HomeMy WebLinkAbout19 Birch Road (10) Bectric# 19 BIRCH ROADAPPLICATION FOR BUILDING PERMIT
Plumbing# Date:
HVAC # �. 26243
Sprinkler#
F rm-E
Estimated Cost $ 3 J DD
Buildi tb COMPLETE RED BOXED AREAS Permit Fee 3 /
6'gi i TYPE OR PRINT ONLY Occupancy Fee
CO.Affidavit SIGN ON VERSE SIDEAppr.for Total Fee $
TO BLALD1-IG DEPARTMENT,TOWN OF SOUTH WWSOR,CT (Additional Cost) $
The undersigned hereby applies to do work according to the following specifications:
Job Location t v c- Lot No. Side of Street S Z
Applicant �... Tel.# 2 6
Addr ss g-4 SD ye) Zip 7 Lic.#
Own r Address ry � S
Architect Address
Sq. Ft.New Area: 1st Fl. 2nd Fl. 3rd Fl. Total New Area
#Rooms #Lavatories #Bathrooms #Garages
Purpose of this permit: (Zo 01- AxeA, I A,* &4=4 A-,) 6NA±f)
9WWater ❑ Well ❑ Septic System ❑ Sewer ❑
Ins. H.O. S.P. Cert. Area Basement Garage
Approved by Dat Use Group Construction Type
ReYW 1197
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 d' ce from all str t lines,side yard lines,and required
distances from all other zones and is located in h this g a its u is allowed.
� r
Signed "Oor
I hereby apply for a Certificate of Occupancy for the work described in this application for the permit
Signed
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS