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Home My WebLink About181 Scantic Meadow Road (2) 4 r Application No. ............2.7..34................. Permit No. ......Z474................. TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. It...... hereby make application for a permit to (erect (�!!� 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. .......... ....II............................... 1�.?.. .. Signhere ................................................................................................................. Address ................................................................................................... ................. SO Location? ............................... ......................................................side of? I.........South............................................................................................ Nearest cross street?Sc anfti c M R .................................. Lot No. .......6.1.................... ...................................�.��4W........�:s�.............Street No. ................... Owner of land is? * .Address N "wft AT ........................... ................................................. ...... .... Owner of building is? Address ................................................. .............' �r.....................�.... Architectis? ...........................................................................................................Address ....................................................................................................................... Builder is? '.................... !' 'i •................-Address ..........41.194T.. .. �!.... ... .... Dimensions of building? ' �' * ? ? deep?...................................Feet front. ................................... Feet rear. ............................. Feet ............................ Extreme height to highest point of roof? ........... . ................... .... ........... ... No. of stories in height? ................. Purposeof building is? . .. ....... ..............No. of stores? ...... .................... ......... ................................................. 3 How many families? ........................................................................................No. of rooms? .... ................................................................................................... Distance from street line is? ' .......... .............from building line �s.? ....................................................................................... ADDITIONS AND ALTERATIONS (Give Brief Description) ................................... .................................................................................................................................................................................................................................................... ......................................................................................................................... ..................................................................................................................................................................... ....................................................................................................................................................................................................................................................................... ....................... MapNo. ............................, 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? . ... ......... ..... ............................................................... Roofconstruction 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 Wallis Side Wallis Rear Wallis Partition Walls Basement, .............................................................................................................. ................................................................................................................................................I......................................... ......... 1st Story .............................................................................................................................................................. ....................................................................................................................................................... 2nd " ........................................................................................................................................................................................................... .................................................................................................. 3rd " ............................................................................................................#................................................ ...................I.......................... ...................................................................................................... 4th 49 ................................................................................................................................................................................................................................................................................................................... 5th is .................................................................................................................................................................................................................................................................................................................... 6th 441 ..................................................................................................................................................................................................................................................................................................................... 7th it .................................................... ......................................I.............. ..............................................r..............................................I.....................................I........... .................................................... 8th " ...............................I............................................................................I.......................................................................................................................................................................................................... 9th it .......................................................... .;� 10th.................. ........................................................................ ............................................... ........................................................................................................... I I I I 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 JOISTS GIBDE88 COLUMNS FIoors Size Longest Span Centres Bridging Size Longest Span Centres She Length Centres 1st Floor ■ ................ me lip $tt 16 INS �$V ra+r►�Ir f as 2nd ........ .. ........................................ .-......._....... _.._ ......�w. ...... ..._..... 3rd.....��..... .. .............. ............................. ..........._.... ........_ ....._ ............._... 4 .... ..... .............. .................................. ................... ......................... .................. ........._.-.. .-......... _.......... ._.........._.. _..._.._........ Size of outside studs? ........................................ Distance on centres? ......... �............................ Size of sill? ............................................... Size of rafters. 7 stance on centres?................................................... Size of plate? ...............". !......................... Size of ledgers or girts? .................................................................................Size,of deck rafters? ...................................................................... ............... .*•r 4b" �10#01 0 Distance on centres? .........................................................................................Size of studs in bearing partitions? .................................................. MISCELLANEOUS Style of roof, flat, pitch, Mansard, or hipped? ....... ............................................................ Fireplaces? ........................................................ ? 1 Hai Material of Cornice? ................... `�+ �' ' Material of roof covering. .................................�'.............. .......................!...................................... How is building heated? ................. ..............................................Lining of flues? ....... O'#' ►.............................. I".Co. + o ..,►�� Thickness of shell of flues? .................. .............�......................... elevators or lifts? ......................................a*.. ...................... 47 10 What kind? ................................................... How many? ............... .40...................... Any hoistways? ... . .................................... How protected? .................. .......................................................... ..................Total Value of Building °/1j rJa................................................ Whenwill work be commenced? ............. ........... ....................................................................................................................................................................... The applicant warrants that the lot for residential purposes, shown on a plot plan accompanying this appli- cation, has 20,000 square feet, or more, and at least 100 foot frontage on a Town road shown on a map of South Windsor showing Town Roads dated December 1949, or on any other roads officially accepted by the Town of South Windsor since 1949. s P Applicant 24711_ BUILDING APPLICATION Application No. 27..34......................................................... onthe .........S uth.o........................................................................ side of S.c... n.t. ..G..... '.e. c�.�.W.... d...................... Street. Street No, ........LQ1..J#6.1.................................................... Owner I...:....�'.'.. S t i c:h Assoc . ............................................................................ Applicant .........S ame.. ............................................................. CLASSIFICATION Dwe 11ing 24... ........... ..................... �.... .. .. .......I............ ............... . ..... ..........................I...................... ..... ........................................................................................................... Permit issued on above Application. Date, .Sept.,.......—*............. 19......a�� DOE i 1 E • 1 4 I TOWN OF SOUTH WINDSOR BUILDING PERMIT Date -Sept. 17 s 19 58 Fee Paid $ 44P DO 'k Est. Value y$ 11s,000 Permit N O 2474 I on the South side of i Scantic Meadow Rd_ Street Street No. Lot #61 4 d G Owner I. R. Stich Assoc , Applicant Same CERTIFICATE OF OCCUPANCY ISSUED: Date No. 1497 Fee Paid .00 .\ CLASSIFICATION Dwelling 24 t 8"x41 t 6'1 BUILDING PERMIT NY 24'74 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. Sept* lT• 19 58 T4i's t i to Trrflffu, That I• RN sticla Assoc is hereby granted permission to Dwell ins 20 R a x % t 6" -- at estimated value of $ 11 000 on the South,h, side of S C R r-t t c I le ad ow ','d• T4 t #61 Street on land owned by Stich ASSOC. Said Work to be as described in Application No. and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. A pfi Issued * 171 19 58 `�` rr � Building Inspector. Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers dur- ing 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." Permit No'. ....� TOWN OF SOUTH WINDSOR yam.-•-�'""` SOUTH WINDSOR, CONN. Permit No 1497 Certificate of Occupancy THIS IS T0 CERTIFY that the 71V/f'/ at No. g, `a°fr e �!�''-��-�'"�/" �� in t Town of South Windsor, Connecticut, has been erected and completed in accordance with the Building Code and Zoning Regulations of the Town of South Windsor, and is hereby approved for occupancy. i j BU5AING INSPECTOR OWNER, BUILDER . Fee Paid ( Date ' „= `7 40� S vim• -�--_�`J OZ- so N i r , I i Q � _ � N y R `~ "�r• f � ” � ' � 4t, tau � • -� _ - � _ - "ASI" Moo `F'an6M aso I� 1 F V nsw �,. 19570 j 8�et 173 Ces�,f�'ied . tom rt=tia11' Cisrrectl Hoi� .a . . & joi n - EA W ROAD -LWUT I hereby certifg th8tr this ��`, SCANTIC WADbW'RW' map is _substantiall.,_*Qr- rect and,mo ,zoning. regulM_ +o. 2931 ,P• J C L .,lit , - 4Q' OCT 3,j 1158 tions have been"vioiated. 4$TON�g. Wit � HARTFORD, -CONN. A.3. 5972 5702 Application No. Permit No. . TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. _ . hereby make application for a permit erect, (make alteration to) a building according to the following detailed statement of the specifications an 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 .g l........X3;z X... 19.6.�� Signhere .................................................................................................. .._........... _ Address .............................. ........................... . .................... ................. Location? . ......... .`Z ........................... ................side of?Nearest cross str t. j. ...., ° Street No. . /' ..................... Lot hTo. ... ............Address .1.....Jd... � �cry Owner of land� �....;,�.L�� . ...... .... �' .. . 0 Ownerof building is? . _ � .�� ............Address .......................................................................................... Architectis? .. .. ............ . .................................................... ......................Address .. ........................ ........................................................... .................... . .........................Builder is? .::.... ....................Address ............ ..................................................................................... ........... • y.�...Foot front? ......... '-7 o Feet rear? ...... /.......... Feet deep? ... ..... .. ... Dimensions of building.? .. � Extreme height to highest point of roof? .......... ....... .............. No. of stories in height? . .. ......... Purposeof building is? ............. ............................................................No. of stores? ..... ................. ..................................................................... Howmany families? .......................................................................................No. of rooms? .... ............................................................................................. Distance from street line is? .. .. .... ....... ................... ..........from building line is? ....................... ................................... .. ..... ADDITIONS AND ALTERATIONS Give Brief Description) �--� ......... ....... ......................................................................I........ .. .................................................................... ................................................... ...............,.............................. ................. . ................................................................................. ................................... ............ .............. . Map No. 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 N. 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 Reftbt Stories Front Waft Side Walls Rear Walls Partition WaUs Basement, ........................................................................................................................................................................................................................................... ...................................... .... ... 1st Story ..........................................................................I....................I........................................................ ............................................................................................... .................................. ....... 2nd " ....................................................................................................................................................................... ..................... ................................................. .............................................. 3rd 64 ............................................................................................................................................................................................ .................................. ........................ ........................... . 4th 14 ...................................................................................................... ....................................................................................................................................................... ............I....... . ...... 5th of ................................... ..................................................................................................................I................................................................................................................................................. 6th Of .. ..............I................................................................................................................ ..................................................................................................................................................................... 7th && .......................1........... ...........................................................I............................................. ....... .................................................................................................................... 8th to ...........................I...............-........ ..................................................I...........................................I........................ ............ ............. .... ....................... .... ............................................... 9th it .... ......................................... ....... ....10th.................. ......... ..................... ... ................. ........... ... ..... ...... ............................................. ............................ Of 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 JOINTS G=DZRS 00LUMNS Floors Sim Longest Span Centres Wideng Size Longest Span Centres Size Lengft Centres Ist Floor ......... 64...... ....................................................................................................... ....................................................................... ................. ............... ....... ....................................................... .................. ......................... ....................................... ..................... .................... ....... ............. ................. 11 ....1.........................*******]"****...**F**' 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?ed? .. ............... . ...... .............................. Fireplaces? ....................................................... Material of roof covering? ..................................................... ...........Material of Cornice? ...................................................................................... Howis building heated? ... ...............................................................Lining of Rues? .. ............................................................................ .............. Thickness of shell of flues? ............ .....................................................Any elevators or lifts? ......................................................... ...................... What kind? ..... ..... .... ............... .......... How many? ...- - - - ................... . Any hoistways? ................... ............... ................. . How protected? .......... .. ..................................................... ................Total Value of Building .........(*. ......,5...-6............0................................... ... .... Whenwill work be commenced? .. .. .. .......... .. .... ..... .............. .......................................................................................................... ................. 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 '7 570P BUILDING APPLICATION Application No. .........5..9.7.2................................................... .. .......... east onthe ................................................................................. Side of ..........................S.c.a.n.tic......Me-ad-ow.....R.d..Street. ............. ...... ... . ...... ....... ... ... 