HomeMy WebLinkAbout124 Pine Tree Lane ot
Pere° ... TOWN OF SOUTH WINDSOR L h
SOUTH WINDSOR, CONN.
' U a
Permit N. 119 S
Certificate of Occupancy "
THIS TO CERTIFY Ala that the
at No. - " � tic h ' � in the Town of South Windsor, Cwnnectictit,
j has been erected,and completed in accordance with tlie73uilding Code and Zoning Regulations.of
the Town of South Windsor, and is hereby approved f ,occupancy.A r---�
�x
t,/,� B INS' INSPECTOR
AbwdER, BUILDER
9"j
Fee Paid .C�0 Dat
..Application No. . . 6049 Permit NO.5 7.7 9 .............. .. ......
TO THE BUILDING INSPECTOR
of the
TOWN OF SOUTH WINDSOR, CONN.
Qjr.. hereby make application for a permit to (*Ama (make alteration to) a building according
to the following detailed statement of the specifications and plans herewith submitted. (Draw a fine 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 whedw specified herein or not.
2- 3 IQ C, 6
South Windsor, Conn., .......................... ..........0
sip ...here .... ................. ...... ...............................
Address ./;.. ..... . . ................ ............... ........................................
Location? . ...........................................................................................................side of? ........................................................................................................................
Nearestcross street? .......................................................................................Street No. .......`7 ................... Lot No. ...... ,7
....... caAt......Address /...>/...
Owner of land is? .....I-X.!...... ...........tze..............
Ownerof building is? ................................................i..................Address ... ............*f................................................................................................
Architectis? ... ..... ...........................................................................................Addrm .............. .......................................................................... .....................
B ... ./ ..Address . ................ .....................
Dimensions of building? ... ... . ........... Fact front? ................................ Feet rear? ...... ....... ........... Feet deep? .........
Extreme height to hest int of roof? ....................................... .... .... . .. ... No. of stories in height? ................
...........................
Purpose of building is? . er-C...... ................No. of stores? ...... ................. ........................................................................
Howmany families? ............................................ ......._.....No. of rooms? .... ................................................................................................
Distancefrom street line is? ... ... ...... ..... ....................................from building line is? .................. ........ ....................................................
ADDITIONS AND ALTERATIONS
(Give Brief Description)
0000'
..... .............................. ........ ....r..Z.A.11...................eZ���.............................),(..../.X/... ............................. .......
........... ..............f ........... ................,...............
. ....... ....................
7
OP
.... . ..............
............... . ................... ......... ................ .. ... ... . ....
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 asafe load of
16. 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
lffe*bt stories Front Walls Side Walls Rear Walls Partition Walls
Basement,
.....................................................................................................................................—.................................................................................................. .......I..............................
1st Story
.......................................................................................................................................................... ............................................................................................ .......................................... .....
2nd "
.................................................................................................................................................................... .... .... ........ ........................................... .... ......I........... .......... .. .......
3rd "
....................................................................................................................................................................................................................................................................................................... ......
4th 14
..................................................................................... .................................................. ......................................................... .......................... ........................... .............. ....... .......
5th 11
................................... ................................................. .................. .......................................... .............................................. .................................................. ......I......... ...............I...........
6th 'A
............ .............. ............................................................. ............................ ..................................... ..............................................................................................................................
7th #'
........................ .................... .............................. ........................I............ .... ..... ... . .......................................................... ............... ................................
8th is
.................................................................................................................. ... ......... .......... ........... ........... .. ......... ... .. .................... .................. .............I.........
9th 11
. ........................................................................... ....... . ... .......... ........... ....... .. . ... ........I...... ................ ..............................
10th
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
Jown GERDM COLUM"
FIMM Nu Longest ftm Centme SCUSbC I ffin L=P" apse CARt"S ffift IAOSS CARtm
1st Plow
......d...... .."....... ......................................................................
2n ........................
....... ............ .........................................................................
.................................................................................................
11
Size of Outside studs? .......................................... Distance on centres? ................................................ Size of sill? ...............................................
Size of rafters? .......................................... Distance on centres?...................................................Size of plate? ......................................................
Size of ledgers or girt:? ........................................ . ..................................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? .....................................................................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 ... .... .....................................
When will work be commenced? ....... ........... ...... ...........e>'
..... ........er..0........... I.......
