HomeMy WebLinkAbout0 Gardenia Lane FINAL INSPECTIONS: APPLICATION FOR BUILDING PERMIT
/23Q ��
Building U -
Plumbing �-
HVAC �� �� U'�- Date:
Sprinkler 8 GARDENIA LANE
Electric
�Z �� ��� Estimated Cost $ S 3 2 7O
-�T
Zoning Permit Fee$
Affidavit 6' �''��1 f '- NO. 19441 Occupancy Fee $
Eng. Dept. a 13t- K {-pRore-D o
COMPLETE RED BOXED AREAS.
-Fire Dept. Total Fee $ J'V� _
Health Dept. TYPE OR PRINT ONLY
Approved for CO: SIGN ON REVERSE SIDE. (Additional Cost) $
TO BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT
The undersigned, hereby applies to do work according to the following specifications:
Job Location ITX &A I Lot No. Side of Street R Zone p�
Applicant row 12 vi T�C_ Tel. # E'E I -
r S
Address 07 VUe T .. p .
STREET CITY STATE
n
Owner Address
F
Architect w Mc.'7 4y v, - Address .l 1 71 G� '?,
Size New Area: Ft. Front Overall 39-5'Ft. Deep Overall ?z Total Area I3SS #Garages
Lavatories 3
No. of Families No. of Stories 2 Construction Woo 'Fr- Bathrooms ;-,Y2Rooms 1st 3 2nd ? 3 r d
Size of Lot b�JL) s�7 Dist. from Street Line 2= Dist. from Side Street Line
Purpose of this Permit 4y r �M.r'A"C Lo"^
City Water 17(l Well ❑ Septic ❑ Sewer kSCANN 111..4 ,
Approved by Date B6i ii iiss
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 th proper distance from all street lin s,side yard lines and required distances from all oth r zon s and is
located in a zone in which this building and its use is allowed. M��,G,0.e MAS,>F►,,,►1�yyw e r
Signed
I hereby apply for a Certificate of Occupancy for the work described in this application for permit.
Signed 04ZLj
—DO NUT WRITE BELOW THIS LINE—
INSPECTION RECORD
Footing S�21 - Or I< . Framin j
Foundatio Fireplace/Chimney Insulation- L n-
r
Plumbing Permit# eg � Inspections
� e-i 11 ls- , CAN A)
HVAC Permit# o � Inspections:
Electrical Permit# n�1 7 Inspections.
Sprinkler Permit# Inspections:
Location of job g Gardenia Lane AFFIDAVIT Additional Fee . . . . . .. .. .�'�..�. ..
State of Connecticut South Windsor, CT
ss.
County of Hartford
I Michael Nastronunzio ofrom Build Owner. .. Agent for building erected under
Contractor
mit No, ..194.41. . . . . . . .... .... ..... issued by the Dep't of Building of the Zbwn of South Windsor being duly sworn,make oath
say that the actual cost of the completed work authorized under said permit was.. ..$6.Q r 531...0 0 .. . . . . . . . . .... . .. . . .. . . ..
Signed .. A . . .. . . . . . . .
/4/ . ... . . .. . . .
Subscribed and sworn to before me this ............ . .�? .. . ..day of .. ........D:ac. .. .. . . . . . . . .. A.D.19 . q .
Fs. s Cost:$
i $ L Notary Public
BUILDING INSPECTION DEPARTMENT
SOUTH WINDSOR, CONNECTICUT
FEE PAID: $3.00
CERTIFICATE OF OCCUPANCY ,
ZONE: DATED 12/3 0 19.91
This is to certify that 8 Gardenia Lana
Erected under permit No. 19441 conforms substantially to the requirements of the building ordinances and the
zoning regulations of the Town of South Windsor and is hereby approved for occupancy as indicated below.
Approved for Occupancy— New single family welling -- Lot J8
Use Group: R4
Constr. Type: 5B
Building Official
Notice:if this certificate is lost or destro i �rDiimmediately from the Building Department.
CAS _
Any change or extension of roved requires new certificate of occupancy.
