HomeMy WebLinkAbout1042 Ellington Road TO THE BUILDING INSPECTOR
of the APPLICATION FOR
NATION AND
AMI
TOWN OF SOUTH WINDSOR., CONN. BUILDING PLAN EXAMINATION PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, and IV. O
I• AT (LOCATION) / ( 01- �e f•' V ( , �. ZONING
DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
4 I'd 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 �
1 New building Residential Nonresidential
2 Addition(If residential, enter number 12❑ One family 18❑ Amusement, recreational
of new bousing units added, if any, 13❑ Two or more family — Enter 19❑ Church, other religious
in Part D, 13) number of units— — — — --►
3 ❑ Alteration (See 2 above) 200 Industrial
14❑ Transient hotel,motel, 21 ❑ parking garage
4❑ Repair, replacement or dormitory — Enter number
5❑ Wrecking (1/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.KOther — Specify 25❑ Public utility
7 ❑ Foundation only
26 E] School, library, other educational
B. OWNERSHIP 27❑ Stores, mercanfile
8 Privat (individual, corporation,
28❑ Tanks, towers
n npr fit institution, etc.) 29❑ Other — Specify
9 ❑ Public(Federal, State, or
local government)
C.COST (Omit cents) WORK DESCRIPTION:
10. Cost of improvement. . . . . . . . . . . . . . . $ l7 a ClO.,
a. El ctrical . . . . . . . . . . . . . . . . . . . .
b. Plumbing . . . . . . . . . . . . . . . . . . . . .
c. HVAC . . . . . . . . . . . . . . . . . . . . . . . X 3 - --
d. Sprinkler . . . . . . . . . . . . . . . . . . . . G�v �y r
Garag s. . . . . . . . . . . . . . . . . . . . .
f. Other . . . d
11. TOTAL S l? 00 d Fee: 70 CO Fee: Total: l�0
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. PRINCIPLE TYPE OF CONSTRUCTION G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
40❑ Public or private company 48• Number of stories................
30 ❑Type 1: ❑A ❑B 41 ❑ Private(septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
31 ❑Typ 2: ❑A ❑B ❑C dimensions ....................
32 ❑Typ 3: ❑A ❑B H. TYPE OF WATER SUPPLY
42❑ Public or private company 50. Total land area, sq.ft. ...........
33 El Type 4 43❑ Private(well, cistern) K. NUMBER OF OFF-STREET
34 D�Type 5: N A ❑B PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35❑ Gas Will there be central air 52. Outdoors.......................
96❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44❑ Yes 45❑ No 53. Numb r f b dr ms..............
3B❑ Cool
39❑ Oth r— Specify Will th re be an el vat r? 54. Number F Full.,,.,.,,,.
46❑ Y s 47❑ No bathr ms
Partial....._
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing addr ss — Number, street, czty, and State ZIP code Tel. No.
1.
Fl2K �• !!/ lD�v2 T
Owner or / (p&7 }�
Lessee SO
2. VreL /Ve0
Contractor
3.
Architect or
Engineer
The owner of this building and e u dersigned agree to conform to all applicable laws of this jurisdiction.
Signature of applicant Address p� Applic tion date
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 A rova 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
Bui Iding
Permit number
Building
Permit issued V 19 U
Building
Permit Fee $
Approved by:
IJA�—
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