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HomeMy WebLinkAbout119 Farmstead DriveApplication No. 7151 Permit No. 6851 TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. r hereby make application for a permit to (erect (make alteration to) a building according to the following detailed statement of the specifications and plans herewith submitted. (Draw a line through word "erect" or words "make alteration to" as the case may require.) All provisions of the Building By-Laws (Sections 2 to 32 inclusive) shall be complied with in the execu- tion of this work whether specified herein or not. South Windsor, Conn., Z-5.................... 19..6...7 sign here ...&,!...j...!:'(....... ...... Address '.. . }........1.04....................... ................. %t t.............. Location? .,r/..Cl..... r..... .. 1..................side of? Nearest cross street?NJ Street No... .N..ir/'................ . ................... Lot No. ... .. ................. . Ownerof land is?Address ............................ ......................... .......................... ... Ownerof building is? . ....... . ........................................................Address . ....... .......... ................................................... Architectis? ....... ........... ..................................................... ......................Address ...................................................................................... .................... Builderis? . ........................................................................................................Address ........... ....................................................................................... ........... 3, ensions of building? . ... ...........Fat front? .......... Feet rear? ..... ... ......... Feet deep? ... .. l Extreme height to highest point of roof? ...... ... ..... .............. . No. of stories in height?. .. .......... eU Purpose of building is? . ..... .No. of stores? .... ................ ....................................................................... Howmany families? ........................................................................................No. of rooms? ... . ......................... ............................................................ Distance from street line is? .... . ..... .......................................from building line is? ....... ........ .......... ... ADDITIONS AND ALTERATIONS Give Brief Description) 04,R.. ....... .. Map No. ...... ........ If of steel frame, what is exterior construction? What kind of columns used? .......... .. Size of columns used? What length of columns used? . How protected? What kind of beams or girders? Size of beams or girders? ..... Longest span of beams or girders? . These rest on? . Roof construction is? ................... .............. ...........................................Roof covering is? The floors are of construction and are calculated to carry a safe load of lbs. per square foot. See Section 14, Building By-Laws.) BRICK CONSTRUCTION. Of what material will walls be constructed? ...... ... . . . ..... .... .. . . ................ . Compositionof mortar? . ........ ........ ........................................ ....... ............................................... .... ....... . ........ . Height and Thickness of Walls Hakht Stories Front Walls Side Walls Rear Walls Partition Walls Basement, 1st Story 2nd " 3rd " I..... ............................................................................................... ........................................... e................................................ .......... .. .......... ..... .... ... 4th " 5th " 6th " 7th " 8th " 9th loth " Material.of Front? If stone, what kind? Thickness of Ashlar? Thickness of Backing? Backed up with what? Arches or lintels over openings? WOOD CONSTRUCTION. Giv Size, Longest Span and Distance Between Centres, of Joists, Girders and Columns JOISTS GIRDERS OOLUMNS Floors Size Longest Span Centres Erldg- Size Longest Span Centres Size Length Centres 1st Floor d............ .............. .............I.................... a......,..... ............. ....................... ... ... ..................... ..._....._.. ................... w i .... ..... .............. ................................. ................... 