CERTIFICATE OF OCCUPANCY CHECK LIST
Applicant Brom Builders Certificate of Occupancy ML �
� y
Address
Bldg. Permit No. t �U��1
Lot No. 8 (g Gardenia Lane) Date Submitted 12-30-91
Project PEACHBROOKE Reviewed By
Date QZf 3�-9
/ 2 - 30 -9
As required in the Zoning Regulations, no certificate-of-occupancy
shall be issued until grading plans have been complied with and
approved by the Town Engineer. The minimum requirements shall
inlcude:
Approved Denied N/A
1. Approved building permit plan.
2 . Finish grading per approved
building permit plan.
3. Site work; i.e. trees, shrubs, dumpsters ,
required parking
4. Utility location
a. sanitary sewer
b. foundation drain
c. electrical & telephone
d. water
e. other
5 . Appropriate certification
6 . Bonding
Sewer Permit No.
Pavement Excay . No.
COMMENTS:
P PD
a _
BUILDING PEP11IT CHECK LIST Tq q
Applicantgr„m AW 1 dQrsln: Building Permit No.
Address gn2 w_ Tnwn fit- ,Nnrwi r-h;_CTDate Submitted 05 91 g_ .
Lot NO. g g Gardenia Lane Reviewed by
Proj ect pPa r-hhrnnk Date
In accordance with the Subdivision Regulations, prio t uildi of
any structure on a lot, a Topographic Plot Plan shal e y�®
9
approval. The minimum requirements shall include : CC
lo�� O S ,
9Q1 ® 12
Approved Denied N/A oepL1E17g 'p
ML , 1. Name, address & phone numbe
applicant.
aL
2. Name, address & phone number of plan preparer.
3. Zoning information - i.e. zone, open space,
floodway, etc. �a
4 . Plot plan at 1" = -4(' scale.
a. Subdivision reference, abutting
properties, etc.
_ b. Easements of record.
c. Lot description, bearings, distances,
building lines, area, etc.
d. Contours, existing & proposed, 1 or 2 fte
interval where appropriate.
e. Building location with dimensions.
Elevations of proposed finish floor,
garage floor & center line of road at
driveway.
f. Elevations of gravity drainage systems,
sanitary & foundation drain at the
house and the street.
g. Tentative utility location gas, electric,
water, etc. '
h. Title block with name and address of
preparer, date appropriate certification,
live seal and signature.
5 . Sedimentation and erosion control.
6. Special Planning & Zoning, Inland/Wetlands
considerations. (Plans on file w/Town Clerk)
BUILDING DEPT.
PZC
IWA/CC y
WPCA A(. Gk,i I - a wv� c,lrt a.�.�� � �0�i►�s wwf�
OTHERS 5,1��u 4-o v,e un t j of- �ol-�
COMMENTS
I
i
PERMIT #
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby:
TOWN OF SOUTH WINDSOR
APPROVED DISAPPROVED BUILDING INSPECTION DEPT.
644-2511 Ext . 230
7 2wH - 5// Application must be printed or typed.
Date Bu ' ding Inspector
1 . LOCATION OF JOB
111-Y 7 Axe
No . Street
FEE SCHEDULE
$ 0 - $19000 - $10. 00 Floor Apt . No.