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
5779
BUILDING APPLICATION
0
ApplicationNo. ..........'........4..9....................................................
anthe ................................................................................. side of
Pine Tree Lane
.... ...........Pine..........Tree.. .. ..... ... ....................... Street.
Street No, .....1214— ...... ... .....................
Emil H-Do7ron
Owner .. .... ......... .... ...... ................ ............
Same e
. ..... .............. . ... ... .. ..
CLASSIFICATION
Recreation room in basement
. . . . ... . ... . ..... ........... ...................
21 T x1.4.1... ...... . . . ... ...... . .. ........... ....
... .. . ... . .. .. . .............. ...........
Permit issued on above Application.
9-26-66
Date, 19 ........
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date Sept.26, , 19 66
Fee Paid $. 3 '00 Est. Value $. . . 5 0.0 0
Permit N° 5779
on the side of
Pine Tree Lane Street
Street No. 124
Owner Emil H. D oyo n
Applicant Same
CERTIFICATE OF OCCUPANCY ISSUED:
Date
No.
Fee Paid $
CLASSIFICATION
Recreation room in basement
211 x141
BUILDING PERMIT
N:' 5779
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. Sspt•26 v 1966
X#ia is to Tertif1j, That Hail H. Doy ou
Reorea:3.ots I��o�; ire ' €�3e�:�:nt ?�.�:�.�.l�.t
is hereby granted permission to
-'
at estimated value of $ 0.00
on the side of F l r a 'Ir r a l Street on land
owned by Emil E.D 3yorl
Said -- WO'rk to be as described in Application
No. 6049 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
Issued Sapt 26 r 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 f rom 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."
TO THE BUILDING INSPECTOR
of the APPLICATION FOR
PLAN EXAMINATION AND
'[OWN OF SOUTH WINDSO�C.CO�iN. BUILDING PERMIT
z
IMPORTANT - Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
/ a / ZONING
I• AT (LOCATION) 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 -4
�o
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking' most recent use T
1 ❑ New building Residential Nonresidential
2 Addition(I/residential, enter number 12 0 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 religi us
number of units— — — — -� 20❑ Industrial
3 ❑ Alteration (See 2 above)
14 ❑ Transient hotel, motel, 21 E] Parking garage
4❑ Repair, replacement or dormitory — Enter number 22
5❑ Wrecking (1/multi/amily residential, o/units ——————— — -i ❑ Service station, repair garage
enter number o/units in building in 15❑ Garage 23❑ Hospital, institutional
Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17❑ Other — SpeciJy lJ -S'��4E; 25❑ Public utility
7❑ Foundation only
kk 26❑ School, library, other educational
B. OWNERSHIP / /dN 27❑ Stores, merconfile
8 Private (individual, corporation, Q Q 28❑ Tanks, towers
IkAj �f� �7�`" �� 29❑ Other — Specify
nonpr fit institution, etc.)
9 ❑ Public(Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
36
t0 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 AJ O
a. Electrical......................
b. Plumbing ...................... A)d
c.Heating, air conditioning......... A�Q
A/0 ,
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $
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 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
34❑ Other — Specify 42❑ Public or private company `� Total land area, sq.ft. ...........
43❑ Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35❑ Gas Will there be central air 52. Outdoors.......................
36❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37❑ El ctricity 44❑ Yes 45❑ No 53. Number f b dro ms..............
38❑ C al
39❑ Oth r— SpeciJy Will there b an I vator? 54. Number of Full..........
46❑ Yes 47❑ N bathr ms
Partial........
NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Nam Mailing addr ss — Number, street, city, and State ZIP cod Tel. No.
Owner or ,c/� 0 607� 6qcl—
Lessee ;v s 09 G ly
nn 6 607
Contractor
tea. C�,,v� s ore l
3.
Architect or
Engineer
The ow f this building and the a igned agree to conforT to all applicable laws of this jurisdiction.
Signa of applicant Address Application date
ids . �A, �/7
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans R vi w R quired Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $ i
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approva I Check Obtained Number By Permit or Approval Check obtained Date 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
P rmit numb r 11061
Bui Iding
Permit issu d Aug. 29 19 79
Building
Permit Fee $ 24.00
Approved by: ,
r `
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SHISH i=tss =:==s���:a.i=.t...�i:....s.te.:.ms:::::injU:__::::::::::=a:==ra:ites�:fsss:'s:'sa�aa:� tg 1:' i a sst 1 ,N . ad\o . ems m\e. m\eee\er■eoe\8 .seen mess... ■■ moos ....deem.. ma■ ... ... . ... . . •H aN■ . ..