11 Size of outside studs? ................................... Distance on centres? ......................................... Size of sill? ............................................. Size of rafters? ................................. Distance on centres?.............................................. Size of plate? ..................................................... Sizeof ledgers or girts? .......................... ...........................................Size of deck rafters? .................................................................... ............... Distance on centres? .....................................................................................Size of studs in bearing partitions? ................................................. MISCELLANEOUS Style of roof, flat, pitch, Mansard, or hipped? .. .. . ........ . .. ... ............... ........... Fireplaces? ...................... Materialof roof covering? ................ ............. ..................... .........Material of Cornice? .................................................................................... Howis building heated? .. ....... . .......................................................Lining of flues? . ....................................................... .......... . .............. Thickness of shell of flues? ............Any elevators or lifts? ........................ ............................. ...................... What kind? ............. ... ...... ... ....... .. How many? ......... Any hoistways? ................ . ........................ . How protected? ............ .. ........................................................ .................Total Value of Building ........'2..,.R. ....0--4,4.................... Whenwill work be commenced? .. ... ........ .. .. . .... ............................................................... ......................................................... ................. The applicant warrants that the lot for residential purposes, shown on a plot plan accompanying this application, conforms to the zoning regulations of the Town of South Windsor. Town of South Windsor since 1949. A C Applicant 6851 BUILDING APPLICATION 151ApplicationNo. ....7..................................................................... on the .........east. . .. . ....... ....... ......... ............... side of Farmstead Drive Street. Street No, 119 Ernest M. Ford Owner Same Applicant CLASSIFICATION Convert garage into family room and construct carport or garage in near future. Permit issued on above Application. 9-29-69Date, 19 . . . TOWN OF SOUTH WINDSOR BUILDING PERMIT Sept.29,Date 19 9 Fee Paid $. . . . . . Est. Value $. . . . 2800.00. .00.00 Permit N° 6851 on the east side of Farmstead Drive Street Street No. 119 Owner Ernest M. Ford Applicant Same CERTIFICATE OF OCCUPANCY ISSUED: Date No. 3883 Fee Paid y$ 3.00 CLASSIFICATION Convert garage into family room and construct carport or garage in near future. BUILDING PERMIT N° 6851 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. Sept*29 0 19 69 T4ta to to Ter#tfjj, That Ernest M. Phrd is hereby granted permission to Convert garage into family room and oonstruct carport or garagewin near future. 2800000 at estimated value of $ on the eae t side of Farmstead Drive #119 Street on land owned by Ernest M• Ford Said Work to be as described in Application No. 7i51 and to conform to specifications and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. Issw Sept.29, 9 69 uil ng 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." INSPECTION REPORTA"7u-ly Pgrmit # $!!97/ Job 1 Footing 2 Foundation 3 Framing 9'Z 6 - 6 4 Wiring V-30-6 9 5 Plumbing 6 Heating 7 Lathing 8 C.O. 3'' Permit No. v TOWN OF SOUTH WINDSOR SOUTH WINDSOR, CONN. I Permit N 3883 Certificate of Occupancy THIS IS TO CERTIFY that he J-00/'. ' V 2k at No. the Town of South Windsor, Connecticut, has been er c d and completed in accordance with the Building Code and Zoning Regulations of the Town of South Windsor, and is hereby approved for occupancy. y Building Inspector Owner, Builder DD Fee Paijoq, Date 19 I Permit No. TOWN OF SOUTH WINDSOR SOUTH WINDSOR, CONN. I jPermit N 0 3883 I Certificate of Occupancy I I THIS IS TO CERTIFY that he M at No. f the Town of South Windsor, Connecticut, hasI been ere and completed in accordance with the Building Code and Zoning Regulations ofI I the Town of South Windsor, and is hereby approved for occupancy. I Building Inspector Owner, Builder D( Fee-PaidIC5 Date 19 I I 4542 ELECTRICAL APPLICATION Application No. ...............48 3...................................................... onthe...........east.. ast...... ..... ......... .... ................. ........... ..... side of Tarm.s.t.ea.d.. Drive.Street StreetNo. 