18 Street No, .. .1.81..........1 . . . .......... . ......... ....................... Michael E. Riley Owner ............. ................. ..... ........ ............................... Same Applicant ........... . . . ..... ........ ...... CLASSIFICATION Tool shed 81x8f ... ...... .. .... ....... ............. .................... . ............ ........ .. . . . ... ......... .... .. ............ ... .......I ........ .. ............. .. .... ... ....... .............. ........... Permit issued on above Application. 6-24-66 Date, . .. ......... TOWN OF SOUTH WINDSOR BUILDING PERNiTI' Date June 2U 1 1966 Fee Paid $. 2.0.0 Est. Value $.5 0..0 0 Permit N° 5702 on the east side of Scantic Meadow Rd.Street Street No. 181 Owner Michael E. Riley Applicant Same CERTIFICATE OF OCCUPANCY ISSUED: Date No. Fee Paid $ CLASSIFICATION Tool Shed 81x8l BUILDING PERMIT N? 5702 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. June 24 s, 19 66 94is is to T rrftfjj, That Michael F,-. 'R 1 l e y. is hereby granted permission to T:)71 F',i e d A't x 8 t . at estimated value of $ 50 00 on the East side of 1�1 S e R n t i C Meadow Rd. Street on land owned by M-i Ohs e i �,. -Lq i 1 e y _ Said Work to be as described in Application No. 5972 and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. Issued June 24.o 1966 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." o� TO THE ]HUELDING INSPECMR of the APPLICATION FOR TOWN OF SOUTH WINDSM MW PLAN EXAMINATION A N D BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O I• ZONING AT (LOCATION) / � / c,� ��` �a � C/o �G DIISTR CT LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE N 11. 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 ❑ N w building Residential Nonresidential 2 Addition(If residential, enter number 12 7] One family 18❑ Amusement, recreational of new housing units added, i/any, 13❑ in Past D, 13) Two or more family — Enter 19❑ Church, other religious number of units— — — — -i 20❑ Industrial 3❑ Alteration (See 2 above) 14 Transient hotel, mote , ❑ T i h l l 21 ❑ Parking garage 4 ❑ Repair, replacement or dormitory — Enter number 5❑ Wrecking (If multifamily residential, o/units ——————— — —! 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) 25 Public utility 17 Other — Specify ❑ Y 7 ❑ Foundation only • 26❑ School, library, other educational B. OWNERSHIP 27❑ Stores, mercantile 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 J Describe in detail proposed use of buildings,e.g., food processing plant, machine shop, laundry building at hospital,elementary 10. Cost of improvement,,,,,,•,,,•,,,,, SID 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.H sting, air conditioning......... d. Other(elevator, etc.)............ 11. TOTAL COST OF IMPROVEMENT s III. SELECTED CHARACTERISTICS OF BIJRLDING — 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 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 I. TYPE OF MECHANICAL 51. Enclosed ....................... 35� Gas Will there be central air 52. Outdoors....................... 36❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37❑ Electricity 44❑ Yes 45❑ No 53. Number f b dr oms.............. 38❑ Coal 39❑ Oth r— Specify Will th re b an levat r? 54. Number f Full.......... 46❑ Y s 47❑ No bathrooms Partial........ v.v i ES and Data — (For deportm nt us ) IV. IDENTIFICATION — To b compl t d by all applicants Nam Mailing address — Number,qtreet, city, and State ZIP code Tel. No. Owner Lessee 2. Contractor 3. Architect or Engineer The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction. Signature of a icant Address Application dot V; / :::' 12- 12 DO NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review R uired Check Plan Review Date Plans B Date Plans B Notes 4 Fee Started y Approved y BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER Is I VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check ObDtc,need Number By Permit or A pprova I Check ObtDa ned 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. 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N�e::•�i::.aH•;fH:N�■e:rHH..■ereH.•H:■aH.:•=■■:r=;e:•�/.!IN\N�O\;=e�i; = •�.t s;;: :r fM :N�::: :i: :m\ • ■:�:.��:•:■i. srse■ri■rmar.■'■.raasnr■rsome\manman'•e■ee..r..ira■aaarra•■•■.■errs mri ireee iim■■nee\..e/■.■afaeleeaee •/re •e/ ■■ a\• as eNe ■aea names 1�eee:=a*�e:e:a*.::.l�e�e:a.e■��.I�:a�f�I�a�.e:/�l.aaa..e:e■N:••r�lne etee��e■i�:•tee: :■■=�—on-11ee e11a.:i -==1a!/:i=•N.=�•\ i_��n'��a��a��[�R�ea�.er TOWN OF SOUTH WINDSOR BUILDING PERMIT Date May 2 , 19 82 , Fee Paid $. .30...00 Est. Value $. .5.,000.00 Permit N° 12 7 3 4 on the side of Scantic Meadow Road Street Street No. 181 Owner Salvatore Cicero Applicant Salvatore Cicero CERTIFICATE OF OCCUPANCY ISSUED: Date No. Fee Paid $ CLASSIFICATION Alteration and two car garage BUILDING PERMIT 12'734 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. May 22 no 94is is to Tjortifu, That Salvatnra CA earo is hereby granted permission to Expand ki tehen tjitin axf St j nit .;ar@ a>aA WA two car nara a 3139 x 270 Tr. 7.As 1466-97 jS2 at estimated value of on the side of I A I Scant is Meadow Read Street on land owned by Salvatore Cicero SaidWork to be as described in Application No,1 3034 and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WIMSOR. Issued May 7 7 920 uildiag Insptctor- 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." DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# t� 3 Application is hereby: TOWN of SOUTH WINDSOR _ BUILDING DEPARTMENT Bldg Permit# PROVED 1540 SULLIVAN AVENUE r 1?)q� r�s 644-2511 ext.230 Date Building Inspector Application must be printed or typed Location of job <) 5�4?/I d1eC -/"(Q?ri'dits 4/1 Street No. Street Lot No. FEE SCHEDULE $0 - $1,000 - $12.00 Floor Apt.No. Over $1,000 $12.00 per$1,000 OWNER or any fraction thereof / ADDRESS w�7�►/�o -_ P OWNERS PHONE# APPLICANT 61/ \ OWN S ADDRESS �� e7 "'y . q< tFC) / I C ESTIMATED COST$ C IS THIS A CONTRACT COST? YES NO FEE ENCLOSED $ s�R-C O TYPE OF JOB: Original Installation Alteration/Addition 1 epair Revised 11/95 r APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A RESIDENTIAL BUILDING PERMIT APPLICATION YES / NO BUSINESS ASSEMBLY CURRENT USE AND OCCUPANCY MERCANTILE EDUCATIONAL FUTURE USE AND OCCUPANCY INSTITUTIONAL FACTORY STORAGE ENGINEER'S NAME PHONE GARAGE MIXED USE ADDRESS CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF MAIN FEEDERS AND RATING OF WIRE USED NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED?YES/NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK Q THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN. BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT PHONE NO. C-)--q — 3()I� DATE ✓��` /9,3-1�p INSPECTOR J DATE TIME LOCATION �C"fl�-`I rC �t•'�L yl r_�G�v INSPECTION: CODE: RESULT(D/A) : BUILDING: f ELECTRICAL: rc, PLUMBING: HVAC: ' OTHER: r 4 yt[tf F