::== :s ::; :'s:=::'s=:::::::'si==;::s':: :::: ::::::'s:::::::: ::::s:c:::::: s::= =_ � �==hi s= ==o;6's�� = s' aat'ss ='s='��E=�=:=s's . iim :::.
.:\■■•i::s.:::r.••■tossiew■■r■=i...rs.e•ri\r.■:.rae•.a•■rr.■■.•■■•..r.a..r...........wiaa.•S:rattee\■....atliii=i.•w=•■:::r:•o«i: ..i.:..is:eeii:: :r.a■•
;osit:::=-some-----=;:-a=::ce-------- -- --s:sc::t�:::::::::::s::r:::=�::_::;::_:::::e�::t:l:=Zs:::::s: ::s�:Alt:::�s:;s:>:=�::::-:::;;::;-
a
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date Auk. 29 , 1979
Fee Paid 00 Est. Value s.3.!600.O� r
Permit - 11061
� A
on the side of
Pine Tree Lane Street
Street No. 124
Owner E_ H. Dwan
Applicant Dnvi A- Psi t ri a
CERTIFICATE OF OCCUPANCY LSSUED:
Date
No.
Fee Paid $
CLASSIFICATION
Addition
BUILDING PERbff r
N° 11061
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. kupt• 29 ig 79
X#is is to Certify, That nA3-_d P&trj%j
is hereby granted permission to Outside shell addi ian to c-s=rrxt
at estimated value of 0
on the side of 124 Pine T-c_o Cane Street on land
owned by E. .i. Doyn
Said Wo rk to be as described in Application
No. 11361 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
Issued 19 79.
s z
•v
G- B 'ding 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."
7�x/�P nNSPCTION REPORT
Permit # Job
1 Footing --
2 Foundation
3 Framing It _i tj—
17
4 Wiring '�
5 Plumbing
6 Heating
7 Lathing
8 C.O.
�,, �c�r���2� ��
�� h
I
TO THE BUHMING INSPECTOR
ofthe APPLICATION FOR
TOWN OF SOUTH WINDSM C RM PLAN EXAMINATION A N D
BUILDING PERMIT
IMPORTANT — Applica complete all items in sections: 1, 11, 111, IV, and IX. O
ZONING
I• AT (LOCATION) � � � l DISTRI
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 i>r
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 Past D, 13) 13❑ Two or more family — Enter 19❑ Church, other religious
3 ❑ Alteration (See 2 above) number o/units— — — —-� 20❑ Industrial
140 Transient hotel, motel, 21 0 Parking garage
4❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (1/multifamily residential, of units ——————— — -i 22❑ Service station, repair garage
enter number o/units in building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part D, 13) 16❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17 Other — SpeciJ 25❑ Public utility
7 ❑ Foundation only t 26❑ School, library, other educational
B. OWNERSHIP 27❑ Stores, merconfile
8 X Private (individual, corporation,
28❑ Tanks, towers
nonprofit institution, etc.) 0= e=1 29❑ Other — Specify
9 ❑ Public (Federal, State, or
joo-
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,,,,,,,,,,,,,,,, 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.......................a4cp
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 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 410 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
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35❑ Gas Will there be central air 52. Outdoors.......................
36❑ Oil conditi ning?
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44❑ Yes 45❑ No 53. Numb r of b drooms..............
38❑ Coal
39❑ Other— Specify Will th re be an elevat r? 54. Number of Full..........
46❑ Yes 47❑ No bothro me
Partial.......
NOTES and Data — (For department use)
IV. IDENTIFICATION — To b compl ted by all applicants
Nam Mailing dress — Number, s 1, city, and State ZIP code Tel. No.
Owner or r /z -le ,
�*'P+ • T`1� O_ ��
Lessee Of
�++ _
v�
2.
Contractor
L/- ✓L� .ems+
3.
Architect or -T
Engineer
The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction.
