HomeMy WebLinkAbout141 Rosemary Laneell
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TO THE BURDING INSPEMIR
of the APPLICATION FOR
Iro" OF$SO rM WIIrDSM C )W PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applican!!A complete all items in s ctions: 1, 11, 111, V, and IX.O
T D STR CA Q
r% ZONING
A (LOCATION)
LOCATION i"o• ET)
OF BETWEEN AND
BUILDING CROSS STREET) CROSS STREET)
AP LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDIN — All applicants complete Parts A — D v
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use
1 ® New building Residential Nonresidential
2 Addition(If residential, enter number 12 One family 18 Amusement, recreational
of new housing units added, if any,13 Two or more family — Enter 19 Church, other religi usinPastD, 13)
number of units— — — — -i
3 Alteration (See 2 above)
20 Industrial
14 Transient hotel, motel, 21 Parking garage4 Repair, replacement or dormitory — Enter number
5 Wrecking (1/multifamily residential, of units ——————— — -i 22 Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13)
16 Carport 24 Office, bank, professional
6 Moving (relocation)17 Other — Speci/y 25 Public utility
7 Foundation only 26 School, library, other educational
B. OWNERSHIP 27 Stores, mercantile
8 W 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,,,,,,,,,,,,,,,, I ZZ-104V 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 S Ze
III. SELECTED CHARACTERISTICS OF LDING — 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................
31 It Wood frame 41 ni 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 50. Total land area, sq. ft. ...........
43 Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
v
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
51. Enclosed .......................
35 Gas Will there be central air 52. Outdoors........................ /
36 Oil c nditi Wing? L. RESIDENTIAL BUILDINGS ONLY
37 El ctricity 44 Yes 45 Up N 53. Number f b dr ms..............
38 C al
39 Other— Specify Will th re be an elevator?
54. Number f
Full..........
46 Y s 47 Q No bathr ms
Partial........
NOTES and Data — (For department use)
IV. IDENTIFICATION — To be complet d by all applicants
m Mailing address — Number, str et, city, and State ZIP cod Tel. No.
f!Owner or e
e,
Lessee
c-
2.
Contractor
3.
Architect ordk;i
Engineer
o n r of this buil in and the undersigned agree to conform to all applica le laws of this jurisdiction.
Signa ure f applic t Address A lication date
ex
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans R view R uired Check
Plan Review Date Plans By y
Date Plans B NotesqFeeStartedApproved
BUILDING V.-%,
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Obta ned
Date Number By Permit or Approval Check ObtDained 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 1 062 5
Building
Permit issued DPC__ 7 19 _ 8
Building
Permit Fee $ 444.00
Approved by:
Zk-F
TITLE
ZONING
FRONTDISTRICT
SIDE YARD SIDE YARD
REAR r
IX. SITE OR PLOT PLAN ForApplicant
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i
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date Dec_ 7 1978
Fee Paid $. .44.4.00 Eat. Value $3 4.9.000.00
Permit N2 1.0 6 2 5
on the aide of
Lot #2 Rosemary Lane Street
Street No. 402r fy
Owner RSK Cnntrar_i-nrs
Applicant Richard S. Ke l l a i
CERTIFICATE OF OCCUPANCY ISSUED:
Date
No. 5268
Fee Paid $ 3.00
CLASSIFICATION
Dwelling
i
BUILDING PERMIT
N? 10625
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. Dee 7 1978
94is is to Cerfiffg, That RSK Con'.-ractors
is hereby granted permission to Dwelling
at estimated value of 4 s 000•QD
on the side of Lot #2 Ro sui tax y Lane Street on land
owned by RSK Contractors
Said Work to be as described in Applicadoa
No. 10925 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
Issue D e 7 19 780
B ding 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."
7P-4
INSPECTIO EPORT
Permit # Joo
1 Footing
V
2 Foundation
3 Framing
4 Wiring
5 Plumbing
6 Heating
7 Lathing
8 C.O.
Permit No.o?TOWN OF SOUTH WINDSOR
SOUTH WINDSOR, CONN.