11.E .. . .. . .............. ................. ...... .......... Owner Electrician Lane...El.e.c.tric.......... . FILED IN OFFICE OF The Building Inspector 9-.3.0-6 19 ...... ........ . ..... Wsprkviox. AwNo Electrical Work shall be started until a Per. mit is granted by the Building Inspector. In New Buildings no wiring shall be started until the plumbing and heating pipes, and the fire stops (if of wood) are Installed, without a special permit from the office of the Building Inspector. I APPLICATION FOR PERMIT TO DO ELECTRICAI, WORII. No. 4853 . . Permit No. . . .4542 .... r C o' TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR., CONN. hereby make application tq perform Electr cal Work according to detailed description below. All provisions of the Rules for Electrical Installation, Section 48, Building By-Laws, shall be complied with whether specified herein or not. i `i,s RIC 19-C.y Sin here ' f W- 014.—I-.......... .......... ..........South Windsor, Conn., .. . g 1.,..ti-r i 'A D431tL,_i Y; Address ...... ... . ... .. ..... ... .... ........................... ............................... SOUTH INRDSO CONN Location ......................................... ................ ..................... ... ........... . Side of /..!y.. Nature of Building .. ......... How many stories . ................ ....... ...................................... ................... New or old Building . ... .. ems .. .. . ... How many families ........................................................................................... Kind of Installation ....... How many Stores ........................................................................................ Owner .....X/a<r; . ,, %?nG .... .. . ....................... ... .... ...... .. Address ...? ..; ? `r ..OA.............................................. Architect .. . .... ...........Address ... ......................................................................_.....L ,N*!_`- E L EC I fr` I G Builder ........... .... ... . Address Electrician ......... Address 31 E.LL i N a T 0 N R 0A f D SOUTH WINDSOR, CON Size of Main Wires . .................................................. No. of Light Loops No. of Heat Loops .. ... No. of Power Loops .............. ......................... No. of Light Outlets No. of Heat Outlets ... No. of Power Outlets ..... .. No. of Light Circuits No. of Heat Circuits .. No. of Power Circuits . No, of Sockets ............ No. of Heat Receptacles .. No. of Motors ............. .. . ... . ................ No. of Panels ................. ... . ... . Size of Heat Circuit No. of Power Receptacles No. of Switches ....... ...... . ... Total Wattage Size of Power Circuit Total Horsepower No. of Straight Electric Fixtures .....No. of Combination Fixtures No. of Receptacles .. ... .. ....... .... No. of Cord Drops ... . . .. .... .......... ...... . Remarks: For other kind of Installation .. . ................... . . I.... ..... ........ Estimated Cost ..../°.`'.. . . .. .. . .. .... oV TO THE . BUELDING INSPECTOR aE the APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. ZONING O 1• AT (LOCATION)I 1 FARnnSTEA'D bAkVE 0 STR CT'+—w 1, LOCATION NO.) STREET) yy CC ro OF BETWEEN N ®RrA R IR V • AND r'\FRDD1J1 ! 2 I y BUILDING CROSS STREET) CROSS STREET) LOT SUBDIVISION AIM LOT BLOCK SIZE /00 X -,L00 j N II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D v A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use 1 New building Reside ial Nonresidential 2 Addition(If residential, enter number 12 One family 18 Amusement, recreational o/ new housing units added, i/ any, 13 Two or more family — Enter 19 Church, other religi usinPartD, 13) number o/units— — — — --ji- 3 Alteration (See 2 above) 20 Industrial 14 Transient hotel, motel, 21 Parking garage4 Repair, replacement or dormitory — Enter number 5 Wrecking (if multi/amity residential,o/ units ——————— — --it+ 22 Service station, repair garag enter number o/units in building in 15 Garage 23 Hospital, institutional Part D, 13) 16 Carport 24 Office, bank, professional 6 M ving (relocation) 17 FO Other — Specify 25 Public utility 7 Foundation only II T 26 School, library, other educational B. OWNERSHIP X4 x ,b U ECK 017N 27 Stores, merconfile 28 Tanks, towers8 Private (individual, corporation, 1.1 x 'b A7FA HEp SHED 29 Other Specifynonprofitinstitution, etc.) p /y 9 Public (Federal, State, or local gov rnment) C. COST Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., fo d m processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement,,,,,,,,,,,,,,,, SO '— school, 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 $11500. 