HomeMy WebLinkAbout1104 Ellington Road (2) NAL
I d ng INS P to APPLICATION FOR BUILDING PERMIT
/7 s3 C oJ e C-7
Plumbin
HVAC Date:
Sprinkler 1104 ELLINGTON ROAD
El ctric Estimated Cost $ ii,c 4
Zoning Permit Fee$ v
Affidavit NO.
19564 Occupancy Fee $
Eng. Dept. COMPLETE RED BOXED AREAS.
Fire Dept. Total Fee $ 20
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 d Lot No. Side of Street Zone
Applicant F .tA A /-(-4 1_?S0 N Tel. 6�W
Address 1[0 q RC4 CNN Zip d GV?y Lic.#
STREET CITY STATE
Owner Address 6—1d1" 8d
Architect Address
Size New Area: Ft. Front Overall Ft. Deep Overall Total Area #Garages
Lavatories
No. of Families No. of Stories Construction Bathrooms Rooms 1st 2nd 3rd
Size of Lot ist. from Street Line Dist. from Side Street Line
Purpose of this Permit �_ �
City Water 19 Well 0 Septic I:. Sewer 0 R
Approved by Date Pn-z- BD1A 11/88
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 lin s,side yard lines and required distances from all other zones and is
located in a zone in which this building and its use is allowed. c�
Signed .T<< --�1'"
I hereby apply for a Certificate of Occupancy for the work described in this application for permit.
Signed -7 y�
—DO NOT WRITE BELOW THIS LINE—
INSPECTION RECORD
Footing Framing
Foundation Fireplace/Chimney Insulation
Plumbing Permit# Inspections:
HVAC Permit# Inspections:
Electrical Permit# Inspections:
Sprinkler Permit# Inspections:
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AVNA%ANcr PROM
TOTAL LOSS 8 SALVAGE REPORT CNA
CLAIM NO. INSURED: YEAR 8 MAKE OF VEHICLE D/L:
TYPE OF DAMAGE: COLLISION FIRE [3 THEFT FLOOD VANDALISM OTHER
EQUIPMENT (SHOW ADD OR DEDUCT AS LISTED IN GUIDE BOOK)
ADD DEDUCT ADD DEDUCT ADD DEDUCT
1) AIR CONDITION 8) POWER BRAKES 15) SPECIAL: TRIM
2) AM-FM RADIO 9) LOCKS 16) WHEEL
3) W/TAPE 10) SEATS 17) OTHER
4) ALARM SYSTEM _. 11) STEERING 18) TILT WHEEL _
5) CUSTOM PACKAGE 12) WINDOWS 19) WINDOW DEFROST
6) CRUISE CONTROL ._ 13) ROOF: SUN 20) OTHER
7) ENGINE 14) VINYL 21)
ADDITIONS DEDUCTIONS TOTAL
TOTAL LOSS EVALUATION
1) NADA (DATE) VALUE $ 1) RED BOOK (DATE) 'VALUE $
2) ADD/DEDUCT EQUIPMENT (BY #) 2) ADD/DEDUCT EQUIPMENT (BY #)
A $ A $
B $ B $
C $ C $
D E D
E $ E
TOTAL $ $ TOTAL $
3) SUBTOTAL E 3) SUBTOTAL $
4) MILEAGE ( ) ODOMETER 4) MILEAGE ( ) ODOMETER
A) HIGH MILEAGE (DEDUCT) $ A) HIGH MILEAGE (DEDUCT) $
B) L(A4 MILEAGE (ADD) $ B) LOW MILEAGE (ADD) $
5) SUBTOTAL $ 5) SUBTOTAL $
6) SUMMARY NADA $ (+) RED BOOK $ = $ 2 = $
7) OTHER DEDUCTIONS
A) OLD DAMAGE
B) DEALER PREPARATION E MECHANICAL t INTERIOR/EXTERIOR s _ TIRES = $
8) SUBTOTAL (SUBTRACT #7 FROA #6 MARKET VALUE $
9) SALES TAX ( % X MARKET VALUE #8) S E $
10) TOTAL EVALUATION $
11) LESS: SALVAGE (IF APPLICABLE) $
DEDUCTIBLE (IF APPLICABLE) $
12) TOTAL LOSS EVALUATION $
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shown on this plan appear(s) to b—L
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