Permit N?5268
Certificate of )
t ,
c panty
THI CE FY that the
at No. in the Xwn of South Windsor, Connecticut, has
accordance with the Building Code and Zoning Regulations ofbeenerectedandcompleted6
the Town of South Windsor, and is hereby approved for occupan
wl%qo / Tuilding Inspector
46 A,,
caner, Builder
000,
Fee Paid` Date 19
6722
ELECTRICAL APPLICATION
Application No. 7030
on the side of
Lot #2 Rosemary Lane Street
Street No. 2::qf / q .1
Owner RSK Con _rn _ _ors
Electrician Alan Petersen
FILED IN OFFICE OF
The Building Inspector
Mar. 19 ig 79
INSPECTION.
1:4)No 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.
s
5
leill APPLICATION FOR PERMIT TO DO ELECTRICAI. WORM,
No. ........7.434..................
Permit No. .......6.7.2.2.................
TO THE BUILDING INSPECTOR
of the
TOWN OF SOUTH WINDSOR, CONN.
c.... hereby make application to.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.
s 44 r--
South Windsor, Conn., ....... .. g..... —7.l....... 19.. . Sign here ..........
Z) 7- Address
Location .... . A de of .... .... ........................................................................ ...........................
Nature of Building How many stories ...................... .............................................................
Nw or old Building ........... Y How many families ................................................................................................
Kindof Installation ........... How many Stores ......................................................................................................
Owner G. .
Architect ........... ................. . .... .......... ... . .. .. ....... ................. Address ..........................................................................................
Builder .................. . ............................ . ... . ... . ........ ...... .... ........... Address .... . .......... ............ ................................................_.__......_............
Electrician T.......... Address ...... ........................................................................_.........._.............
Size of Main Wires ... .......... kp
No. of Light Loops .. ........ ......... ....... No. of Heat Loops .........No. of Power Loops ..........................._...._....
No. of Light Outlets . .../... ......... No. of Heat Outlets ..... .No. of Power Outlets ....................................
NoO 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 ..............2.....40... .. .. Total Wattage ................................................. Size of Power Circuit ........ ...... . ...
Total Horsepower . ... ... ... ................ .
No. of Straight Electric Fixtures .. ... .. ... . .. .... ........ No. of Combination Fixtures .......................................... .... ...............
No. of Receptacles .................
4 .1tuZ.. .................... .... ... . .......... No. of Cord Drops ............................................................................... .........
Remarks: For other kind of Installation .. .. ....0 4A--)e,A-001A6............... .••.•..1000 6.4e.-I
0 411i... -.......................................... ... ................_................................................................................................... .....................................
l ... .............. ....................................................................... ................... . ............ .... . ... ....... ..... . .................................Estimated Cost
533,5
PLUMBING APPLICATION
qpp No. 6116
on the ......_..... tide of
Owner .
Plumber?A&aw
Filed in Office of
The Building Inspeceor
Feb. 8 19—Z2
In RIECIRON.
No person shall crosuva, add to or alder my
portion of the drainage system of any buikiog
except to repair leans) until a Plenob is gmmd
by the Building Inspemr.
Application No.......6.11.6.................... Permit No. .33.
TO THE BUILDING INSPECTOR
of the
TOWN OF SOUTH WINDSOR, CONN.
hereby make application to perform plumbing according to detailed description below. All
provisions of the Rules for Sanitation, By-Laws, Sections 33 to 47 inclusive, shall be complied with whether
specified herein or not.
SouthWindsor, ....................... 197-.... Sign 16 .... . . . .... .. ........ .........
Address !L?.... ........... . . .. ..... ................... A
Location . .......... ........ side of ...... ..... ..........Street
Nature of Building How many stories .. ..
Owner .........................C-5 ...... Address...........
