HomeMy WebLinkAbout17 Brookfield StreetElectric# APPLICATION FOR BUILDING PERMIT
Plumbing# 17 Brookfield Street
HVAC # 27670
Date: 3 —
Sprinkl r#
NO.
FINAL APPROVALS Estimated Cost $ i,m o u
Building COMPLETE RED BOXED AREAS Permit Fee 3
Engineering TYPE OR PRINT ONLY Occupancy Fee $
Affidavit SIGN ON REVERSE SIDE
Appr.for CO. FTotal Fee
TO BUILDING DEPARTMENT,TOWN OF SOUTH W14DSOR,CT Additional Cost) $
The undersigned hereby applies to do work according to the following specifications:
Job Location ( 7 Ste.a 0 V, {/J S L Lot No. Side of Street Zone
Applicant IR i L- A y`xA -D f-\ (ti•i iJ o c Tel# S2 -3C)0
Address 1 -7 i Q`c9>n 1,-Y-^t .P i d Zip Lic.#
Own r Address
Architect Address
Sq.Ft.New Area: 1st FI. 2nd FI. 3rd Fl. Total New Area
Rooms Lavatories Bathrooms Garages
Purpos of this permit: 1t C
City Water Well Septic System Sewer
Ins. H.O. S.P. Cert. Area Basement Garage
Approved by Date 3- -6 Use Group Construction Type
Rev:.d 1197
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 which this building and its use is allowed.
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