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Electric#
APPLICATION FOR BUILDING PERMIT
Plumbing# 15 6 Le fo 11 Road Date: /d
HVAC #
Sprinkler# L 1,7 29240
FINAL R Estimated Cost $ - 'C G
Building) 3 03 7`-7 COMPLETE RED BOXED AREAS
Permit Fee Co 0
Enginee 'n V/ TYPE OR PRINT ONLY Occupancy Fee $
Affidavit Eng. Insp. Fee $
Appr. for CO. SI GN ON REVERSE SIDE , Total Fee 6,0
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant Location of Work ! 5L L C-LoLl e2 Lot No.
Applicant's Address 1 1-1 n v a I20it 6D S . ,LJ 1 z2 So./ Tel.# Co L/9 q6/C.-
Town 600TG, L.,-),f17d S o/'-- Zip >6,o7-1 Lic.# S7 ® 7!F
Owner Architect
Owner's Address 6e foll 019 Architect's Address
Zip Zip
Sq. Ft. New Area: 1 st FI.2nd FI. 3rd FI. Total New Area
Purpose of this permit
City Water Well Septic System Sewer
Ins: HO SP Cert. Area Basement Garage
Approved by Date v t Use Group i Construction Type
R vlsed W02
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 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 wh this building and its use is allowed.
a
Signed
I hereby apply for a Certificate of Occupancy for 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
29240-B 4,000
B10 FINAL 01/23/03 JFF A
B10 FINAL 01/23/03 JFF A CLOSED OUT.