Architect ............................................ ........................................................... Address .....................................................................................................................
Address ...................................................................................................................Builder.
7...................Plumber Address .....r...... . ...................................................................................
DRAINAGE
CESSPOOLS, How many Where located ...................................................................................................
Are they water tight .. .............................................................................. Of what materials are they built .......................................................
Sizeof pipe from house to cesspool . ........................................... in of pipe ................. .....................................................................................
MAIN DRAIN IN CELLAR, Material .... ......c........... Diameter .................
I.....................................................................................
Above or below cellar bottom ..............A.&4.. .............
SOILPIPES, Material ' **.. .... Diameter ................!............................................................................................
WASTE PIPES, Material ......... Diameter
TRAPS,Type proposed to use is ...
RAINWATER LEADERS, where do they run to ......... ................................................................................................................................
REFRIGERATORWASTES, where do they run to ....... .. .................. .............................................................................. ..............................
TANKOVERFLOWS, where do they run to
FIXTURES
WATERCLOSETS, How many ............. ............................ Where located ... ......................................................................................
Distance from trap to vertical soil pipe ......................................... Pattern
WASHTRAYS, How many ............................................................ Where located . .... ..........................................................................................
SINKS, How many .............................. Where located .. Ar"14' '/-r,... .
BUTLER'S SINKS, How many ........................................................ Where located. ...................................................................................................
REFRIGERATOR SINKS, How many.. ................................... Where located ..................................................................................................
LAVATORIES, How many ............................. .................................. Where located ....................................................................................................
BATH TUBS, How many............................1;2--Where located .....................................................................................................
URINALS, How many .............................................................................. Where located .....................................................................................................
Are water closets and urinals to be local vented If not, is there a window in outer wall
ofroom where same are to be located ......... 11111?0_. . .......................................................................................................................................
Estimated Cost.
Application For 6041
PERMIT
4940
DEPARTMENT DECISION Heating Permit
3 E APPLICATION IS HEREBY:DEPARTMENT OF LICENSES AND INSPECTIONS
O
IryNMPPROVED DISAPPROVED
TOWN OF SOUTH WINDSOR
C
1.4Ocd
a 21919
00 DATE INSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BEL W
O4-3
to A
o - 1. LOCATION OF
JOBgo_-vk"At Aea
I
cc 0 NO. STREET
vco
LOTNO. FLOOR APT. NO.
O
V
79
a. OWNER
cc
o S. ADDRESS
be
4.PHONE
7
ad
C S. APPLICANT Mg/M I
vi a~d
c00 a. ADDRESS
a dLT. iucq r-/
S. LICENSE NO. 3::gl ry z,
Q
o w s. EXPIRATION DATE OF LICENSE
A i o. ESTIMATED COSTO
4-3 -C:
IS THIS A CONTRACT COSTf IEJ,YES NO
be
y 12. FEE ENCLOSED S Permlt 10625
a
4)is. TYP OF BUILDING
b RESIDENTIAL COMMERCIALOA
C' 14. TYPE OF1 JOB: INDUSTRIAL
3
ORIGINAL ALTERATION
INSTALLATION ADDITION
REPAIR
APPLICATION FOR HEATING PE T (C atiaued from Reverse Side)
11. LOCATION OF JOB OI eigz- L
NO. ST 11EET FLOOR AFT.NO.
12. TYPE OF INSTALLATION: OIL BURNER ELECTRIC VENTILATION SPRINKLER
GAS BURNER STACK INCINERATOR MISCELLANEOUS
IDENTIFY
SIZE LOCATION SIZE l j SIZE it
13. OF TANK OF TANK J OF FILL OF VENT r• L
14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO. AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND NO T.U. OR SQ. FT. NET B.T.U. OR SQ. FT. GROSS FIRING RATEI
FLOORS TO BE HE ED NEW OR OLD BUILDING e I Y SULATED — YES OR NO
TYPE OF WALL INSULATION c__ ROOF OR CEILING INSULATION
AVG. SYSTEM W TER TEMP. Ikd B.T.U./SQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE f 0 FAHRENHEIT
MAKE OF RADIATION: BASEBO RD. COPPER CONVECTORS. OR C.I. RID IA ION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ.