Over $1 ,000 - $10.00 2 . OWNER �.ee0; �xled s
per $1 ,000 or
fraction thereof 3. ADDRESS ,r7Q,;7
e4el
4. APPLICANT
5 . AD D R E S S
6. ESTIMATED COST $
7 . IS THIS A CONTRACT COST
s iN
8 . FEE ENCLOSED $ O �� le�
9 . TYPE BUILDING:
RESIDENTIAL COMMERCIAL
10 . TYPE F JOB:
Original Installation
Alteration/Addition/Repair
BD 3A 11/88
APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side)
11 . LOCATION OF JOB �QV?✓/� x 0-
NO . STREET APT. NO ,
12 . TYPE OF INSTALLATION ♦IOC z.51
13 . SIZE OF MAIN FEEDER 5
14 . NO. OF LIGHT LOOPS Z11 15 . NO. OF HEAT LOOPS �-
16. NO. OF POWER LOOPS 17 . NO. OF LIGHT OUTLETS
18. NO. OF HEAT CIRCUITS 19. NO. OF POWER OUTLETS 3S
20. NO. OF CONVENIENCE OUTLETS 21. NO. OF HEAT CIRCUITS
22 . NO. OF POWER CIRCUITS 23. NO. OF LIGHT CIRCUITS_
24. SIZE OF HEAT CIRCUITS 25 . NO. OF MOTORS
26. NO. OF PANELS / 27 . TOTAL WATTAGE
28. NO. OF POWER FEEDERS 29 . NO. OF SWITCHES 3�
30. A/C LOAD 31. SIZE OF POWER FEEDERS
32 . NO. OF FIXTURES 33. TOTAL HORSEPOWER
34 . NAME OF SUBCONTRACTORS AND THEIR TRADES
35 . REMARKS AND FURTHER DETAILS :
LICENSE NO. SIGNATURE OF APPLICANT D ICTE
PHONE NUMBER:
Wl NQ._`
Building Permit L J i
Temporary Service
� , ent Service
Pursuant to Permit No.0
/r
rtifies that the Electrical Work for which the above named Permit was granted
l sis tpeen duly inspected and is hereby approved.
6wner Electrician
etNNW
►
r
Building Inspector
r`.
PERMIT NO.
z9a,.
DEPARTMENT DECISION A P P L I C A T I 0 N F 0 R
Application is hereby: PLUMBING PERMIT
TOWM OF SOUTH WINDSOR
APPROVE DISAPPROVED BUILDING INSPECTION DEPT.
onA 644-2511 Ext. 230
a e Building Inspector Application must be printed or typed.
1. LOCATION OF J7 y 9A(RDC//l {�Jq NF
IV
�f -#k W
FEE SCHEDULE
2. OWNER:
3. ADDRESS: 207
$ 0 - $19000 - $10.00
�jZ Cif G�3�
Over $19000 - $10.00
per $1 ,000 or /1G 4. APPLICANT: E
fraction thereof &7-Cu
5. ADDRESS: �G
Vt7l&4
6. EST. COST: $
7. IS THIS A CONTRACT COST? �ES N
8. FEE ENCLOSED: $ ^
9. TYPE OF BU DING.
RESIDENTIAL COMMERCIAL
10. TYPE OF JOB:
ORIGINAL ALTERATION
INSTALLATION ADDITION
REPAID.
BD 2A 11/88
APPLICATION FOR PLUMBING PERMIT (Cont. from Reverse Side)
11. LOCATION OF JOB: �i GC1�a rru c' Z�7�lC LL/� el
GENERAL PLUMBING
12. KIND OF INSTALLATION: 13. SIZE OF MAIN DRAIN 4
14. NO. OF TOILETS STYLE 15. NO. OF URINALS STYLE
16. NO. OF BATHTUBS 16A. NO. OF SHOWERS 17. NO. OF LAVATORIES
18. NO. OF SINKS 19. DISPOSAL 19A. DISWASHER_L_
20. NO. OF CONDUCTORS SIZE 21. NO. OF STACKS SIZE 4
22. AREA OF ROOF 23. NO. OF CATCH BASINS 24. NO. OF FLOOR DRAINS
25. NO. OF OTHER FIXTURES KIND
26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW? S
27. SIZE OF WINDOW / 3
28. IF NO WINDOW, WHAT KIND OF VENTILATION IS THERE?
29. SIZE OF DUCTS 30. SEWER OR SEPTIC TANK? 4�kei Z,
31. SIZE OF WATER MAIN Vf 31A. SIZES OF WATER PIPING & RISERS
32. REMARKS AND FURTHER DETAILS
WATER HEATER
33. TYPE KI Cud I ijle • 34. MANUFACTURER
TANKS SAFETY DEVICES
TEMPERATURE
35. CAPACITY 39. RELIEF VALVE
36. TEST PRESSURE LBS. 40. MANUFACTURER
37. WORKING PRESSURE LBS. 41. PRESSURE RELIEF VALVE
38. TYPE 42. MANUFACTURER
20Z�o z z �12
LICENSE NO. DATE SIGNATURE OF APPLICANT
PHONE NO.