Signature of applic Address Application date
% _
r� �
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By Notes
Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obtate ained ned Number By Permit or Approval Check Obtaate ined
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
P rmit number 11167
Building
Permit issued Oct. .5 19 79
Building
P rmit Fee $ 6.00
Approv d by:
zi;04 .:—L,%S2:0,
TITLE
Vill. ZONING PLAN EXAMINERS NOTES
DISTRICT
FRONT YARD
SIDE YARD SIDE YARD
IX. SITE OR PLOT PLAN For Applica_ _ =.s �i
nt Use
■
•
•
zzzz
Ile a H60028:11 son : of =Z=
H
as was I a S a 11MI HHHUS111, lesq.
senng@ ago a a :88
.f� i= 11 Milill: HIPSH
So a. Us l"IssupoMMUNHO USH IMP
I uniniffiluelp,
.11 ::.No :1: 6
a a n : son a ••H Iii a an Ill me-sullinuplul 088 CHII a
I a
I mi 11juillupi will seen Il as fluillnup:is
Illman so :800206.29 a to
a a 3 SON I does a
all
onesn"GH on
liInq Memel a
.
is is�
in
�iiu Ils: H Is H
NO a 11:11: illf! I , lvd M I 1 0 Blile HHOWI 31111HISHISIM USUNUIN .111
691666HIN as 0 s191a�*is �"
.s: isiii='i�.=i�:: :=isIsm il Sill an ulng
rpilfliflIBIH: Owast:oo a so 0u
lHifliunlLglinlitifill in 1,ffilUll are as anwadiiison
IUNS we ilniulr:G :: ::uili !!i Uff MINORna u s Wfficz
HUM In Ia 10.,TdPa.%I alS* o
nillilln: H HWoUli a , M:.! li: '::I:rjginii, nuli ,q!, 1111
mass a 8:•was soon as a Sam :::OEM I.HalWoUlal...one in. HHH'Iffili: a 12 ���iii��� a HISHIM
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date Oct_ 5 , 19 79
Fee Paid $- b.00 Est. Value pw l 00
Permit N9 11167
on the side of
Pine Tree Lane Sava
Street No. 124
Owner E. H. Doyon
Applicant Emil Doyon
CERTIFICATE OF OCCUPANCY ISSUED:
Date
No.
Fee Paid $
CLASSIFICATION
Finish interior of breezewaX
also wood burning stove.
BUILDING PERMIT
9 11167
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. Qet. 5 1970,
94to is to Terrify, That E. i3. T)oyoa
is hereby granted permission to finish interior o i breL aewav_ Tn gu 1 at_,
Panel and Install wood burning stove.
at estimated value of $
on the side of 1?.4 Pine Tree Lane Street on land
owned by - E. H. noTOn
Said W-6 rk to be as described in Application
No.11467 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
Issued Oct - S----,7-, 1970
ilding 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."
TO THE BUILDING INSPECTOR
of the APPLICATION FOR
TOWN OFSOUM W111105 ,CONK. PLAN EXAMINATION ANO
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O
77 �
I• AT (LOCATION ZONING) v4� ��� �_" DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN !%r��-.Lf'G✓i1�/� 24 AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION 1z 4eA6Q&z9 LOT &,::E: BLOCK SIZE
oe
II. TYPE AND COST OF BUI ING — All applicants complete Parts A — D
�v
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
1 X New building Residential Nonresidential
2 ❑ Addition(it residential, enter number 12❑ One family 18 ❑ Amusement, recreational
of new housing units added, if any,
in Past 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, 21 ❑ Parking garage
4❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (I/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 — Speci/y 25❑ Public utility
7 ❑ Foundation only
26❑ School, library, other educational
B. OWNERSHIP �OGic.� SdiGI� 27❑ Stores, mercantile
r
8 � Private (individual, corporation, 28 0 Tanks, towers
l v� �( 1� 29 Other — Specify
nonprofit institution, etc.) ❑ P fy
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,,,,,,,,,,,,,,,, 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 'r
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $ .�
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 ❑ 49. Total square feet of floor area,
Private (septic tank, etc.) all floors, based on exterior
32❑ Structural steel dimensions ....................
33❑ Reinforc d 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.......................
36❑ Oil conditi ping? L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44❑ Yes 45 A No 53. Number of bedrooms..............
38❑ Coal
39❑ Other— Specify Will th re be an elevator? 54. Number f Full..........
46❑ Yes 47X N bathrooms
Partial.......
IV. IDENTIFICATION — To be complet d by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Owner or
Lessee COI
2.
