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Home My WebLink About166 Old Farm Road J��- f 0 THE BURDING INSPECTOR APPLICATION FOR PLAN EXAMINATION AND 'DOWN CIF 50WH W1105 ,CO- BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, It, III, IV, and I O X. ZONING • AT (LOCATION) LL•Z:�� Z!� DISTRICT LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING _ (CROSS STREET) (CROSS STREET) r LOT SUBDIVISION LOT BLOCK SIZE V1 II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D f �v A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use � 1 ow building Residential Nonresidential 2 Addition(If residential, enter number 12❑ One family 18 0 Amusement,recreational of new housing units added, i/any, in Part D, 13) 13❑ Two or more family - Enter 19❑ Church, other religious number o/units- - - - -p- 20❑ Industrial 3 ❑ Alteration (See 2 above) 14❑ Transient hotel, motel, 210 parkin 4❑ Repair, replacement or dormitory - Enter number g garage 5 ❑ Wrecking (1/multifamily residential, of units ------- - -- 22 ❑ Service station, repair garage enter number of units in building in 15❑ Garage 230 Hospital, institutional Part D, 13) 16 ❑ Carport 24❑ Office, bank, professional 6❑ Moving (relocation) 17❑ Other - SpeciJy 25❑ Public utility 7 ❑ Foundation only 26❑ School, library, other educational B. OWN RSHIP 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 - Describe in detail proposed use of buildings, e.g., food processing plant, machine shop, laundry building at hospital,elementary 10. Cost of improvement,,,,,,,,,,,,,,,, o� -6 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 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 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 ood frame 41 Private(septic tank, etc.) 49• Total square feet of floor area, all floors, based on exterior 32 r I Structural steel dimensions .................... J� 33❑ Reinforced concrete H. TY;PFF WATER SUPPLY34❑ Other - SpeciJy 42 ublic or private company 50. Total land area, sq. ft. ........... r 4 ❑ Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. *PRINPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... asWill there be central air 52. Outdoors........................il conditioning? L. RESIDENTIAL BUILDINGS ONLY / 37❑ Electricity ,44❑1-ees 4a` o 53. Numb r of bedro me.............. t� 38❑ Coal 39❑ Oth r- Specify Will Cher be an elevator? 54. Number f Full.......... 46❑ Yes 47 bothr me Partial....... IV. IDENTIFICATION — To be completed by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. � 5 Owner or 103 Lessee co m-) i 2. Contractor 3. Architect or Engineer The owner of this building and t-he undersigned agree to conform to all applicable laws of this jurisdiction. Sign 7teoff applicano/, Address Application date L � 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review 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 Approval I Check Date Number B Permit or Approval I Check Date Number By pp Obtained Y pp Obtained BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GRADING USE OF PUBLIC AREAS OIL BURNER WRECKING OTHER OTHER VII. VALIDATION Building Permit number Building Permit issued 104211,111f,-3 19 Building low Permit Fee $ Appr a by: TIT 1 TOWN OF SOUTH WINDSOR BUILDING PERNUT Date Dec. 1 , 1983 Fee Paid $. . .372,00 Eat. Value $. 