FOR ( F� E U5 ONLY APPLICATION FOR,,HVAC PERMIT DATE:
-7,e,9w TOWN OF SOUTH WINDSOR EST.COST:
BLDG. PERMIT NO. 1540 SULLIVAN AVENUE FEE
/ SOUTH WINDSOR, CT 06074 FEES:
- Ext. 230 $ 0 - $19000 - $10.00
/,44-2511
��
$1000 or fraction
LO OF BUILDING e�cm t�
�y j d y- 44five-v;A boor. thereof - $10.00
C
�/h Z)&k� E'er All % �ls✓�C t rl 7/46
OWN ADDRESS TOWN PHONE N0,
Opel 14
HVAC CONTRACTOR ADDRESS TOWN PHONE NO.
TYPE OF SYSTEM: HEATING ✓ TYPE OF BUILDING: RESIDENTIAL
A/C COMMERCIAL
VENTILATION BUSINESS
INDUSTRIAL
IF HEATING: STEAM WW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC I/ WARM AIR
UNIT RADIANT HEATER (INCLUDING WOOD COAL BURNING STOVE)
TYPE OF FUEL: OIL-GPM GAS IN-PUT ELECTRIC KW
WOOD COAL 7fLW114//�'��
OIL TANK - SIZE & LOCATION: INSIDE OUTSIDE CAPACITY 7 ,"`
LPG TANK - CAPACITY
EXISTING RADIATION ADDITIONAL RAD TION TOTAL RADIATION �3
DESIGN TEMP. OUTSIDE O OF INSIDE XJ OF DIFFERENCE OF
TOTAL HEAT LOSS (BTUH) ,S A (HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEATING EQUIPME INCLUDING MAKE & MODEL NO.):
G "q el-A"g�� 94
GROSS HEATING CAPACITY (INPUT-BTUH) / d�o NET RATING (OUTPUT-BTUH) oad
IF AIR CONDITIONING: DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT GAIN (BTUH)
(HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT (INCLUDING MAKE & MODEL NO.):
TONNAGE COOLING CAPACITY (BTUH)
IF VENTILATION: DESCRIBE ALL AIR-HANDLING EQUIPMENT (INCLUDING KITCHEN EXHAUSE EQUIPMENT):
TOTAL SIZE OF SYSTEM (CFM) FRESH AIR INTAKE (CFM)
(PLAN MUST ACCOMPANY APPLICATION)
The undersigned hereby applies for a permit to perform the following work and is to comply
with all local ordinances and State of Conn. Building Codes in the performance of such work.
FURTHER DESCRIPTION OF WORK:
STATE LICENSE - NAME & TYPE # AT SIGNATURE OF APPLICANT
jie.el Y 4
APPROVED DAT
BD 4A 11/88
I - 0- R CALCULATION SHEET 1503 (Modern Method) Copyright 1977 by The Hydronics Institute
OWNER ADDRESS DESIGN TEMPERATURE DIFFERENCE F. DATE
COL.A COL.S COL.C COL.D COL.E COL.F COL.G
1 ROOM
lL
O H L W H L W H L I W H L W H L W Design Water Temp.
2 ROOM DIMENSIONS, FT. ~
_ U BTUH per Fo t of
3 LENGTH EXPOSED WALLS,FT. A Radiation Selected
4 WINDOW AND OUTSIDE DOOR AREA U.
STUN STUN BTUH BTUH STUN
WALL CONSTRUCTION
(Table 9, Line 3 x M) ROOM LIN.FT.OF
TOTALS RADIATION
5
r6 TYPE OF GLASS FROM LINE 12 SELECTED
(Bottom of table used f r Line 5)
7 CEILING CONSTRUCTION C
(Table 9,L x W)
B FLOOR CONSTRUCTIONt
(Table 9.L x W r Lin. F t) E
9 COLD PARTITION CONSTRUCTION F
(Table 9, L x H)
