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APPLICATION FOR
PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant
to complete all items in sections: 1, 11, III, IV, and IX., O
AT (LOCATION)
9 /,�jA �% S: W. Gar. ZONING
I• DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use Im
M
1 ❑ New building Residential Nonresidential
2❑ Addition(If 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- - - --+�
3 ❑ Alteration (See 2 above) 20❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory - Enter number
5❑ Wrecking (If multifamily residential, of units ------- - i ❑ Service station, repair garage
enter number of units in building in 15❑ Garate 23 ❑ Hospital, institutional
Part D, 13)
16 Carport / � 24❑ Office, bank, professional
6 ❑ Moving (relocation) y f �+ 25 Public utility
1 Other — Specify ❑ Y
7 ❑ Foundation only 26❑ School, library, other educational
B. OWNERSHIP t�tJ64/���NGE 27❑ Stores, mercantile
8 ❑ Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other - Specify
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement•,,•,,•,•,,,,... chool, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical.......................
b. Plumbing ....................
c. Heating, air conditioning.........
d. Other (elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $ /O u v
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. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30❑Masonryg) ❑ 48. Number of stories................
(wall bearing) 40 Public or private company
31 ❑ Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32❑ Structural steel dimensions ....................
33 ❑ Reinforced concrete H.•TYPE OF WATER SUPPLY
34 ❑ Other - Specify 42❑ Public or private company �• Total land area, sq. ft. ...........
43 ❑ Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed .......................
35 ❑ Gas Will there be central air 52. Outdoors.......................
36❑ Oil conditioning?
L. RESIDENTIAL BUILDINGS ONLY
37❑ Electricity 44❑ Yes 45 ❑ No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other - Specify Will there be an elevator? 54. Number of Full..........
46❑ Yes 47❑ No bathrooms
Partial.......
NOTES and Data — (For department use)
IV. IDENTIFICATION — To be completed by all applicants
Name Moiling address — Number, street, city, and State ZIP code Tel. No.
Owner or O
Lessee �' ✓� S' (/LJ//f o'�,, . 6:�r 1,
Builder's
2. License No.
Contractor
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signature of applica Address Applic tion to
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
y
Plans Review Re wired Check Plan Review Date Plans B Date Plans B Notes
9 Fee Started Approved y
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Ob Date
tained Number By Permit'or Approval Check Obt Date
a'ned Number By
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 FOR DEPARTMENT USE ONLY
Permit number
Building Use Group
Permit issued 19
Building Fire Grading
Permit Fee $ Live Loading
Certificate of Occupancy $ Occupancy Load
prov d b
Drain Tile $
Plan Review Fee
TITLE
ZONING •
FRONTDISTRICT
. ,
SIDE YARD SIDE - .
REAR YARD
IX. SITE OR PLOT
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A
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date May 1 , 19 97
Fee Paid $6,9 0 Ent Value $4...6 0 0.0 0
Petit N2 15 810
r�
on the tide of w
19 Ann Road Sava J
Street No.
OwnerPred Falcone
Applicant Dorithy Falcone
CERTIFICATE OF OCCUPANCY ISSUED:
Date
No.
Fee Paid $
CLASSIFICATION
fence
BUIIDfNG Pffi2M1T N:' 15 810
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. May 1 1987
94ts is to iffPYtify, That Fred Falcone
is hereby granted permission to f e nc e
at estimated value of 11 .0 0 0 - 0 0
on the side of-19 Ann Road Street on land
owned by -Pre-d Fa j -pne
Said work to be as described in Application
No. 1 61 Q 4 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
May 1 19 87
�w d -Building Inspector.
Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers
during the day and by both barriers and colored lights by night.
SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place
or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a
license therefor from the city or borough in which such highway may be situated, he shall pay said city,
town or borough all costs and damages which it shall sustain, or be compelled to reason therefor."