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Home My WebLink About111 Palmer Drive 39 4567 Application No. 4827 Permit No. . TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. hereby make application for a permit to (erect Awe 60) 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.. ........... 19... X? -........... ....... . Signhere ................. ................................:-..................... ............... ......... Address X� .... .... - -ra. ....>. Location? . i �r.7'`'. side of? .��.... . ' .............. ... ....��.. L Nearest cross street? ........ IP..m. ... .....,.Street No. .................................................. Lot No. ... .t ........ . ner of land is? �....... . . ... .�.............. ..... ...Address ... .. �: • fj Owner of building is? ...........Address .. ....... ................................................................................................ . v K v CJ - Architect is? "`...................................................................Address .............................................................................. ................................ Builderis? . ..................`.`........... ................... ............`:`........................Address .................... ................... `.'.........:........................ .......`' Dimensions of building? .. (o X v6... Feet front? ..... ...G Feet rear? ....... ....��....... Extreme height to higher t of roof? .........., No. of stories in height?. r Purpose of building is? . .. .v 97/.�r...-r l No. of stores? ...... ....................... ................................................................... Howmany families? .. ......................................................................_.........No. of rooms? .... ..........400 ............................................................................ Distance from street line is? . ... ...., 'l,,C�........................from building line is? ................. `...... . .......................... .............. ADDITIONS AND ALTERATIONS (Give Brief Description) • ... ............................................. ................................................ .......................................................................... ..s4...i �r•—.r_" �.,�°s...rPrr .................................................................................................................... ................................................................................................................................................................ ENDOR by SANITARILY OFFICE; ............... ... ...... ................................................................................................................................................................................... .......... ........................................ IN ACC077" 'N" eb `��e f 11-1 TOWN OF Map No. ....... ........ tUTH W�a�' �..�� O INAiNCE 0. 6 ('4Oky OFFICER 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 He*ht Stories Front Walls Side Walls Rear Walls Partition Walls Basement, ........................ ...... ......__................._................-...._... ......... ..... .........._.........................._.. -.................................. .................. .............. ....................................................... ... 1st Story ........................... .... ...................................................................... ........................................................................ ...................................... ...... . ...... ................ .......... 2nd " ..................... .................._.................._................ ... ............................................._..................................... .... ......... ...................... . ....... .... ... .......... 3rd " ..................._. .... ..........._........................................................ ....................................... .............................................. ,..................... ....... ......... ............ ............. .... .... . . 4th " ... ..................... . . ... ......__................................... .... ......... ....................................... ... .........................................................I..... ..... ..... .... ... .I... ....... . ....... .. ...... 5th 11 6th " .... ............ ...._................_.................. ...................... ..................................................................................................................................................................................... 7th " ............... ........ .... ... . ..... ............................... .......... .... .......... ..... ,. ......... .... .............................. ... . ...... ......... ................................ 8th " .................................................. ............. . ...... . . . ........ .. .............. ...................... 9th is ....................._...................... ......loth.....� .. .. . ........ ... .......... . .. ..................... Material.of Front? If stone, what kind? Thickness of Ashlar? Thickness of Backing? Backed up with what? Arches or lintels over openings? it � �. i �r� � � ' � �t'r � � _ � � �.. .. l�� •��•�+ •� ' � � '' � i ��-� q WOOD NS CT . Give Size, 1. agest Span and --Ne+e Behr► en Ceres, of Jobs,C rden and Cow JOB ems. NO M::=jj Sk XAM604 OPM Cankm 2d40isgi Bea Langea Opm Caulm La W& C utm lit moor Q 11 p ...... ....... ...... , .......l.. ....... bQ...»... .4 ....:. ........... .................................. .......»...... ............... ........»................... ._. »....._. Size of outside studs? .... ............ Distance on centres? .................�..4a ........ Size of sill? ... x.. .....�.......»...... 000, All. Size of rafters? .... Distance on centres?................ ...�;. .................. Size of plate? ......... '.' .Y..I............ Size of ledgers or girn? .................................................................................Size of deck rafters? .................................................................... ............... Distance on centres? .............. ......................................................................Size of studs in bearing partitions? ....Z.x.....5!<................. MISCELLANEOUS Style of roof, fiat,.pitch, Mansard, or hi . . . Fireplaces? Material of roof covering? .... ............ .. .. . .nsP.............Material of Cornice? ............. ...... ............... .. ......................... ...........Linn f Hues? How is building hea e . . .........70e�.T........�.�-C.. ... g o ... ........ ��741% Thickness of shell of flues? .............../...............................................Any elevators or lifts? ........................................................... ...................... Whatkind? ..................................... ..... .. How many? ........ ................... .. Any hoistwa ? .................................. ............... . How protected? . . .... ....................................... ....... ..... .................Total Value of Building ............ ......49....ap... ................ When will work be commenced? .�,� . ..........t-%. ......... „Q.. %..., ................. 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. Town of South Windsor since 1949. 010, pplicant i 4567 BUILDING APPLICATION Application No. ... 82.7....................................................... South onthe ...... ........................... .................... ............... side of Palmer Drive .... ....... ...... . . . .. .......... ...... Street. Street No, ...L t. #5 8. ... . . .. Owner U & R Housing Corp. Applicant S amp . ....... CLASSIFICATION Dwelling 461x26f . .... ........ ... . ............. ........ Permit issued on above Application. Date, 18-11-63 19 ` 4VY ^+t3 TOWN OF SOUTH WINDSOR - ��- BUILDING PERMT b Date 0 e t.11 s 19 63F,K; ri+ Z. Fee Paid �$. Est. Value 0. . .82000 RECD. Sip�IC PAYMI-NT 0.00 Permit 4567 _ 'max . � on the South aide of �_ Palmer Drive Street Lot #5a Street No. = g- L ff, a., Owner U & R Housing Color Applicant Same ,3r , CERTIFICATE OF OCCUPANCY ISSUED: , Date � ,i ,. No.2687 �. Fee Paid 3.00.s CLASSIFICATION Dwells ;x26 1 _ �'r- BUILDING PERMIT N° 4567 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. Uc t+2I i 19b3 94is is to Tertif1j, That =J & R HOUSIng c:)rP* is hereby granted permission to Dwell-AM 46 tx261 at estimated value of 1 a 0 0 00 on the South J side of PA11mer Dr iyo• Lot #58 Street on land owned by U & R Housing Corp' Said work to be as described in Application No. 4827 and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. Issued Oct`lit 19 b3 Building Inspector. Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers during the day and by both barriers and colored lights by night. SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a license therefor from the city or borough in which such highway may be situated, he shall pay said city, town or borough all costs and damages which it shall sustain, or be compelled to reason therefor." I I I Permit No. TOWN OF SOUTH WINDSOR I I SOUTH WINDSOR, CONK I Perini I t N° 268'7 I Certif' ate of Occupancy ,1 THIS 7'eA1-T-- TIFX that the �.C--at No. s- in the To of South Windsor, Connecticut, has been erected and completed in accordance with the Building Code and Zoning Regulations of the Town of South Windsor, and is hereby approved for cy. 1 � . f " Building Inspector Owner, Builder Fee Paid ,� J Date �h!=fir y, _f ` ,7,.�9Y .:+�!�41` - `,v+ ., ,-�."{"" �"'S.t.P"' �P ST� �._,r �+• ,�'''e�� ,y r , 1. �, i,� .} !ti .t 4 4 y= . •v r-.$) x a 1,, m1t° e�'C; �_}n k• i`� 'J;+R 00° . ULj O r at a 31 O` chp PA LW Slott 1. C., J PROPERTY OF P NO. PALMER DRIVE SOUTH w iNDS4R, CORN. �. H ing Lot, No. 58 on map entitled "BIRCH HILL, ESTATES Foster Street a. South Windsor, Conn . Property of U & R Housing Corp. Scale 1 " 1001 Date: Jan. 21 , 1963 Hayden L. Griswold C.E." A Scale 1" 50 ( `Cr►-�' 19103 HAYDEN L. GRISWOLD C .F. a.�:,..�''�.kl.. ,,.A1ii'�'#im.•..31ee.�•,.�ibc•hr9,�,ea ,�v,Wu.r 6,e. ., ss y... . _ kr 5 �th _ 1. ,- -, T� f3 Al - Xt 2634 S South an dw Paper Drive MIM, r�u -zr Lot #58 .. . a .a a+aec Na. 0 & R Rousing Corp. ITS 4uastamaohio Ila aka✓.+ +c.3{,,' as 10-25-63 ilk R4, no logo is 5� "— a. .. NO am M p xr as of &e &ainW ages of amp baPt to XIFM _. r ��b.9.5'�r�.Fy,�+.��i�.u_�� _ uKi�•?i.�, __ _ � rra �:��z'$�h?'' �i.k��`N�-*5-',-mow`;. j -°�,�r,•.- Application No. 26.34. Permit No. 28.4.5.... .........TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. � hereby make application to perform plumbing according to detailed description below. All provisions of the Rules for Sanitation, By-Laws, Sections 33 to 47 inclusive, shall be complied with whether specified herein or n&. South Windsor, 194 Sign here Address .............. ....... Location . %'S'e.... side of Street Nature of Buildm' ....... How many stories Owner Address .. ...... L3.(. Architect Address . .. .............. .. Builder Address Plumber . .....1 Address V.7 .. .. . ............ DRAINAGE CESSPOOLS, How many Where located ............................ ................................. Are they water tight vu� . .......... Of what materials are they built ...... Size of pipe from house Zocesspool Kind of pipe C MAIN DRAIN IN CELLAR, Material Diameter . ....... .. . Above or below cellar bottom ............ ........................................................... . ............... SOIL PIPES, Material Cr 'T— Diameter 5;/ .. ........ ...... ..... ... ............................ WASTE PIPES, Material Diameter ..... ...... ...................................... TRAPS, Type proposed to use is .... ............................................ ............. ...... .... ........ RAIN WATER LEADERS, where do they run to .. . ..... .......... ..... ..... ..... ..... . .................... .......... REFRIGERATOR WASTES, where do they run to . . .. .... . ......................... ... ...... ........ ........................... TANK OVERFLOWS, where do they run to . . ... ..... ..... ........ ... .... .......................... ................. FIXTURES WATER CLOSETS, How many ......9?. . Where located Distance from trap to vertical soil pipe Pattern ................... .. WASH TRAYS, How many Where located ... SINKS, How many 4 . ....... Where located ...... ... ... . ........ . ...... BUTLER'S SINKS, How many Where located ......... .. .......... . ..... .......... ...... ............. REFRIGERATOR SINKS, How many . Where located ................... ............ ... ................. LAVATORIES, How many Where located ................ ..... ................... ......... . BATH TUBS, How many Where located . . .................................................... ....................... MINM , m t ow any Where located . .............................. ...... ................... ..... .Am � Are water closets and urinals to be local vented If not, is there a window in outer wall of room where same are to be located ...... ....... ... ......... . ....... Estimated Cost 1748 OIL BURNER OR FUEL STORAGE APPLICATION Application No. 1759 Permit No. 1 748 on the South side of Palmer Drive Street Street No. Lot #58 Owner U & R Housing Corp* Application D.F.Trame ntana CLASSIFICATION American Std. PH5-2 i Permit Issued on Above Application Date 10-25-63 19 Fee Paid $ Permit #4567 TOWN OF SOUTH WINDSOR APPLICATION TO INSTALL RANGE AND FUEL OIL BURNERS EQUIPMENT AND TANKS PERMIT N ��48 DATE ZZ— The undersigned hereby applies for a permit for the installation of range and fuel oil burners, equipment and tanks of the following description: Address —� 1st floor _2nd floor 3rd floor Character of Building: Frame --Brick Owner of Burners �v�,� Owner of Building _ Lessee or Tenant RANGE BURNERS Capacity of Tank at Range in cellar outside Name of Range Burner _ Purchased from POWER BURNERS _ Name of Fuel Oil Burner Model Number c Purchased from Name of Tank Gauge of Tank 2 Where is Tank Located Size of Tank Size of Motor Size of Wire Will other heating equipment be installed? If so, by whom _ Name of Party Making Installation Address _ Electrician Address Signed APPLICANT All provisions of Ordinances of this Town Regulating Oil Burner Equipment and Fuel Storage (Sections 1-23 in- clusive) and Underwriters' Code applicable to the subject matter of same shall be complied with in execution of this work whether specified herein, or not. Estimated Cost $ ?we�_ Application for Permit received 10-21-63 and Permit No. 17 " O_ 1 Permit Fee Paid _P Crmi t # 5 6 7 Approved BUILDING INSPECTOR TO THE BUILDING INSPECTOR of the APPLICATION FOR PLAN EXAMINATION AND '!'SOWN OF S4VTH WIlrDS4R,t�0 BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O �j ZONING • AT (LOCATION) 4 DISTRICT LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE N II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D �v A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use ro 1 ❑ New building Residential Nonresidential 2❑ Addition(If 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 ❑ Transient hotel, motel, 21 ❑ parking garage 4❑ Repair, replacement or dormitory — Enter number 5 El Wrecking (If multifamily residential, of units ——————— — i ❑ Service station, repair garage enter number of units in building in 1S❑ 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 ��/ 27❑ Stores, mercantile 8 ❑ Private(individual, corporation, 28 0 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 rVO O processing plant, machine shop, laundry building at hospital,elementary 10. Cost of improvement,,,,,,,,,,,,,,, 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 3 I'® 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 d 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 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 51. Enclosed ...................... F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 35❑ Gas Will there be central air 52. Outdoors....................... 36 0 Oil c nditi ning? L. RESIDENTIAL BUILDINGS ONLY 37❑ Electricity 44❑ Yes 45❑ N 53. Number f bedr ms.............. 38❑ C al 39❑ Other— Specify Will there b an levator? 