HomeMy WebLinkAbout160 Benedict Drive (4) TO THE BUILDING INSPECTOR
of the APPLICATION FOR
TOWN OF SOUTH W INDSOR, CONN. NATION AND
BUILDING PLAN EXAMINATION X AMI PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, and IV. O
ZONING
• AT (LOCATION) / `�, .(� `��" ��\ "� DISTRICT
LOCATION (N0.) (STREET)
OF BETWEEN P - AND -� �" Ay
,
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D
�v
TYPE OF IMPROVEMENT D,I PROPOSED USE - For"Wrecking" most recent use M
1 ❑ New building Residential Nonresidential
2❑ Addition(It residential, enter number 12❑ 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 religious
number of units- - - - -p- 20❑ Industrial
3 ❑ Alteration (See 2 above) 14 Transient hotel, mote
❑ T i l 21 ❑ Parking garage
4❑ Repair, replacement or dormitory - Enter number
5❑ Wrecking (1/multifamily residential, o/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[Sa Other - Specify bL 25❑ Public utility
7 Foundati n only
p 26❑ School, library, other educational
OWNER I P 27❑ Stores, mercantile
8 X Private(individual, corporation,
28❑ Tanks, towers
n nprofit institution,etc.) 29❑ Other - Specify
9 ❑ Public(Federal, State, or
local government)
C.COST (Omit cents) L/WORK,DESCRIPTION:
10.Cost of improvement. . . . .. d V Z7 $ 177kAd
't
a. El drical . . . . . . . . . . . . t-
o and
b. Plumbing . . . . . . . . . . . . . . . . . . . . .
c. H VAC . . . . . . . . . . . . . . . . . . . . . . .
d. Sprinkl r . . . . . . . . . . . . . . . . . . . . .
e.Garag s. . . . . . . . . . . . . . . . . . . . . .
f.Oth r . . . .
11. TOTAL $Z 0�00 Fee:'IQ, S4t CO Fee: Total: G
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
48. Number of stories.........
40❑ Public or private company """
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
420 Public or private company 50. Total land area, sq.ft. ...........
33 ❑Typ 4 43❑ Private(well, cistern) K. NUMBER OF OFF-STREET
34 ❑Type 5: ❑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.......................
%❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37❑ El ctricity 44❑ Yes 45❑ N 53. Number of bedrooms..............
38❑ C al
39❑ Oth r- Specify WiII ther be an levot r? 54. Number f Full..........
46❑ Yes 47❑ N bathr ms
Partial.......
IV. IDENTIFICATION — To be comp) t d by all applicants
Name Mailing address — Number, street, city, and State ZI P code Te I. No.
Owner or
Lessee
2.
Contrac+or
3.
Architect or
r
The wnipr of this building an xh undersigned agree to conform to all applicable laws of this jurisdiction.
i na ure 'bf applicant Address Applica ion 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 Approval Check Date Number By Permit or Approval Check Dote Number By
Obta ined Obta fined
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 17/
Permit number
Building
Permit issued 19
Building ��
Permit Fee $
Approved by:
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