61.,.2 50 Permit NY 13592 on the aide of Lot #17 Old Farm Road Sued Street No. 166 Owner Southridge Estates Applicant Pierre Giroux CERTIFICATE OF OCCUPANCY ISSUED: Date No. 6606 Fee Paid $ 3.00 CLASSIFICATION Dwelling BUnDLNG PERMIT N« 13592 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. Dec. 1 103 94is is to (frrft f#., Th-t Southridge Estates is hereby granted permission to Dwelling at estimated value of $ 619 2 5 0 on the side of Lot #17 Old Farm Road Street on land owned by Southridge Estates Said Work to be,as described in Application No. 13892 and to conform to specifications and plans filed with said Application, and'Building By- Laws of THE TOWN OF SOUTH WINDSOR. Issued Dec. 1 1983. �*-'Building Impect s. 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." Dwelling - Lot #17 Southsidge IV 12/1/83 SouthAdge Estates 166 Old Farm Road Permit # 13592 Electrician A Mozzicato # 8187 Heating Contr. Ace Mello, Jr. # 5795 Plumbing it Ace Mello, Jr. #6319 Oil Burner # Certificate of Occupancy # 6606 Plot plans apprd. per Engr. I ' I Permit No. TOWN OF SOUTH WINDSOR I SOUTH WINDSOR, CONN. I I I � Permit W00 - 66 n vs Certificate of Occupancy I i THI&4S TO CERTIF th the- 1/22-P I at No 4he South Windsor, Connecticut, has been erected and completed in accordance wit Code and Zoning Regulations of the Town of South Windsor, and is hereby a I y pupancy. I I I � Bui ding Inspector I ` O er, Builder I Fee Paid '3 Date 01te Adf19 I I 8187 ELECTRICAL APPLICATION Application No. 9293 on the sick of Lot #17 Old Farm Road Street Street No. 166 Owner Southri dge Estates Electrician A. Ma z z i cg r o FILED IN OFFICE OF The Building Inspector I Dec 5 19_ I INSPECTION. M No Electrical Work shall be started until a Per- mit is granted by the Building Inspector. in New Buildings no wiring shall be started until the plumbing and heating pipes, and the ere stops (if of wood) are installed, without a special permit from the office of the Building Inspector. Electrical Permit No. ...��1.� ................... Master License No. ..,1(.�. TOWN OF SOUTH WINDSOR Building Permit No. ..,C��.?-..................... BUILDING DEPARTMENT Date Filed ...�.1. .`....�..=5....�-...�.�................. Date Final Approval ................... ......................_..... APPLICATION FOR ELECTRICAL WORK Electrical Inspector _ f7 ` JOB LOCATION: .l/ . . 151-A-5....jq�JOB OWNER: ...................... Side of Between . -A� ve 1"S .. ... . ......... and ..../9.h, ................. d............... ..-5 .�.r.,.S Address Name of Building Owner ��./�,l.C'�L.>C .... .. .. .. � . .. . '.� ....-...... ....��„C,z1 If work is for Lessee--aGive name ...... ........ Address ................ ........................................... .......................... Building now occupied as (unless new) ...deez, ... No. of family units now . ..... Building to be occupied as ....... Number of family units to be ....... /... Is this work included in a Building Permit? 1;11d Permit Fee .. .. .................... .................... ..........._..... ' (If no Building Permit Permittee`�i�t-/ i'��-.