FT. OR B.T.U.
DESCRIPTION OF WORK
15. TO BE DONE:
te. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS):
R OM SIZE WINDOWS AREA - SQUARE FEET a,T.U. S.T.U.DISTRIBUTION INSTALLED
AND DOORS VOLUME TOTAL TOTAL F LL
ROOM REGISTER
L W N
NO.
y GROSS GLASS NET WALL CEILING FLOOR CU.FT. AT MP Ill CORTECTED j 1Q TYPE AND SIZE RAD. OR LEADER
SIZE WALL
f'CSG INFILT.) DIFF. F O dl SC' FT. FREE AREA
av ti a i is*21 l azJ a
k + 6 fa- Fl v 6 o S960 io
f r y- / 0 , r 3 freV l3d1>
k{
47
33ry 3Er(/7J
v x v r 1
k
g 2- / i Vla-
3 56
fl1i 7
TOTALS
A. HEAT LOSS FROM BUILDING - O 6 B.T.U./HR.
B. DOMESTIC HOT WATER DEMAND B.T.U./HR.
C. PIPING, OTHER THAN NORMAL B.T.U./HR.
ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR
17. ELECTRICAL WORK BY:
NAME ADDRESS
SUBCONTRACTORS AND
te. THEIR TRADES
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE(OWNER) OR (AGENT) OF THIS PROPERTY AND WILL
BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE.
APPLICATION TO BE COMPLETELY FILLED IN. „ /
r DATE IIGNIATUR9 OF APPLICANT
FINAL INSPECTIONS.s:
Building APPLICATION FOR BUILDING PERMIT
Plumbing
HVAC Date: 7
Sprinkler 141 ROSEMARY LANE
Electric Estimated Cost $ a ooc,
Zoning Permit Fee$
Affidavit NO. 17 9 3 9 Occupancy Fee $
Eng. Dept.
Fire Dept. COMPLETE RED BOXED AREAS. Total Fee $
Health Dept. TYPE OR PRINT ONLY
Approved for CO: SIGN ON REVERSE SIDE.Additional Cost) $
TO BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT
The undersigned, hereby applies to do work according to the following specifications:
Job Location / / #49-0-SEMAALY Lot No. d2 Side of Street Zone
Applicant ?—fsoln as -37 AZ r?4.4 so Tel. # 6 564--e/9,I--
Address I IV 40.sE M AhQ_y 1 Aj E S. W,-osote C ip enCL/7o Lic.#
STREET CITY STATE
Owner S A M E Address-
Architect 5Arn G Address c—
Size New Area: Ft. Front Overall Ft. Deep Overall Total Area Garages
Lavatories
No. of Families No. of Stories Construction Bathrooms Rooms 1st 2nd 3rd
Size of Lot Dist. from Street Line Dist. from Si-4- Street Line
Purpose of this Permit a F
City Water Well Septic Sewer
Approved by Date -1 BD1A 11/88
I hereby agree to conform to all th 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 distance from all street lines,side yard lines and required distances from all other zones and is
located in a zone in which this building and its us is allowed.
Signed
I hereby apply for a Certificate of Occupancy for the work described in this application for permit.
Signed
DO NOT WRITE BELOW THIS LINE—
INSPECTION RECORD
Footing Framin 17_-,Ug
Foundation Fireplace/Chimney Insulation Sc ar SZ s
Plumbing Permit# Inspections:
HVAC Permit# Inspections:
Electrical Permit# Inspections:
Sprinkler Permit# Inspections:
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HEgEav -EgTTFY Tn : THnTA5 J . A NANCY V. NATHAN5009 .
