building or land parcel.
If you have any questions or need assistance, please call David McBride 713-5731. Return this completed form to : David McBride, DPW Facilities Planning, State Office Building, Room G5, 165 Capitol Avenue, Hartford, CT 06106
Type of Request: Add a new land parcel and get a land number assignment.
Add a new building and get a building number assignment.
Change information existing in the inventory.
Delete a land parcel from the inventory.
Delete a building from the inventory.
Information needed:
Owner Agency Name:
Owner Agency Code:
Name / Building only:
Land only:
Name of Location (if part of a campus, etc.):
Street Address:
Town:
Town Code:
For Buildings: / For Land:
Usage: / Usage:
Number of floors: / Number of acres:
Total area in gross square feet: / Existing DPW land number, if any:
Type of construction: / Year acquired:
Agency building number, if any: / Cost of acquisition:
Existing DPW building number, if any: / Type of acquisition (purchased/ gift):
Year acquired: / Land Value:
Cost of acquisition:
Type of acquisition (new const./purchased/gift):
Building value:
For Deletions, please give reason and details:
Applicant Information:
Name:
Address:
Phone number:
Date:
DPW Action: A land number has been assigned. The number is:
A building number has been assigned. The number is:
Existing information has been changed as requested.
A land parcel has been deleted from the inventory.
A building has been deleted from the inventory.
DPW action by: / Date:
710 / 710F-00-OCT05-PMT