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HomeMy WebLinkAbout1156 Sullivan Avenue Application No. 6046, Permit No. 5776 TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. hereby make application for a permit to (+rest (make alteration to) a building according to the following detailed statement of the specifications and plans herewith submitted. (Draw a line through word "erect" or words "make alteration to" as the case may require.) All provisions of the Building By-Laws (Sections 2 to 32 inclusive) shall be complied with in the execu- tion of this work whether specified herein or not. South Windsor, Conn., 77...... ....... 19.�a..C. Signhere ..................................... ..... ...... ................._........... Address `�..... ,1'/ ........ ... ...�1.. ,....... Location? ....... ..0.,5.?0'..............side of? .............................................................� .........................a.................... ...... .... .. Nearest cross street? .. ...�'.. .......Qq.-AL..a...........Street No. .................. .............................. Lot No. .......................... . Ownerof land .®,_%............................................... i ._. ....-¢r...... ....... . ........ .. Owner of building is? . `�... ''r.. . ...................................'......................Address ... ......... ............................................................................................ � Architect is? . . ............ A................................................... it...................Address .................... .........................................1-11................................. " .... Builderis? . '...................................................._.:`......................Address ....................... ..............................................'.4...............................I..........M Dimensions of building? . .. . . ............. Fat front? ......... ... . .......... Feet rear? ..... ...... .........g .. Feet deep. .. . .. ....... ... Extreme height to highest Lint of roof?_................. ............... No. of stories in height?. . ......... . Purpose of building is? ......1.......f'�.....................................No. of stores? .... ................. ................... .. .... Howmany families? .................................................._...............r................-No. of rooms? .... ............................................................................................. Distance from street line is? .. ........... .... .....................................from building line is? ........ ......... ...................................................... ADDITIONS AND ALTERATIONS (Give Brief Description) .......... .....Vf4....... ........... ........ V...... iC...�,.. .. ........ . ..... .......... r......... ... . .................. . ..................................................................................................................................................................................................................................................... MapNo. . . ................... _ _ r T If of steel frame, what is exterior construction? .................. ..... ......................................... ....................... What kind of columns used? ....................................... ................Size of columns used? What length of columns used? .. ........ ............ ........ ..... ......How protected? .. ........ ... ....... .. ........... ................ ... What kind of beams or girders? .................... . ... ............. .. Size of beams or girders? ................. ......................... ... Longest span of beams or girders? .. ......................................... These rest on? .. . .... ... ......... .............. ............................ ... Roof construction is? .......................... .......................................................Roof covering is. .... ... .... .......... ...... The floors are of ....................... .......................... construction and are calculated to carry a safe load of lbs. per square foot. (See Section 14, Building By-Laws.) BRICK CONSTRUCTION. Of what material will walls be constructed? .................... . .. ....... ........... ......................... .................... .................... Compositionof mortar? . .................................................................................................................................. ................. ....... ... .... ... ... ........................ Height and Thickness of Walls Height stories Front Walls Side W&Hs Rear Walls Pm-titlon WaUs Basement, ................................. .......­­..................................................................................... ....................................................................................................................................... . .... ... 1st Story ......................................................................................I................................................................... ....................................................................................... .... .......................................... 