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 Masonry (wall bearing) 40 Public or private.company 48• Number of stories................ 0 N E 31 ® W d fromi 41 Private (septic tank, etc.) 49• Total square feet of floor area, all floors, based on exterior 576s32 Structural steel dimensions ..................... 33 Reinforced concrete H. TYPE OF WATER SUPPLY 34 Other — Specify 42 Public or private company Total land area, sq. ft. ........... ` S 43 Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed ....................... 35 Gas Will there be central air 52. Outdoors....................... 96 conditi Wing Oil L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44 Yes 45 No 53. Number of b dro ms.............. 38 Cool 39 4 Oth r— Speci/y "O/V E Will there b on el vator? 54, Number f Full.......... 46 Yes 471K N bathrooms Partial....... IV. IDENTIFICATION — To b comp/et d by all applicants Name ] C Mailing address — Number, street, city, and State ZIP code Tel. No. Owner or LL ZG L J NI.SO2 msCI, 6 071 J—8993 Lessee 2. S'A i'''f Contractor 3. sA r11 E—Architect or Engineer The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction. Signs a of applicant Address Application date 9Wm i DR, s I N D.SO V- CT. a-5 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 NotesFeeStartedApproved BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS DatePermitorApprovalCheckObtained Number By Permit or Approval Check ObtDaateined 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 Permit number Bui Iding Permit issu d 19 Building r Permit Fee A v y: TITLE R TOWN OF SOUTH WINDSOR BUILDING PERMIT Date jt3 n e 3 1, 19 85 Fee Paid $.1.2 ..0 0 Eat. Value $1.,M 0 Permit M 14442 on the aide of Farmstead Drive Suet Street No.1 1 9 Qqner Donald Rra ZPaLl Applicant Tin n a 1 d Firs zQ au CERTIFICATE OF OCCUPANCY ISSUED: Date No. Fee Paid $ CLASSIFICATION DP .k f hP 7 BunDiNG PERMIT N ' 14442 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. June 3 1985 94is is to Terttt-u, That Donald Bra Beau is hereby granted permission to Deck 2 4' x 16' /attached shed 12' x 16' at estimated value of on the side of 119 Farmstead Drive Street on land owned by DnnAld Bra 2pan Said Work to be as described in Application No. 1 47 4 2 and to conform to specifications and plans filed with said Application, and Building By. Laws of THE TOWN OF SOUTH WINDSOR. Iss ed J=a 3 1985 ilding Inspector. y 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." ectric# 16©43 APPLICATIOW rvk BUILDING PERrAf Plumbing# d 119 FARMSTEAD DRIVE HVAC# EDa PIOUSU 25718 Sprinkler# FNU OV Estimated Cost $ :25 060,00 Buildinq/o g COMPLETE RED BOXED AREAS Permit Fee 3 M ineeri TYPE OR PRINT ONLY Occupancy Fee $ f Affidavit SIGN ON REVERSE SIDE Total FeeAW.for CO. r1 TO BULI)ING DIEPARTME T,TOWN OF SOUTH WIDSM CT Additional Cost) $ The undersigned hereby applies to do work accorcling to the following specifications: Job Location /f f faA-M '-t''2 of No. Side of Street Zone Applicant ef-,e,,J cc v V;S i f-LC.- Tel# 3to0 56$ 1(o Addr ss j 5 4--c fA-5+ Zip Ze, 1 (9 Lic.# Owner v ri 1'a?2 ect Address 11q 10: t4""S Pt Architect Address Sq.Ft.N w Area: 1st Fl. v2 a j 2nd Fl. .3 6 0 3rd Fl. Total New Area S 5,"S Rooms Lavatories Bathr ooms Garages Purpose of this permit: Cc).'o y" e4 -I 664ro.wt , 1 ;fy r-t k3As-e ' City Water 0 Well Septic System Sewer 9 Ins. H.O. S.P. Cert. Area I I Basement Garage Approved by Date I Use Group Construction Type RevbW 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 a ration in the plans or specifications of the Building for which this permit is asked,and agree that this building is to be loca a proper distance from all street lines,side yard lines,and required distances from all other zones and is located in whic ilding and its use is allowed. Signed I hereby apply for a Certificate of Occup r the work described in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS Inspection / Approval Date By Appl Code Description Due Whom Code Comment 98-25718-B 25,000 BO1 FOOTING 11/16/98 JFF A P02 UNDERGROUND 11/19/98 JFF A B03 FRAMING (ROUGH) 12/08/98 JFF A E03 ROUGH 12/17/98 DCJ A B04 INSULATION 12/23/98 DCJ A B10 FINAL 03/05/99 DCJ D GFCI IN BASEMENT, SWITCH/RECEPT. PLATES LABEL SUB PANEL, SEAL AROUND BILCO DOOR B10 FINAL 10/27/99 JFF A WITH OWNERS B10 FINAL 10/27/99 JFF A APPROVED FOR CO AND CLOSEOUT 98-16083-E 1,000 98-10280-P 500 Alt Y + y' 1 • t ' /C•, 4t '',}'trh}••hr1 * 1.4+' `•` t 1' 1; ir4t, tea' ,. 