G
10 C 1 Wall(With Openings)
_ C
2 Wells(With Openings) eX
3 Walls(With Openings)or Ent. Hall J 1
11 I TOTAL BTUH AT 70F TEMP DIFFERENCE'
12 TOTAL BTUH AT DESIGN TEMP. DIFFERENCE K
—^ COL.A — _ COL.B COL.H COL. 1 COL.J COL.K COL.L TOTAL BTUH TOTAL
1 ROOM OF BUILDING RADIATION
E AT SELECTED
O H L W H I L W H L W H I L I W H L W DESIGN TEMP.°
2 ROOM DIMENSIONS, FT F DIFFERENCE
u - -
3 LENGTH EXPOSED WALLS, FT. i
1 WINDOW AND OUTSIDE DOOR AREA U.
BTUH STUN BTUH BTUH BTUH
5 WALL CONSTRUCTION
*INCREASE BATHROOM
(Table 9,Line 3 x H) TOTAL 20%
6 TYPE OF GLASS
(Bolt m of table used for Line 51
7
--- — tFOR CONCRETE FLOOR ON
CEILING CONSTRUCTION
( GROUND OR FILL AT
Table 9, L x WI
GRADE LEVEL,USE LINEAR
9 FLOOR CONSTRUCTIONf FEET OF EXPOSED EDGE
(Table 9,L x W or Lin Ft.)
9 COLD PARTITION CONSTRUCTION
(Table 9,L x H)
10 _C 1 Well(With Openings) C
Z 2 Wells(With Openings) O X
3 Wells(With Openings) or Ent.Hall J
11 TOTAL BTUH AT 70F TEMP DIFFERENCE'
12 TOTAL BTUH AT DESIGN TEMP DIFFERENCE
This form is available from The Hydronics Institute,35 Russo Place,Berkeley Heights,N J 07922 FORM 1503
110- F.OTECH INC. F'0:=KV I LLE, C ONN. 8 7 1-7 9 0'92 Page 1
10B NAME: The Princeton STREET DESIGN CONDITIONS TOTAL BLDG. HEAT LOSS/GAIN
40NE TOWN CONNECTICUT -------------------------- --------------------------
BLDG : Heating: 80 deg f.t/d BLDG Heat Loss BTU 35,114
Estimator: NOTES: Cooling: 20 deg f.t/d BLDG A/C Gain BTU 33,539
Room i Room 2 Room 3 Room 4 Room 5 Room 6 Room 7 Room 8 Room 9 Room 10 Room 11 Room 12
AREA NAME: FAMILY DINING KITCHEN MASTER M/BATH BATH BR#3 BR#2
itside Wall Length: 44.0 26.0 22.0 48.0 14.0 5.0 23.0 26.0 0.0 0.0 0.0 0.0
itside Wall Height: 8.0 9.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0 8.0
I/Ft S or W Glass 1 42.0 0.0 51.0 0.0 6.0 0.0 12.0 0.0 0.0 0.0 0.0 0.0
I/Ft N or E Glass : 30.0 30.0 0.0 24.0 0.0 0.0 0.0 24.0 0.0 0.0 0.0 0.0
of Doors : 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
loon Width 11.0 10.0 14.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
loor Length 22.0 11.0 9.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
)of Width 0.0 0.0 0.0 11.0 5.0 5.0 10.0 10.0 0.0 0.0 0.0 0.0
)of Length : 0.0 0.0 0.0 13.0 9.0 9.0 10.0 11.0 0.0 0.0 0.0 0.0
------------------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- -------- --------
Area Cubic Feet 1,936 880 11008 11144 360 320 800 880 0 0 0 0
,oss Wall sq/ft 352 208 176 394 112 40 184 208 0 0 0 0
!t Wall sq/ft 259 178 125 360 106 40 172 184 0 0 0 0
:11 Heating BTU 11450 997 700 21016 594 224 963 11030 0 0 0 0
ill Cooling BTU 518 356 250 720 212 80 344 368 0 0 0 0
FW Glass sq/ft 42 0 51 0 6 0 12 0 0 0 0 0
FW Glass Heating BTU 21083 0 2,530 0 298 0 595 0 0 0 0 0
FW Glass Cooling BTU 521 0 632 0 74 0 149 0 0 0 0 0
FW Glass Solar BTU 31360 0 41080 0 480 0 960 0 0 0 0 0
FE Glass sq/f t 30 30 0 24 0 0 0 24 0 0 0 0