54. Number f Full.......... 46❑ Y s 47❑ N bathrooms Partial... . NOTES and Data — (For department use) IV. IDENTIFICATION — To b c mpl t d by all applicants Nam Meiling address — Number, street, city, and State ZIP code Tel. N 1. Owner or Lessee Afzt�! /A ,Q zt,2� 2. Gr Contractor 3. Architect or Engineer Th own r of this building and the undersigned agree to conform to all applicable laws of this jurisdiction. Signature of applicant Address Applica on da 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Revi w Re uired Check Plan Review Date Plans By Date Plans By Notes 9 Fee StartedApproved BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approva I Check Date Number By Permit or Approval I Check Date Number By Obtained Obta ined 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 numb r 10570 Bui Iding P rmit issu d Nov. 6 19 78 Bui Iding Permit Fee $ Appr ved by: ITLE • • • .. .aw.wwaa aw w••wwww. ww.w ww..wwww.. .�... ww..www. wwaaa■■■.w.www.ww wwwwwwww w w ■ w wwww■*w /\\ • ■w w\aau ...ia sH:s�N w\is::aw # ■.::%■■: me :*:aii:::aw �: ■• .! 0!■. :� : ■ ■1_.!r■.• 1_ry_� • • ■ :�■wi!# r r` ■ ■ ri• :�#■■i :5 a *w.wnsw :■r.aw .\�aw.■.!■wassw•.r Nl■a /:laa aa• ■ * ■ fir■. s. fi'i■ir a N..■saaast■ ■ ■**asaN•■.!r ■/N �It r i a/ ■a■■ ■■e: �as:sa MONSOON :f■ ■ :■:i*: ■ " ■::rsr ■ i■ ! ■ M.sow/a•!w N ii■■ iiflNiilMMtMMN■■ ■ ■ ■/�•••■N s11 ■ •■■ .a•• /■ a/■.also sow wa lw/s■• •r ■■/■ ■ - a..#.iu. ss ■ ■s■: : fir■, r n s ■ B ■■■ ! •lrw#� r■■n:�is �il� i is s �w it � siaiit� ■ s! Lim i ::i'wafGia. i{i■N'=i ■ ��rRia ■■ ■ ■ as LLw rL ■.s.' 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'.&SH S H tL_S_==�w:SsiH!... _S:r■'N:11�: :i=•_!:" :5::: : ;_:: :: ls:: : :i::='•l:==C::i:L_S:lf=:r■'==:L=:::IL=:LIm ■ 1:■�:L:..� '■::Cis:■sal !N::: 1 •• !■■■ ■\ww• ■�\ w/\■ ■\•a •a■ a e■ ■lran •r.■•�ara.•■rr•\•■■ra■Ha• ■r•■wa.• ■!!■a• ■• ■■ •N■■•i■H ■ ■ aw�li■ ■•■N Nw •■ #a■as i a: ■ar/■==a:w rair =_=■==:L�:i�aw as■■�=aa:w••a:ww•\:■■■a\=■■■■ =■s:■■:■� ■il:w jLi == ■■=■■L:=_■s■sii= easel � 25 � L:sa.1 �s:ia:=:N= .s=:�L�saw.w■ �H ==HH:i=■L==:=■■:_■■■■:■ =as\■■a::• ■:■■■■■: •■•:■wr■■ . ■� ■ ■_ _ :■ ■ ■■ • S:s■a:=■ �• •\iw ■ar ■r\■■ •\■ ■•■w\• .aww/aa•• .lw■draw ••aarw■•■\■\■\■■•\\\.■•\•.ar•\■a\•a ■■•• was •a\wwawwa■■ w ..rr ■■ ■ . ar ■ ��\::�a�i�a:r=■*��■w . :: /•a=■a--::-w--al --■-3:\!w■:=!-■�■w�■:Ll■w::■S\�` li= ------r::s.l.= -l- ---5--------■■sow■--- TOWN OF SOUTH WINDSOR BUILDING PERNIIT Date Nov. 6 , 19 7 8 Fee Paid $.3...00 Est. Value $.ZOQ.00 Permit N° 10570 on the ode of Palmer Drive Street Street No. 11 1 Owner Mary Serkoskv Applicant Ma 3=V r n-qkv CERTIFICATE OF OCCUPANCY ISSUED: Date No. Fee Paid $ CLASSIFICATION Wood burning stove BUILDING PEI INUr NY 10e5'70 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Co.. Nov. 6 1978 94is is to Tiertifgp That Mary Serkosky is hereby granted permission to Wood burning stove at estimated value of $ on the side of ii1 Palmer Drive Street on land owned by Mary Se rko s ky Said Work to be as described in Application No. 10870 and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. Issued Nov. 6, 1978. �Y � .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." 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 IV 4 ui g Inspector ;77 Application must be printed or typed Location of ob: FEE SCHEDLTI,E � P,A?z L — $0-$1,000=$13.00 Stree No. Street Lot No. Over$1,000= $13.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT JU APPLICANT ADDRESS So S6)ilisE C,-4-,Q l414�b , CT— APPLICANT PHONE# �� N OWNER P O q� OWNER ADDRESS Pre l- v tat OWNER PHONE 6 qLl— C :D ESTIMATED COST$ 7.S D a IS THIS A CONTRACT COST. CK'es C!No FEE ENCLOSED$ ?2�- � � TYPE OF JOB: s�R 0 New Installation YAlteratiordAdditionMepair Revised 8/99 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑NO ❑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 el-V -e SIZE OF SERVICE 2c U SIZE OF MAIN CONDUCTORS 5k f 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 SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK S'PIVIC ,e 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. 00 IF3( Z�Jc::;p �F— // 0% CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT c -le, DATE 2 INSPECTOR DATE 2- TIME _9 LOCATION C! INSPECTION: CODE: RESULT(D/A) : BUILDING: i i ELECTRICAL: r PLUMBING: HVAC: OTHER: G t f