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A!( , f: S` t?M •! , •,••10 L• c'.'is,r "`,. t` .,.i. a, yj,:' c C ,• A•.,•r;.r•.. ••7<•c.' 7•/ yi,,•4}.,'ath;1. .. r r. to r ;•: 1 ,•. r ' Kr s TO THE BUILDING DEPT. WvM of 1 INDSOR This certified that this plan and specifications are true copies of the proposed building or alterations to bA erected at M r 1 `] IYj Street together with amendments stated in application and filed with plan and I agree to comply with all zoning, Building and state laws and such orders as shall be issued by the Building Department during pendency of this application and final issuance of a building permit. 1 Signed This plan is approved subject to the condition that orders and ordinances regulating building shall be complied with. Conditionally Approved These filed with Building Inspector Clark Oat* No. r ZONING C`iOfPLTAN C use(s) and/or structure(s) on this plan appear(s) to be in I,.-•mice w,,L-h current Sou l[h Windsor 1 ,-,;,;;. 'Variances and special exceptions g nt a did 400 DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PE # Application is hereby:TOWN of SOUTH WINDSOR BUILDING DEPARTMENT Bldg Permit# PRO 1540 SULLIVAN AVENUE 4 644-2511 ext.230 Date Building Inspector Application must be printed or typed Location ofjob Street No. Street Lot No. FEE SCHEDULE Floor Apt.No. 0 - $1,000 - $12.00 Over $1,000 12.00 per$1,000 OWNER Z O or any fraction thereof ADDRESS 1 C ct OWNERS PHONE# APPLICANT Fel, N$~ADDRESS ice ESTIMATED COST$ l ( C IS THIS A CONTRACT COST? V YES NO FEE ENCLOSED $ TYPE OF JOB:SCR CO nal Installation Alteration/Addition/Repair Revised 11/95 APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH APRESIDENTIALBUILDINGPERMITAPPLICATIONYES / NO BUSINESS ASSEMBLY CURRENT USE AND OCCUPANCY MERCANTILE EDUCATIONAL FUTURE USE AND OCCUPANCY INSTITUTIONAL FACTORY STORAGE ENGINEER'S NAME PHONE GARAGE MIXED USE ADDRESS CITY STATE ZIP Other please specify) TYPE OF INSTALLATION/WIRING METHOD R SIZE OF MAIN FEEDERS AND RATING OF WIRE USED NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED?YES/NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED: DESCRIPTION OF WORK 4 ,, THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. a q NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT PHONE NO. s " DATE ( t DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT id D P Application is hereby:TOWN of SOUTH WINDSOR BUILDING DEPARTMENT Bldg Permit# APPROVE1540 SULLIVAN AVENUE g 644-2511 ext. 230 rt 1 1 Date wilding Inspector Application must be printed or typed a r ti ofjob Street No. Street Lot No. FEE SCHEDULE Floor Apt.No. 0 - $1,000 - $12.00 Over $1,000 12.00 per$1,000 OWNER i bra L eA or any fraction thereof aADDRESS OWNERS PHONE# APPLICANT -1 Caoere, l c7 VIJN~$+t ADDRESS I D o S r A19— A P1 F,13RD CIj ESTMATED COST$ , DO,D a C - IS THIS A CONTRACT COST?r/ YES NO FEE ENCLOSED $ OR CQ TYPE OF JOB: Original Installation Alteration/Addition/Repair Revised 10/96 APPLICATION FOR PLUMBING PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION (52—Ln NO RESIDENTIAL BUSINESS CURRENT USE AND OCCUPANCY I-eS i t s'9 ce-a ASSEMBLY MDC IT ILE FUTURE USE AND OCCUPANCY Sa INSTITUTION FACTORY ENGINEER'S NAME PHONE STORAGE GARAGE ADDRESS MIXED USE CITY STATE ZIP Other please specify) TYPE OF INSTALLATION U,1 cJ ``'~J rc`4 SIZE OF MAIN DRAIN NO. OF TOILETS ( STYLE NO. OF URINALS STYLE NO. OF BATHTUBS NO. OF SHOWERS NO. OF LAVATORIES NO. OF CONDUCTORS SIZE NO. OF STACKS SIZE AREA OF ROOF NO. OF CATCH BASINS NO. OF FLOOR DRAINS NO. OF OTHER FIXTURES KIND ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES/NO SIZE OF WINDOW IF NONE C.F.M. OF VENTILATOR SIZE OF DUCTS SEWER OR SEPTIC TANK SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER WATER HEATER TYPE MANUFACTURE TANKS SAFETY DEVICES TEMPERATURE CAPACITY RELIEF VALVE TEST PRESSURE WORKING PRESSURE PRESSURE RELIEF VALVE TYPE MANUFACTURER DESCRIPTION OF WORK 4 Ile o.) 1` ll D G St'rvtf'.?i Ol vr [//G i.S' THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE PERFORMANCE OF SUCH WO NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT PHONE NO. ;7,> J l DATE