Contractor
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 Address Application/do,
IF
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Re uired Check Plan Review Date Plans B Date Plans B Notes
9 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 ObtDained te 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 ,L ��
Permit number
If
Building
Permit issued 9 °� 19
Building or
Permit Fee
pro ed y:
1%0
ITLE flA
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date May 2 4 1 ig 84
Fee Paid $.4...0 0 Est. Value $5.0.0...0 0
Pit NY 13857
on the side of
Pine Tree Lane Stzeet:
Street No. 124
Owner Emi 1 H. Doyon
Applicant Em i 1 H_ Doyon
CERTIFICATE OF OCCUPANCY ISSUED:
Date
No.
Fee Paid $
CLASSIFICATION
ShPcl
BUn DING PERMIT
N� 1385'7
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. May 2 4 19 84
454tta is to Mertify, That Emil noyon
is hereby granted permission to Shed 121 x 14
at estimated value of $ 5 0 n-n 0
on the side of 124 Pine Tree Lane Street on land
owned by nmii H. novon
Said Work to be as described in Application
No. 141-57 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
I 19840
114
to 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."
TO THE BUIOLDING INSPECTOR
of t6 APPLICATION FOR
')'OWN CW WIM PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: I, It, Ill, IV, and IX.
ZONING
1• AT (LOCATION) j �.�1v / l�C't Z Ad1 F DISTRICT��
LOCATION I N0.) (STREET)
i
OF BETWEEN
BUILDING (CROSS STREET) f CROis STREET)
LOT
SUBDIVISION LOT--BLOCK SIZE
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
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 CErono family 18 ❑ Amusement, recreati nal
of new housing units added, if any, 13❑ Two or more family - Enter 19 ❑ Church, other religi us
in Part D. 13)
number of units- - - - 20 ❑ Industrial
3 ❑ Alt ration (See 2 above)
14❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ R pair, replacement or dormitory - Enter number
5 ❑ Wr eking (it multifamily resideetial. of units ------- - -0. ❑ Service station, repair garage 1
enter number of units :n building in 15 ❑ Garage 23 ❑ Hospital, institutional
Part A Z3) 16 ❑ Carport 24❑ Office, bank, professional
6 ❑ Moving (relocation)
17❑ Other - Specify Al y Ad AlvA-1 25 ❑ Public utility
7 ❑ Foundation my 26 ❑ School, library, other educational
i
B. OWNERSHIP S/!�IAl�' -L� n ALL 27❑ Stores, mercontiI �
28 Tanks, towers
8 ❑ Private (individual, corporation, ��, ❑
nonpr fit institution, etc.) 1 At'y CV rEA,.+LC-47A,10AL 29 ❑ Other - Speci/y
9 ❑ Public (F d ral, State, or
local government)
C. COST (0m:t cents) Nonresidential - Describe in detail proposed use of buildings, .g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of impr vement,,,,,,,,,,,,,,,, S '(/'7/ w school, secondary school, college, parochial school, parking gorag 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( I valor, etc.)............
11. TOTAL COST OF IMPROVEMENT S
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 1V.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 l J Mes my (wall bearing) 40❑ Public or private company 48• Number of stories................
31 ❑ W ad fro" 410 Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32❑ Structural steel dimensions ....................
33❑ R inforeed concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq. ft. ...........
34❑ Other - Specify 42❑ Public or private company
43 F Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35❑ Gas Will ther be c ntral air S2. Outdoors.......................
36❑ 011 c nditioning? L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44 0 Yes 45 ❑ N 53. Number of bedrooms..............
39 ❑ Coal
39❑ Other- Specify Will there be an elevator? 54. Number of Full..........
46❑ Yes 47 0 N bathrooms
Partial.......
IV. IDENTIFICATION — To b c mpl t d by all applicants
Meiling eddress — Number. street. city, and State ZIP code Tel. N
Name
1. ��,,�•ra
Owner or
Lessee N
Contractor
3.
Architect or
Engineer
Th owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction.