� �1/..C� /C,,q/� Business Address 2 lam' Telephone COST OF INSTALLATION: ...... ............... .. TO BE FILLED OUT BY PERMITTEE TO BE WIRED EXISTING APPLIANCES Number of light outlets to be installed . . . . / C/ Number of convenience outlets to be installed VO Number of present Appliance Circuits ...... ... .................. .......... Number of switches to be installed . . . Do these include Range ❑ Water Heater ❑ Number of appliances to be installed . . . � (as listed below) Dryer ❑ Air Conditioner ❑ Oil Burner ❑ TYPE RATING NO. Dish Washer ❑ Gas Burner ❑ Range Well Pump ❑ Elec. Heaters ❑ Range Top . . . . . . Oven . . . . . . . . REMARKS: Water Heater ..�r�--�-Ili-'rG�� Clothes Washer . . . . Clothes Dryer . . . . . Dish Washer . . . . . . Air Conditioning Motor . Oil Burner Motor . . . . Gas Burner . . . . . . Circulator Motor . . . . Attic or Large Fan , , , Well Pump . . . . . . Electric Heat . . . . . Other . . . . . . . Number of new Lighting Circuits _...1�^............... Number of new Appliance Circuits . . . ..........._5....... Number of Heating Circuits . . . . . . ........................... Number of Motor Circuits . . . . . . . ............... �..._ Size of present service ........... .. Size of service to be ...... . ........�'�'.. 6319 PLUMBING APPLICATION Y Ape No. 7098 i on the _...__ --- sick of _ _Lot. #17.Old Farm Road Sam Suat Noce _._ 166 Owner __wSouthridge Estates Plumber Ace Mello, Jr. Filed in Office of ne &nUm�P _ Dec. 5 19M II�iBt�G�O�. ............._..... ........... No person shall add to ew aloes ay portion of the &anup system of nay bald" (except to repair leap) um&a Plermit is griped j by the Building Impactor. Application No. ...... .7098 Permit No. 6319................................................ ... TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. llc�.. ....... her 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 not. South Windsor, . ... ..... ....... 19 U.. Sign here ...... I .. . ...... .......... Address ...... ....... . ........ ...... I. ............... ...... . ......... .........�//40 .... . . side of .......................................... .................................. ......... Street Location 14. �6 Nature of Ruilding .../_4-�.. ........... . How many stories .. ..... ......... ........... . . Address ..A .................Owner ...). . . . . e�'**""""*'***'*"'***"**'*'*"'* '******...*'*'**"** * Architect ..................... ............. ........................................ Address . .... ...................................................................................................... Builder .... . .......................................... Address ... ... .. . ....... ..... .......... Plumber ...... .1414&4, . .... ................... ..................... Address ....................... DRAINAGE CESSPOOLS, How many Where located ................................................................................................... Are they water tight .... . ...... . .. .... .... .... Of what materials are they built ........................... .......... ..... .. Size of pipe from house to cesspool Kind of pipe . ........ .. ............................................................ ................. MAIN DRAIN IN CELLAR, Ma ri*al Diameter ........V............................................................................................. Aboveor below cellar bottom ". 