HomeMy WebLinkAboutMisc Correspondence 24 Greenfield Drive South Windsor Health Department
B 100a application
(for building conversion, change of use, building addition, accessory structure and lot line change)
Address of proposed activity street number
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JV� Owner Name Address telephone
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Applicant name &address if different from above telephone
Describe the proposed structure or activity with dimensions (e.g. _ "addition with bedrooms, bathroom, family
in ground/below
/'ground pool, deck, winterizing porch)
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Residential V Number of existing bedrooms
Non-residential Please describe
Property served by on-site well? Y Property served by public water?
Plot plan-attach a scaled drawing showing property lines and dimensions, location and size of
existing and proposed structures, and site features such as driveways, wells and septic systems,
drains and water courses.
Building plan-attach a sketch/floor plan of the proposed structure, addition or renovation showing
existing and pro osed rooms with door and window locations.
Soil test data (deep test pits and percolation test) are required for the review of this application.
If the data is not available, you will need to schedule an appointment with the health department.
As property owner or duly authorized representative of the property owner of the above referenced
property, I agree to permit the health department staff to enter the above referenced property as part
of this B 100a application review process. I further agree that this authorization to enter the subject
property may extend through a period of time ending with the final B 100a application approval and
affirm such with my signature below.
Applicant Signature L/1� Date //7
OFFICAIL USE ONLY
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Electric _ % ss'yS APPLICATION FOR BUILDING PERMIT
Pluming# /i ft2 - 24 Greenfield Drive Date:
HVAC # u
Sprinkler# 29794 Estimated Cost $ 000
FINAL R
Building'? dG E-
TOOMPLETE RED BOXED AREAS Permit Fee $ 0 . 06
En nee 'n Occupancy Fee $ f 0
Affidavit TYPE OR PRINT ONLY Eng. Insp.Fee $
Appr.for Corr oc GN ON REVERSE SIDE
Total Fee $ 0,61
THE I ING DEP MENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant elr Location of Work - Lot No.
Applicant's Address Tel.# e4c -.B-R /`?IbI
Town 3MA Zip 06e?y_Lic.# �5/�27
Owner Architect `� f—Z/4j c
Owner's Add r ss Architect's Address
VP W - I •`r— Zip 9& Zip—
Sq.Ft. New Area: 1 st FI. .18Y 2nd FI. 3rd FL. Total New Area
Purpose of this permit &ttmr
City Watero Well❑ Septic SystempC Sewer❑
Ins: HO SP Cert. Area A Basemen Garage _
Approved by M N`l Date ffi Use Group Construction Type r
Revised 6102
- II
A16 //v/ -
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