Signature f applicant
Address Application dot
_ ^IiZVI
IV / ,,,4 r o
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans By Notes
Plans Revi w R quired Check Fee Started By Approved
BUILDING
PLUMBING
MECHANICAL S
ELECTRICAL S
OTHER s
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Date Number 3y
Permit or Approval Check Number By Permit or Approval Check Obtained
pp Obtained
PLUMBING
BOILER
CURB OR SIDEWALK CUT ROOFING
SEWER
ELEVATOR
SIGN OR BILLBOARD
ELECTRICAL
FURNACE STREET GRADES
USE OF PUBLIC AREAS
GRADING
OIL BURNER WRECKING
OTHER
OTHER
VII. VALIDATION Building
Permit number
Building 19
P rm i t i s s u d --�—
Bui Iding
Permit Fee
Ap r v d y:
�AV
TITL
TOWN OF SOUTH WIMSOR
BUILDING PF Uff r
Date J-1— 1987 ;
Fee Paid $3().00 Fat. Value $43W;00
Permit N° 16037
on the aide of
i
Street
Street No.
Owner Zft
Applicant
CERTIFICATE OF OCCUPANCY ISSUED:
Date
�A� No.
Fee Paid'$
CLASSIFICATION
d z
BUnDi NG PERMIT
N° 16037
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. July 6 19 87
94is is to Certifg, That Oliver Lallier
is hereby granted permission to Install siding (Aluminium)
at estimated value of $4500-00
on the side of 124 Pine Tree Lane Street on land
owned by Emil Doyon
Said Work to be as described in Application
No. 16335 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
IM110d July 6 1987
Q�✓10.Q � cto�.
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."
Electric# /?sL10 APPLICATION FOR BUILDING PERMIT
PlumWig# /0�0 0 124 Pine Tree Lane
HVAC # Dat : ,z
�. 28258
Sprinkler#
FINAL APPR ALS Estimated Cost
Building -2 9 OZ COIMPLETE RED BOXED AREAS Permit Fee $ 7
Engineering TYPE OR PRINT ONLY Occupancy Fee $
Affidavit SIGN ON REVERSE SIDE 6a
Appr.for CO. C a 2�- Total Fee $
TO BUILDWG lklARTMENT,TOWN OF SOUTH WINDSOR,CT Additional Cost)
The undersigned hereby applies to do work according to the following specifications:
Job Location Lot No. Side of Street Zone
Gy"L�
Applicant �Zaoe�(Z aTA 4g .. l Tel# 72Q3
Address � � Zp Lc # >�>
Owner ejj'�4j i. ,��.�1 Address'/2�0 �_i.�� 14,��
Architect Address � 1/�3.e� -
Sq. Ft.N w Area: lst FI. S`M S� 2nd Flt�� 3rd Fl i�i,�ir� Total New Area C���
#Rooms -Z-- #Lavatories 1 #Bathrooms / #Garages
Purpose of this permit:
00
City Water ❑ Well ❑ Septic System 0 Sewer ❑
Ins. H.O. S.P. Cert. Z Area Basement Garage
Approved by J KA-- Date t 0 6 Q Use Group -4 Construction Type 45tS
Rev'sed 1197
I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of
South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this
permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required
distances from all other zones and is located 7inwhi=ch thi building and its use is allowed.Signe
I hereby apply for a Certificate of Occupancy for he work described in this application for the permit. /
Signed
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
Inspection / Approval Date By Appl
Code Description Due Whom Code Comment
-------------------------------------------------------------------------------
**-28258-B 52,000
BO1 FOOTING 10/26/01 GRM A W/CONTRACTOR
B02 FOUNDATION 10/31/01 CJD A W/CONTRCTR.
BO1 FOOTING 12/04/01 CJD A DECK FTNGS.
B03 FRAMING (ROUGH) 01/17/02 CJD A W/MORIN
E03 ROUGH O1/17/02 CJD A W/MORIN
P03 ROUGH O1/17/02 CJD A W/MORIN-NEED ELEC. AND PLUMB. PERMITS
B04 INSULATION O1/18/02 CJD A W/RICH MORIN
B09 OTHER 02/06/02 CJD A W/BLDR.
E03 ROUGH 02/06/02 CJD A W/RICH
B10 FINAL 08/29/02 CJD A W/RICH
B10 FINAL 08/29/02 CJD A CLOSED OUT.