2nd " ........................ ..................................................... ................... ................................................................ ... ... . ....... .......................... ......... .... .................. . ..... 3rd do .................... ................................................................................................................................. ........................................... ............................................. ................................. .... .. ...... 4th of ........................ . ... ................................................ ....I............ ............................................I.............................................................................................. .......... . .. ..... . ........ ........ 5th So ................................. ............ ............................................... ..............................................P..................................................................................................................................................... 6th 'S .................... ............................................................................................................................................................................................................................................................................ 7th 68 ........................... ...................... ................................................................................................I................... ...... ....................................................................................................................... 8th '41 ................................................................................................................................................... ......... ............ .......................... ........... ................... .. .............................................. 9th $A .. ....................................................................... ........ .. ................... .. .... ..... ... ............... ............... ....................... 10th ..so Material.of Front? ... . .. ....If stone, what kind? Thickness of Ashlar? ....Thickness of Backing? .. ........ Backed up with what? Arches or lintels over openings? WOOD CONSTRUCTION. Give Size, Longest Span and Distance Between Centres, of Joists, Girders and Columns J0182S GMDEM OOLUMNS FIoors size Longest Span Centres Bridging size Longest span Centres sin Length Centres 1st Floor Via.....,,.... .... ...................... ..........._.. ........................................................... ............... ....»........___ ......_...»....._ .... .............. .._......._. ..........»...._.......».�. ...»....... _..._.»_. ........»..._.. _.»._..........».. Size of outside studs? .............. ..................... Distance on centres? ................................................ Size of sill? .............................................. Size of rafters? ...................................... Distance on centres?................................................ Size of plate? ..................................................... Size of ledgers or girts? ........................... .........................................Size of deck rafters? .................................................................... ............... Distance on centres? .............. .........................................................................Size of studs in bearing partitions? ................................................. MISCELLANEOUS Style of roof, flat,.pitch, Mansard, or hipped? .. .. ....... . ... . . ... ......................... Fireplaces? ........................................................ Material of roof covering? ............................ .........I............ ...........Material of Cornice? ....................................................................................... How is building heated? .. ... ... .................Lining of flues? . ......... Thickness of shell offlues? . .................................................................Any elevators or lifts? ...................................................... ...................... What kind? ... ...... .............. ..... ........ .. How many? . ..... .. Any hoistways........ ....... . .......... .............. . How protected? ........... .. ................................................... . ... ............Total Value of Building ........ .......�e:' . ............................... r a When will work be commenced? ... .. .......... -cr........... ...... The applicant warrants that the lot for residential purposes, shown on a plot plan accompanying this application, conforms to the zoning regulations of the Town of South Windsor. Applicant 5776 BUILDING APPLICATION 6046 ApplicationNo. ........................................................................... Eas on the .........................t ....................................................... side of .... .............. Sul.l.i.v a..n..Ave. .. ..................... Street. Street No, . .......11.5.6 . . ........ .. ......... ................ O 'arl Stoddard.ner ..........`. .. ... ......................... ............................. Same Applicant .. . .. . .. .... ........ ...... .... ...... CLASSIFICATION Renovation of existing rear .. . . ... . .. ... ................. ................. porch. ........... ........ .. ... ........ .. .. .......... . .................. ..... ... ..... .......................... Permit issued on above Application. 9-23-66 Date, ........ TOWN OF SOUTH WINDSOR BUILDING PERMIT i Date Sept* 23, 19 6 Fee Paid �$. . .3.•.0 0 Est. Value $. 0 0.00 Permit N° 5776 on the East side of Sullivan Ave. Street Street No. 1156 Owner Earl Stoddard Applicant Same C CERTIFICATE OF OCCUPANCY ISSUED: !� Date No. Fee Paid $ CLASSIFICATION Renovation of existing rear porch. BUILDING PERMIT N? 5776 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. F,dpt&23 1966 94is io to Tortif1j.9 That Eft:6 Stodd."d e .!W nS rear porch is hereby granted permission to at estimated value of 600 00 �$ on the side of�. u"`"tr t` ��• `t, :.�� Street on land owned by e :' St,3dd 0r V Said waT'rs• to be as described in Application No. 6046 and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. Issued BM R"23 t -19 66 Building Inspector. Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers during the day and by both barriers and colored lights by night. SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a license therefor from the city or borough in which such highway may be situated, he shall pay said city, town or borough all costs and damages which it shall sustain, or be compelled to reason therefor." DD TO THE BUELDING INSPECTOR of the APPLICATION FOR PLAN EXAMINATION AND 50l)'tH WIlrD501i,COOK PLAN PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O ZONING I• AT (LOCATION) ` S� Sur L /, U a ✓( �q DISTRICT LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE H II. TYPE AND WST OF BUILDING — A11 applicants complete Parts A — D �v A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M 1 ❑ New building Residential Nonresidential 2 ❑ Addition(/f residential, enter number 12® One family 18❑ Amusement, recreational of new housing units added, if any, in Part D, 13) 13❑ Two or more family — Enter 19❑ Church, other religious number of units— — — — --► 20❑ Industrial 3 ❑ Alteration (See 2 above) 14 l l h i Transent hotel, mote , ❑ 21 ❑ Parking garage 4 ❑ Repair, replacement or dormitory — Enter number 5❑ Wrecking (1/multifamily residential, o/units ——————— — -i 22❑ Service station, repair garage enter number of units in building in 15 ❑ Garage 23 ❑ Hospital, institutional Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional 6 ❑ Moving (relocation) 17® Other — Specify 25❑ Public utility 7 ❑ Foundation only 26 ❑ School, library, other educational B. OWNERSHIP kkl Cat. 13 tA7 N L 1K i! RP 27❑ Stores, mercanti le 8 ❑ Private (individual, corporation, 28❑ Tanks, towers nonprofit institution, etc.) 29❑ Other — Specify 9 ❑ Public (Federal, State, or local government) C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food processing plant, machine shop, laundry building at hospital,elementary 10. Cost of improvement,,,,,,,,,,,,,,,, S CX5 I school, secondary school, college, parochial school, parking garage for, department store, rental office building, office building at industrial plant. To be installed but not included If use of existing building is being changed, enter proposed use. in the above cost a. Electrical...................... b. Plumbing ...................... c.Heating, air conditioning......... d. Other(elevator, etc.)............ 11. TOTAL COST OF IMPROVEMENT $ III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts LL' — L; for wrecking, complete only Part J, for all others skip to IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30❑Masonry (wall bearing) 40❑ Public or private company 48. Number of stories................ 31 ❑ Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area, all floors, based on exterior 32❑ Structural steel dimensions .................... 33❑ Reinforced concrete H. TYPE OF WATER SUPPLY 42 Public or private company 50• Total land area, sq.ft. ........... 34❑ Other — Specify ❑ p p y 43❑ Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ....................... 35❑ Gas Will there be central air 52. Outdoors....................... %❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37❑ Electricity 44❑ Yes 45❑ No 53. Number f b dro ms........... 38❑ Coal 39❑ Other— Specify Will th re be an elevator? Full.......... 54. Number of 46❑ Yes 47❑ No bathr ms PartlaI........ NOTES and Data — (For deportment use) IV. IDENTIFICATION — To be comp) t d by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. i. fnL K I< Owner or Lessee 2. SQ Contractor 3. Architect or Engineer The owner of this building and t-he undersigned agree to conform to all applicable laws of this jurisdiction. Signature of applicant AdJress/ Application date 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans R vi w Required Check Plan Review Date Plans B Date Plans B Notes q Fee Started y Approved y BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check Date Obtained Number By Permit or Approval Check ObDained ate Number By BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GRADING USE OF PUBLIC AREAS OIL BURNER WRECKING OTHER OTHER VII. VALIDATION Building Permit number 10532 Bui Iding Permit issued Oct. 10 19 78 Building Permit Fe $ 4.00 Approved by: 4ZZ-I Z,"16!Z; 4 --46� 4-9-- TITLE Vill. ZONIN-G PLAN EXAMINERS NOTES DISTRICT FRONT YARD SIDE YARD SIDE YARD REAR YARD I_X. SITE OR-PLOT PLAN For Applicant Use • • :00 so" H Lee as HUHH.00IN: 1131131111 16: 1 :00 M. 0 a in 11 -- 81111116:811 1141114111b M: so.Fos fe FA H: 111111121011 !1 IMICHUM Me a @:r Isla a a we I g Is H a 8.1111. 10 . as will M , :11 LE 11 u. wiliflis go. .1 :All • H a U. NO Low its 41110111181111141961 anq 0 0 .. me :081 1 me 11,11mi H I as I mulilnuissueffise 4 son : 11in "I :l as :1 ilmiji: • on : sea as as an 1111 :116H9111111,31:1 to si memmumill 10:1 111101,11ini, I- um. a•mmas be ,u Is M 2v unniunjul';...:1...19; ■:90660 lau!"H11:311HOMILEM !4� � ammomm, His, 1:1:11141 In so: ni Iffill FER ------ -------------- --- ---- ------ 1,41 TOWN OF SOUTH WINDSOR BUILDING PERMIT Date Oct. 10 , 19 7 8 Fee Paid $. 4...0 0 Est. Value $. . 5 00.0 0 Pet N_ 10532 on the - side of Sullivan Avenue Str i Street No. 1156 Owner Frank E. Stoddard Applicant Ffsrank E. Stoddard CERTIFICATE OF OCCUPANCY ISSUED: Date No. Fee Paid $ CLASSIFICATION Wood bi rni n�: stove T BUILDING PERMIT Na 10532 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Qpnn. South Windsor, Conn. Oct• 10 19 78 94is to to gerfid1j, That Frank E. St©d.dard is hereby granted permission to Install wood burning store at estimated value of $ 500.00 on the side of 1156 Su l l ivan Avenue Street on land owned by Frank E. Stoddard Said too i k to be as described in Application No. 10832 and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. Issued Oct 1 d' 19 78 C. Bu Vispector- Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers during the day and by both barriers and colored lights by night. SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a license therefor from the city or borough in which such highway may be situated, he shall pay said city, town or borough all coats and damages which it shill sustain, or be compelled to reason therefor" lel TO THE BUILDING INSP R of the APPLICATION FOR TO" OF SO M WINDSM COIN. PLAN EXAMINATION ANO BUILDING PERMIT e IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O z • AT (LOCATION) C5 o/ ! V A'"' LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE H II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D �o A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use � 1 ❑ New building Residential Nonresidential 2 Addition(IJ residential, enter number 12 •family 18 ❑ Amusement, recreational of new housing units added, if any, in Part D, 13) 13❑ Two or more family - Enter 19❑ Church, other religious number of units- - - - -1p. 20❑ Industrial 3 ❑ Alteration (See 2 above) 14 ❑ Transient hotel, motel, 4❑ Repair, replacement or dormitory - Enter number 21 Parking garage 5 ❑ Wrecking (If multifamily residential, of units ------- - -i 22 ❑ Service station, repair garage enter number of units in building in 15❑ Garage 23❑ Hospital, institutional Part D, 13) 16 ❑ Carport 24 Office, bank, professional 6 ❑ Moving (relocation) 17❑ Other - Specify 25❑ Public utility 7 ❑ Foundation only 26❑ School, library, other educational B. OWNERS 27❑ Stores, mercantile 8 rivate (individual, corporation, 28 ❑ Tanks, towers nonpr fit institution, etc.) 29❑ Other - Specify 9 ❑ Public (Federal, State, or local government) C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings,e.g., food ®cp essing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement................ S�l� �� school, secondary school, college, parochial school, parking garage for, department store, rental office building, office building at industrial plant. To be installed but not included If use of existing building is being changed, enter proposed use. in the above cost a. Electrical...................... b. Plumbing ...................... r c. Heating, air conditioning......... d. Other(elevator, etc.)............ 11. TOTAL COST OF IMPROVEMENT 3 III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; for wrecking, complete only Part J, for all others skip to IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30❑Masonry(wall bearing) 40❑ Public or private company 48• Number of stories................ 31 ❑ W ad frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area, all floors, based on exterior 32❑ Structural steel dimensions .................... 33❑ Reinf reed concrete H. TYPE OF WATER SUPPLY 34❑ Other - Specify 42❑ Public or private company 50. Total land area, sq. ft. ........... 43 ❑ Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... 35❑ Gas Will there be central air 52. Outdoors....................... %❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37❑ El ctricity 44❑ Yes 45❑ No 53. Number of bedrooms.............. 38❑ C al 39❑ Oth r- Specify Will ther b an elevator? 54. Number of Full.......... 46 0 Yes 47❑ No bathr oms Partial........ IV. IDENTIFICATION — To b compl t d by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. y Owner or IDMAU Jkt�-� La /// 117 ��" 7 Lessee Contractor 3. CO, Architect orACTORS 1,IGE?jjif; r Engineer —460�� The ow this building d ndersiyned a e to confor o all applicable laws of this jurisdiction. Sig ture of pp icant Address Applicatio d e 00 NOT WRITE BELOW TH S LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans By y Date Plans B Notes q Fee StartedApproved BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER Is VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check Date Obtained Number By Permit or Approval Check O6t Date a'ned Number By BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GRADING USE OF PUBLIC AREAS OIL BURNER __ _ _ WRECKING OTHER OTHER VII. VALIDATION Building Permit number Z!�Yy99 Building Permit issued �_�� 19 Building Permit Fee $ 02 y J+ p ov 91A - TITLE ' 1 TOWN OF SOUTH WINDSOR BUILDING PERMIT Date June 21 , 19 85 Fee Paid $. .2 4.0 0 Eat. Value $.3.,.5 0 0 Permit N° 14499 on the aide of Sullivan Avenue Smtt Street No. 1156 Owner Earl Rfndaara Applicant P P t-P r T._ Brown Cr) CERTIFICATE OF OCCUPANCY ISSUED: Date No. Fee Paid $ CLASSIFICATION Siding i I BUHDiNG PERMIT I - NY 14499 OFFICE OF THE BUILDING INSPECTOR of the - Town of South Windsor, Conn. South Windsor, Conn. _T,,n o 13 1985 X#iz to to (9PL`ttfti., That Peter L. Brown Co. is hereby granted perin�ss• ioa to .� Install Siding I at estimated value of I on the side of 1156 Sull i van Avenue Street on land I owned by Earl Stoddard I Said Work to be as described in Application I j No. 14799 and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. I Issued 1985 , ,'-L-Building Inspector. I I Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers during the day and by both barriers and colored lights by night. SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a license therefor from the city or borough in which such highway may be situated, he shall pay said city, town or borough all costs and damages which it shall sustain, or be compelled to reason therefor." If -14 DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: _ $0-$1,000=$13.00 Street No. Street Lot No. Over$1,000= $13.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT f APPLICANT ADDRESS ? I APPLICANT PHONE# 8 7 AR -a 0001 0)" 1111 $� OWNER i G ra^e n y 1 OWNER ADDRESS v a y OWNER PHONE C ESTIMATED COST$ 900 , 00 j N V IS THIS A CONTRACT COST? 1i Yes 0 No FEE ENCLOSED$ J3 ,6 0 1� TYPE OF JOB: �SOR.Cps JNew Installation 0 Alteration/Addition/Repair Revised 8/99 t APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? ❑ YES ❑NO RESIDENTIAL ❑BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE FUTURE USE AND OCCUPANCY ❑EDUCATIONAL ❑INSTITUTIONAL ENGINEER'S NAME PHONE ❑FACTORY ❑ STORAGE ADDRESS ❑GARAGE ❑MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD ta cJ\'e SIZE OF SERVICE /D D SIZE OF MAIN CONDUCTORS / ! , NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS /� REMOTE DISCONNECT REQUIRED? ❑YES)<(NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS U NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE o7 O O � INSPECTOR E TIME INSPECTION: CODE: RESULT(R/A) : / ELECTRICAL: � _----_---__ _-----_'_ ` PLUMBING: HVACx OTE[]03Kx � DEPARTMENT DECISION ;} �:ps• : _` i APPLICATION F of �� -:�r�•, ;�"z:� ,__ �v ,� Application is hereby: TOWN SO � BUILDING DEP APPRO 1540 SULLYVA , 644-2511 act. . " A -�,x _' �. ..y..ti 2 G qg u 3 .. - r -h... n - _ Date lding Inspector A At �w .�.{ r y� e� emu. � . ;,f`� �} X r� -, �`,`td�,.',�•rk i_ 4'��bc`&,.�_'� -'"=�'�g'-a�`�'_ ,"',:..=�=r`-'-:�,''}-i'�.y-.��•far �;_n�' , # - Street No. ��� ' ' '�"q '�•-, � �: ��• ;�{�*3.",::�'>.-;ra,.txa�,,:'.xt, � .''#�+evt .fit-.:',S'5��,_ �� ,. y,, _ FEE SCHEDULES "� Floor $o - $1,000 - P-rg - 'r Over $1,000 $12.00 per$1,000 OWNER ' 4 or any fraction thereof ADDRESS ��- � OWNERS PHONE# APPLICANT � sfq `' ADDRESS � ti�_ ,. � �.•�,�� � � � � � - _� - _- A* OW CA) ESTIMATED COSTS - � C IS THIS A CONTRACT T Imo:: FEE ENCLOSED $ '� R OR C Q TYPE OF JOB: } �..�.. '°� Original Installatit Alteration/Additiep x wised 11/i3 APPLICATION FOR HVAC PERMIT (Continued from reverse side) TYPE OF SYSTEM TYPE OF BUILDING HEATING RESIDENTIAL A/C COMMERCIAL VENTILATION INDUSTRIAL HEATING STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. HYDRONIC WARM AIR UNIT RADIANT HEATER EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F TOTAL HEAT LOSS(BTUH) (HEAT LOSS SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL HEATING EQUIPMENT (INCLUDING MAKE&MODEL NO.) GROSS HEATING CAPACITY (INPUT-BTUH) NET RATING (OUTPUT-BTUH) TYPE OF FUEL �,I►`c -GPM GAS-INPUT ELECTRIC-KW OIL TANK SIZE&LOCATION INS OUTSIDE CAPACITY 2�?5 LPG TANK CAPACITY AIR CONDITIONING DESIGN TEMP. OUTSIDE F INSIDE F DIFFERENCE F TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL COOLING EQUIPMENT (INCLUDING MAKE&MODEL NO.) TONNAGE COOLING CAPACITY(BTUH) VENTILATION DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT) TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM) (PLANS MUST ACCOMPANY APPLICATION) FURTHER DESCRIPTION OF WORK Vif Cho�ehnt ��s 1 THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BU G CODES IN THE PERFORMANCE OF SUCH WORK. - / - 0�3 �tlZ ' Ln STATE LICENSE-NO. NAME&TYPE G TURE OF APPLIC t PHONE NO. /,, O C,) DATE �"