THAT TYF PU'LnTN; TS LOCATED AS SHOWN . ZONING RESULATIGN3 ARE NGT VIOLATED ,
Ahlr' THAT TWT3 , 5U9lJEY IS SUBSTANTIALLY rnRRECT . 9EING LOT 2 ON A IAP ENTITLED
044 '?'7VE T T T PRODERTY OF ? . 5 . K . Cf]NTRACTORS , IN- . ROSE*ARY LANE SOUTH 41NDS0 ,
ONA0 Of SCAL= : 1 '•=40 ' , DATE 10/10/78 REVISED 10/10/78 , AND 10/20/78 , SHEET 2
rF 5 , EMT: J . LUrEK ASSOC . " PROPERTY IS LOCATED IN ZONE-C AS DEPICTED ON ' F IR-'
FLFn TvSURA^JCE PATE "1AP TOWN OF SOUTH ' TNDSCR 0 CON,"J . H- RT,FCRD COUNTY , PANEL 4
OF 9 , 7-9wvUN I TY PANEL NO . 090036,0004 8 , EFF ECT T Vc DATE TA Y 1 , 1980. "
STANLEY 'tl SZEST()WTCKT
623 TALCOTTVILLE ROAD
VERNON , CONNECT ICUT 4-64
D JIV bST
V UL 18 1969
South WindsorBUILDINGDEPARTMENT
This certni d tli,:t t':is elan and sh rtkc tv^ns are true
e,opies of the proposed building or ait r,•iions to be
rected at
I/JKLSt/eet
ovet err w' ndm,nts stag in li, -ipin a,-.d
sled with pi,n a.id I agree to 4-omply !i ti
isu°iding and ,t ite laws and such rc; rs s li I. t
issued by the Building Department d,rink
of this application and final issuance of a
permit.
Signed
This plalia roved subject to the cnnd,tion ih
orders aorinances regulating building .3n,,l
complied with.
Conditionally Approved These I lc d with
Gam_
building Inspector Clerk
Datg No.
CERTIFICATION OF ZONING COMPLIAINCE
Proposed building(s), use(s) andlor structurefs)
shown on this U:=an ups,, ;) to Ir, In
a; stzo
n tll i:i 1 o.y- ir tl•2'V
CC?tliorrnancl w
C.UuI.cl.117{1'S. u°
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DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
IT#
Application is hereby:TOWN OF SOUTH WINDSOR PERM
BUILDING DEPARTMENT
APPROVFI]
70
1540 SULLIVAN AVENUE Bldg.Permit#
a 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$13.00 Street No. See Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT C-6
APPLICANT ADDRESS C
APPLICANT PHONE#
OW N S,
q
OWNERRur ryQ A Va
OWNER ADDRESS
do ! OWNER PHONEO a
ESTIMATED COST$
U dYesISTHISACONTRACTCOST?0 Noa
Q` FEE ENCLOSED$
OR,
TYPE OF JOB:dS Cp1`1
Q O Original Installation
1 AAlteration/Addition/Repair Revised 8/99
APPLICATION FOR HVAC PERMIT (Continued from reverse side
TYPE OF SYSTEM: TYPE OF UILDING:
HEATING RESIDENTIAL
A/C COMMERCIAL
VENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC WARM AIR UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH)
TYPE OF FUEL
OIL—GPM GAS—INPUT ELECTRIC—KW
OIL TANK SIZE&LOCATION
INSIDE OUTSIDE CAPACITY LPG TANK CAPACITY
AIR CONDITIONING
DESIGN TEMP.OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT GAIN(BTUH) HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
TONNAGE COOLING CAPACITY(BTUH)
VENTILATION
DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT)
TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM)
PLANS MUST ACCOMPANY APPLICATION)
FURTHER DESCRIPTION OF WORK
THE UNDER ED HE BY APPLIES FOR A PERMIT TO PERFORM WHE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT'c,%a 1 l_t ,\ DATE z