**-17586-E 1,500
**-10900-P 2,500
I
I
GRAPHIC SCALE IN FEET
40 0 40 80 120 160
REFER TO A MAP ENTITLED"SITE ENGINEERING PLAN,SECTION 2,AVERY HEIGHTS,
SOUTH WINDSOR,CONN.,SCALE: 1"=50',APRIL 22,1957,CERTIFIED SUBSTANTIALLY
CORRECT,MORTON S.FINE,CIVIL ENGINEER NO.2931.". cn
,s'• Z
r �11 GPI
160.75'
I-
O
�v M• CONC. •
� -Al' PATIO
j GARAGE t
O �
& 0 115
LSHED I r114,
r i O X 14 a
o C PROPOSED
IT
I a� m Z ADDITION
CONC.MON. r _
FOUND I r REBAR
DISTANCE TO FOUND
1 PROPOSED
CONC.MON � ADDITION •• �
2 FOUND Cr?
�y�YVn CONC MON. �� FE �+��
♦�?' FOUND _o�_o C}yp1l�►= M"'M1'R=49720'
MANHOLE
ir err
_- V
gEN
Epjc;T DRIVE MANHOLE
MANHOLE
JOEL A FULLER
LICENSED LAND SURVEYOR
MOTE:THE INTENT OF THIS SURVEY IS TO SHOW PROPOSED
ADDITION AND ITS RELATIONSHIP TO 40'BUILDING LINE
THIS SURVEY MAP HAS BEEN PREPARED IN ACCORDANCE NTH SECTICINS BUILDING LOCATION MAP,ZONING
20-300b-1 THRU 20-300b-20 OF THE REGULATIONS OF STATE AGENCIES
"MINIMUM STANDARDS FOR SURVEYS AND MAPS IN THE STATE OF CONK' PREPARED FOR
AS ENDORSED BY THE CONN.ASSOC.OF LAND SURVEYORS,INC.IT IS A MAR BUILDERS
IMPROVEMENT LOCATION SURVEY BASED ON A DEPENDENT RESURVEY
CONFORMING TO CLASS A-2 STANDARDS. NO. 124 PINE TREE LANE
TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS MAP SOUTH WINDSOR
IS SUBSTANTIALLY CORRECT NOTED HEREON CONNECTICUT
L M.FULLER CT.L.S.NO.1 97 OCT.,2001 SCALE: 1"=40' 1630
"U -I{r�`
South vVir-11SIC"T
PAS
zre��iet1 tit /�O
tcw
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may ap ,' L
as
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DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR 12 s�
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230�L�Dftw Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT t
APPLICANT ADDRESS T ar-M CT M,?�OP'
APPLICANT PHONE#
00,11 W N S OWNER
�q� OWNER ADDRESS
� x
Er
OWNER PHONE
it ESTIMATED COST$ U
'r IS THIS A CONTRACT COST. 0 Yes QNo
�CJ FEE ENCLOSED$ �
TYPE OF JOB:
OR-00 0 New tallation
teration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
d RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑ NO
❑BUSINESS CURRENT USE AND OCCUPANCYQ�,,
❑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 &A ,
SIZE OF SERVICE 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
NUMBER OF SWITCHES_ NUMBER OF OUTLETS 2�-CD
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.
9 �n t
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT - • DATE
DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WRNDSOR Zo9�Q
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 2 F a
ate Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE 0
F $0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 5 �J � �0''r �C• Chad" 8'*�z'
APPLICANT ADDRESSS/
6(ask-l&inj C�k e60,33
APPLICANT PHONE# &c> — 1 s-^T—cc
N S f OWNER ��' MQ/'kCA
°W � � OWNER ADDRESS 12y
!� (lid5�lr-
r OWNER PHONE
ESTIMATED COST$ 2 •
� IS THIS A CONTRACT COST? MIres- 13 No
FEE ENCLOSED$ 2760
�1
O�� TYPE OF JOB:
OR�C O New Installation
MAlteration/Addition/Repair Revised 8/99
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED A
BUILDING PERMIT APPLICATION? S ❑NO
SIDENTIAL
❑BUSINESS �tjc, '
CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY ((A�<
❑EDUCATIONAL
❑INSTITUTIONAL ENGINEER'S NAME 1 I PHONE
❑FACTORY
❑ STORAGE ADDRESS 15 HAACt kcf wl ��
UGARAGE
❑MIXED USE CITY 90 k6N STATE ZIP
TYPE OF INSTALLATION i VW Ea11, -4
OwF MAIN DRAIN
NO.OF TOILETS� STYLE �a (T "O.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE
AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS
NO.OF OTHER FIXTURES KIND
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW * 'ES ❑NO
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
R , I(
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
V\ 1 . jZ®may, , �,,�, �- ►C jc l�
1-4/,clla(gh
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.
0&3 6 2-Z--- P/
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
CG`CA r-lr¢s evs