1.4...... . . .. . . .................................................................................................................... SOIL PIPES, Material ................. .... .. ... .... Diameter -3 ..................f, -........................................................ ................ ....WASTE PIPES, Material . . .. .. Diameter ......a............... .... TRAPSyType 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 . .... ..........3.. ....... ......... Where located . ........ ...............I........ Distance from trap to vertical soil pipe .................. ................. Pattern . .......................................................... WASH TRAYS, How many . . .. ........... .......... ....... ... Where located ................ ................................................ SINKS, How many .... ...... .. .................. ............................................... Where located t/...................................................................... BUTLER'S SINKS, How many ........................................................ Where located. ................................................................................................. REFRIGERATOR SINKS, How man Where located ................................................................................................. LAVATORIES, How many ........................-... ..... Where located ........&'�.�- ........................................ BATH TUBS,How many ........................I.I.. ..... Where located ............ .. ............................................ URINALS, How many ................. . ........................................................ Where located ......... ........................................................................................ 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 ....... . .........................................I................................................................................................ Estim ed Cost .. .Q?.0'ev.......�_0............... PERMIT # Application For 6895 5795 DEPARTMENT DECISIONCd Heating Permit O 3E APPLICATION IS HEREBY: DEPARTMENT OF LICENgES AND lNSPEC't'IO►► �� N +' IX APPROVED ❑ DISAPPROVED -� TOWN OF SOUTH WINDSOR c co 0 T1. , 00 � DATE i+i4 `S ��C EF S��r; a APPLICATIONS MUST SE PRINTED OR TYPED. 99GIM WITH M MUR OME BELOW O -4-j 7, c -a, 1. LOCATION OF JOB o ^ 166 �'GAW cd NO. OTREng cd v - .� LOT NO. FLOOR APT. NO.. � O lV 79 4) ! a Z. OWNER it cd ° / r � 3 s. ADDRESS (� PHONE 'b1... C U2 � S. APPUCANT vi 0 PC PC 0 cc s. ADDRESS A2/ PC w 7.PHONE Imp G. LICENSE NO. a o s. EXPIRATION RATE OF LICENSE P to. ESTIMATED COST s •"y . Q _� 'b 11. IS THIS A CONTRACT COST? YES -❑ w0 r .� 12. FEE ENCLOSED *- Permit 13592 .c rA 0) is. TrPE F BUIUMN& fA y b4 ERESpEIITIAL ❑ COMMERCIAL O � 3 14. TYPE OF JOB; 0, INDUSTRIAL RNCINAL ❑ ALTERATION ~ INSTALLATION ADDITION REPAIR APPLICATION FOR HEATING PERMIT (C ntinued it m R verse Side) 11. LOCATION OF JOB 7- 1a_4ij<_4 -", NO. STREET FLOOR APT.NO. 12. TYPE OF INSTALLATION: ❑ OIL BURNER ❑ ELECTRIC ❑ VENTILATION ❑ SPRINKLER GAS BURNER ❑ STACK ❑ INCINERATOR ❑ MISCELLANEOUS IDENTIFY SIZE LOCATION SIZE SIZE 13. OF TANK OF TANK OF FILL OF VENT 14. B.T.U. EQUIP. AT REGISTER FURNAC M KE AND NO. AT BONNET FIRING RATE BOILER OR FURNACE MAKE AND NO T.U. OR SQ. FT. NET •104•B.T.U. OR SQ. FT. GROSS FIRING RATE FLOORS TO BE HEA D r� NE OR OLD BUILDING INSULATED — YES OR NO TYPE OF WALL INSULATION ROOF OR CEILING INSULATION v AVG. SYSTEM WATER TEMP. �/I d o- B.T.U./SQ. FT./HR. EMISSION INDOOR-OUTDOOR TEMPERATURE DIFFERENCE �& °FAHRENHEIT MAKE OF RADIATION: BAS OARD. OPPER CONY TORS, C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ. FT. OR B.T.U. DESCRIPTION OF WORK 15. TO BE D NE: G L If is. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS). ROOM SIZE DOWAND Do S AREA - SQUARE FEET VOLUME e.T.U. IS.T.U. I- DISTRIBUTIONINSTALLED TOTAL TOTALWIN y LL ROOM NO. Ggpgg GLASS NET WALL CEILING FLOOR CU.FT. AT 70'F CORRECTED J j 4 REGISTER L W N AND Ir TEMP. TO <f TYPE AND SIZE RAD. OR LEADER SIZE < WALL f'Lt0 (INFILT.) DIFF. •F O N SO. FT. FREE AREA 1 TOTALS A. HEAT LOSS FROM BUILDING B.T.U./HR. B. DOMESTIC HOT WATER DEMAND B.T.U./HR. C. PIPING. OTHER THAN NORMAL B.T.U./HR. ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR 17. ELECTRICAL WORK BY: NAME ADDRESS SUBCONTRACTORS AND 1s. THEIR TRADES ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE. APPLICATION TO BE COMPLETELY FILLED IN. DATE o SIGNATURE OF APPLICA B as R C. ,c ,,j, CALCULAT ION SHEET 1503 (Mode eth ) 7 x7 cal�r. 1 1f77 TM owu1ER— Cs c �h,.,�.-C f t�la �f ADDRESS r WS n 'A DESIGN TEMPERATURE DIFFERENCE rf iF F. PATIN COL.A COL.• COL.C COL.D COL.E COL.r COL.0 1 'ROOM /C/h u L ✓ I ' c o o ►+ w� H w H w NAjoel twwN Dow"rIOW Tomw 7 R00I0 01MENS1ONS,FT. r` u •TUN pw RMt N if-IT S LENGTH EXPOSED WALLS, FT. t 4 .r no""" 4 WINDOW AND OUTSIDE DOOR AREA i STUH ro STUH STUN H , • WALL CONGTRUCTIOti ITOW*9. "3 x ► } Q 0 U �,- G t;J Or Q T Old w .FT.a* TYPE OF OLA88 '• w (6 ttarn f table Used f r Lin,a) o ` o� o� s- 00 7 CEILING CONSTRUCTION C �d ► ITable S,L r'W) j r..._ -- ...w FLOOR CONSTRUCT10Nf I Table S, L M W or L In. F L) �.•-- • COLD PARTIT ION CONGTRNCTION D - .� I T+bb S,L■H) ---�' �-- /r•., —...w! y D D w ► i to L3W*ils all tWlth Open) o 0 O . H .Zr all•I W I[tl Opens s) !x 1/ � +r� +� IW Ith OPenlngo!or Ent. Hall ~ 6 1 ��o t- 11 TOTAL STUH AT ]OF TEMP. DIFFER&NCE• d Q .�Q p y ID 0Z OG O J p Em! iS TOTAL STUH AT DEESIGN TEMP. DIFFERENCE KO o G COL.A COL.■ COL.H COL. 1 COL.J COL.K COL.L 1 T TAL STUN TOTAL`ROOM S r✓ / f Or SUILDIme RA IAwom AT , O H M✓ H I./ H W H Leo' H � JW- 061614111 TKO&P.0 i Z ROOM DIMENSIONS,FT. u l.p Z , y f s p111SRE1iG� NQTH EXPOSED WALLS.FT. .4 3 �. �' .� 4 WIND W AND OUTSipt DOOR AREA � .iv STUH S UM BTUH BTUH STUH s WALL CONSTRUCTION . 1TeW.Y.Line 3 a H) , v ,�- o �, 3 0 o a d o S v G G v o •INCREASE•L"0 6 TrP6 OF GLASS IS teorn Of rapl used for Line a) 7 7 CEILING CONSTRICTION v , 4100 "FOR CONCItETIR FL.000 pN ; (TaW 0, L x W) v5 �� 3 b O / O O 700 GROUND LIVI FILL LL,UUSK AT • FLOOR CONSTRUCTIONt - � � FRET Or EI(AQi�(4�Q4� r iTebl.•.L x W or Lin. Ft.) 0 • COLD PARTITION CONSTRUCTION I TeMe S.L N to) "'— to 1 well(With op.4lnas) o; Y 0 U d !O G 2 Wails lwithopen +x .s� 3 Wally IWlth Openings,►or Ent. Hall 11 TOTAL GTUH AT 70F TEMP. DIFFERENCE• S Cj Q �� " �A 3 12 TOTAL 4TUN AT DESIGN TEMP. DIFFERENCE Thle fwm ie arplloble from The htyOroMcs Institute.36 Russo Place,Berkeley Heights,N. J.07922 1No q f ! Ccz Me, Cc,- 4-= BALCULATION SHEET 1503 (Modern Meth ) 4 /� Copyright 1977 by The M AOOR[5S � DESIGN TEM►tRATUR[DIFFER[NCt .F. DATtCOL.A, COL.B COL.C COL.D COL.E COL.F Col..o 1 ROOM sA It 3 r O " `/ W H ly Ae H L W " L W N L W DeN90 Wa1«TnwF. ��.�.