FE Glass Heating BTU 11488 1,488 0 11190 0 0 0 11190 0 0 0 0
►E Glass Cooling BTU 372 372 0 298 0 0 0 298 0 0 0 0
FE Glass Solar BTU 11200 11200 0 960 0 0 0 960 0 0 0 0
Fors sq/ft 21 0 0 0 0 0 0 0 0 0 0 0
)or Heating BTU 538 0 0 0 0 0 0 0 0 0 0 0
)Or Cooling BTU 168 0 0 0 0 0 0 0 0 0 0 0
oor sq/ft 242 110 126 143 45 40 100 110 0 0 0 0
oor Heating BTU 31872 11760 21016 0 0 0 0 0 0 0 0 0
oor Cooling BTU 0 0 0 0 0 0 0 0 0 0 0 0
)of sq/ft 242 110 126 143 45 40 100 110 0 0 0 0
)of Heating BTU 0 0 0 343 108 96 240 264 0 0 0 0
)of Cooling BTU 0 0 0 143 45 40 100 110 0 0 0 0
ghts Cooling BTU 206 94 108 122 38 34 85 94 0 0 0 0
)pliance Cooling BTU 254 116 132 150 47 42 105 116 0 0 0 0
!ople Cooling BTU 238 108 124 140 44 39 98 108 0 0 0 0
itent Cooling BTU 1,269 576 660 749 236 210 524 576 0 0 0 0
lntilation Heat BTU 1,698 764 944 639 180 58 324 447 0 0 0 0
!ntilation Cool BTU 11459 508 11078 591 212 80 426 473 0 0 0 0
ict Heat Loss BTU 668 301 371 251 71 23 127 176 0 0 0 0
ict Cool Loss BTU 574 200 424 232 83 32 167 186 0 0 0 0
-------------------- ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ ------ ------
,ea Heating BTU 11,797 51309 61561 41440 11250 400 21249 31108 0 0 0 0
,ea Cooling BTU 10,139 31530 71488 4,106 11472 557 21959 31289 0 0 0 0
,ea Air Heating CFM 155 70 86 58 16 5 30 41 0 0 0 0
,ea Air Cooling CFM 338 118 250 137 49 19 99 110 0 0 0 0
TTL Building. Square feet-> 916 Heating Air s/Hour -> 3.78
TTL Building. Cubic feet-> 71328 Cooling Ai �°ur=
--------------------------- ------ ---------- :j
4
TTL Building Heating CFM -> 462 Heating CF �* ;�0
TTL Building Cooling CFM -> 11118 Cooling CFM per SO/FT -> 1.22
06/10/131 HEATIN13/COOLIN13 ETU ESTIMATE:
HOME OCCUPATION FORM LION
QW1 Minoroo� ZEO Approval Date
/ ASSESSOR'S USE ONLY:
Major PZC Approval Date Home Occupation Type
Expiration Date Code
Name
Address of proposed occupation:
Telephone (o a Q '� Zone CZ°
Description of Occupation: T
1 J
i
IV.; C_VSrCAAk_.J2s tg,*^t Tu k4dN%-b; .
A. PROPOSED SIGN
Please use the boxes or an attached sheet to provide the following:
1. Attach copy of plot plan if applicable.
2. Use-box A (or attach sketch)to draw proposed signage .
3. Use box B (or attach sketch) to draw the floor plan of the home
occupation area.
4. Architectural elevations for any proposed additions or modifications
must be provided.
B. FLOOR PLAN �� `"Balement F" 1st Floor &t'02nd Floor)
Floor area of dwelling i a--5,, S
Floor area of home occupation
% of floor area c
I have read the regulations regarding home occupations and intend to comply with said regulations. I
understand I must notify the Planning Department in writing upon termination of this occupation at this
address.
Signature of Applicant �!_ Date 9
� P _
Signature of Owner �� /�' G '� �- Date
White = Assessor Yellow = Applicant Pink = Street File