HomeMy WebLinkAboutMisc Correspondence 18 Mountainview Road sf'
South Windsor Health Department
B 100a application
(for building conversion, change of use, building addition, accessory structure and lot line change)
Moldy-,I e,h V 1' e W
Address of proposed activity street number
W) R i3 1e / Arne /
Owner Name Address telephone
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 _Number of existing bedrooms
Non-residential Please describe
Pro a served by on-site well? Y Property served by public water? Y
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 proposed 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 B100a 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 Date ®/.3,Ol®a
OFFICAIL USE ONLY
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DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
Application is hereby:
TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg,Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT r&L.L N e 6- P V Itil,t'31 o& T H&A-.,1d(r
APPLIC�A+NT ADDRESS ,f ,moo
JCJ U f'� L,i),V1 d sA r C—T 0.60 75t
APPLICANT PHONE# 1-1:?6 6 F`Z ey
0 W N S k. OWNER _ p c tTU n� 5 Ju s'4�n pe.na
< OWNER ADDRESSy
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OWNER PHONE
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ESTIMATED COST$ --
;�. IS THIS A CONTRACT COST? —Yes X No
CJ FEE ENCLOSED$ r
SOR.C,0 TYPE OF JOB:
—New Installation
�[Alteration/Addition/Repair
Revised 4/01//2002
x
Electric# Q PLICATION FOR BUILDING PERMIT
Plumbing# D -- —
HVAC # 008 Date: d T/� Tm g
Sprinkler# dsor
FINAL APPROVALS Estimated Cost $ FOOd.
Building =SIGN
RED BOXED AREAS Permit Fee $ 1 n
Engineering R PRINT ONLY Occupancy Fee $ fQ '-
Affidavit Eng.Insp.Fee $
Appr.for CO. REVERSE SIDE / Total Fee
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR CT � L
(Additional Cost) $
The undersigned.hereby applies to do work according to the following:
Applicant K E LL-N�=R 101 UM I&M6 Location of Work I ? Yt oy h't 4;h -V�rx,) Lot No.
Applicant's Address 3 G'g 11 Tel.#1%3k -G B,2q
Town cS20tk W i nds® e- Zip ed- Lic.# G &7yo24,S-
Owner W \1a 90 i ! ---y Architect
Owner's Address I F i etx) Architect's Address
Zip
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area Zip_
Purpose of this permit
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City Water Well❑ Septic System Sewer❑
Ins: HO SP Cert. Area Basement Garage
Approved by Date Use Group Construction Type
Revised 6102
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