�.. 2 ROOM DIMENSIONS, FT. 1- S STUH pw Poet Of 3 LENGTH EXPOSED WALLS,FT. < �" Radlatiew SolMtiN 4 WINDOW AND OUTS101i DOOR AREA 1 U. f BTU" STUN STUN STUN STUN i WALL CONSTRUCTION (Teb1 9.L Ins 3 a H) �, 0 ROOM LIN.FT. F R TYPE OF GLASS FROM Lwa 1! $61644Ts0 � �Ir� lB tftm Of table used for Line 1UF Z j � f a 7 CEILINO CONSTRUCTION C -� (Table 9,L a W► i V 7 GO 00 o p 0 FLOOR CONSTAUCT10N1 (Tabu 9.L a W r Lin. Ft.) 'rg Q` 0 0 .woo— [ Mw 9 COLD PARTITION CONSTRUCTION F ftww ow lTabl9.LaHl OPOWi 1Q 1 Well IWlth GpenlnSW YLx il v 0 N f 3 o 2 WWI*(With Openings( d J i) 'K 0 1 3 Walls IWlth Openings) or Ent.Hall r 1 TOTAL BTUH AT 70F TEMP.DIFFERENCE* d 1? TOTAL STUH AT DESIGN TEM1.DIFFERENCE 1 IK OG L /tl / COL.A COL.S COL.H COL.1 COL.J COL.K COL.L TOTAL STUN TOTAL OF BUILDING RADIATION i Room AT ULIKCTQO O H L W H L W H L I W /f L W IN L W DESIGN iti[NMCR• 2 ROOM DIMENSIONS,FT. f- 3 LENGTH EXPOSED WALLS,FT. < 4 WINDOW AND OUTSIDE DOOR AREA STUN 8T11H BTUH BTUH BTU" 9 WALL CONSTRUCTION •INCREASE BATHROOM (Table 9,Lln 3 a H) TOTAL 20% 4 TYPE OF GLASS l ttom of tab(•used for Line 61 xi )FOR CONCRETE FLOOR ON 7 CEILING CONSTRUCTION GROUND OR FILL AT (Twle 9,L a W) G RAOE LEVEL,USE LINEAR I S FLOOR CONSTRUCTIONI FEET OF EXP "Q 90" (Table 9,L a W or Lin. Ft.) COLD PARTITION CONSTRUCTION (Tabs 9.L a H) 10 1 Wolf(With Opeoingsl O; C Z Wells(With Openu*sl OX a 3 Walls(With Openenos)or Ent. Hen 11 TOTAL$TUN AT 70F TEMP.DIFFERENCE* E 121 TOTAL INTUM AT DESIGN TEMP. DIFFERENCE � 1rOR'M lei This form is arellable from The Hyaronics Institute, 35 Russo Place,0 rk ley Heights, N.J. 07922 DEPARTMENT DECISION PERMIT# APPLICATION FOR PLUMBING PERMIT Application is hereby: TOWN of SOUTH WINDSOR BUILDING DEPARTMENT Bldg Pemut# APPROVED 1540 SULLIVAN AVENUE 644-2511 ext.230 Date Building Inspector Application must be printed or typed Location of job l6� of f,4 P-14 P-j Street No. Street Lot No. FEE SCHEDULE Floor Apt.No. $0 - $1,000 - $12.00 Over $1,000 $12.00 per$1,000 OWNER WA� or any fraction thereof ll f14 ADDRESS l b aI'd AM 5..u tt, CN (A,J SQ< C-f Q 0-7 `I OWNERS PHONE# C '�'-I " Q 3 1 APPLICANT M M'I 121,',�%J0 1'C- oW SF ADDRESS Ai Plumbi Repair,Inc. At Tolland, CT 060844M &OD ESTIMATED COST$ �'C2-Li C IS THIS A CONTRACT COST? _ YES NO MEW "` C► FEE ENCLOSED $ - f�41) f TYPE OF JOB: SpR.CO Original Installation AN Plumbing Repair,Inc. Alteration/Addition/Repair P.O.8ox 853 Revised 10/96 Tolland, CT OW-0853 APPLICATION FOR PLUMBING PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A f BUILDING PERMIT APPLICATION YES / NO 'V RESIDENTIAL BUSINESS CURRENT USE AND OCCUPANCY ASSEMBLY MERCANTILE FUTURE USE AND OCCUPANCY EDUCATIONAL INSTITUTION FACTORY ENGINEER'S NAME PHONE STORAGE GARAGE ADDRESS MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION t 14,,4 1 eA SIZE OF MAIN DRAIN NO. OF TOILETS STYLE NO. OF 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 YES/NO SIZE OF WINDOW IF NONE C.F.M. OF VENTILATOR SIZE OF DUCTS SEWER OR SEPTIC TANK SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER WATER HEATER TYPE /V-4I'yoi C J4,5 MANUFACTURE S 44 tq- TANKS SAFETY DEVICES TEMPERATURE CAPACITY S RELIEF,VALVE TEST PRESSURE p" WORKING PRESSURE 75 PRESSURE RELIEF VALVE I/ TYPE MANUFACTURER 'L"'''—t DESCRIPTION OF WORK LV"tcA 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. DATE