HomeMy WebLinkAbout17 Evergreen LaneTO THE ]RUITADINGINSPEMR ale y ,
of dw APPLICATION FOR
1'O" OF SCRIM WINDSM CONK PLAN EXAMINATION A ND
BUILDING PERMIT
sIMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX.0
ZONINGI• AT (LOCATION) 2 r•/ DISTRICT 0-
LOCATION NO.) lor (STREET-)
OF BETWEEN zo; "v'e AND C.Y e Cb!` //y't'
BUILDING CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT 9W BLOCK SIZE Da
M
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE F IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use A
1 New building Residential Nonresidential
2 Addition(I/residential, enter number 12 ne family 18 Amusement, recreational
of new housing units added, if any,13 T family — E 19 Church, other religiousinPastD, 13) wo or more am y Enter
number of units— — — — 20 Industrial3 Alteration (See 2 above) 14 Transient hotel, motel, 21 Parkin
y
47 Repair, replacement q garagePPordormitory — Enter number
5 Wrecking (1/multifamily residential, o/ units ——————— — -- 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)
25 Public utility7 Foundation only
17 Other — Specify Y
26 School, library, other educational
B. OWN E SHIP 27 Stores, mercantile
8 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,.,•,.,.,,.•,.•. 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
o. Electrical...................... 5 ./' j S/!16-ow.-Irle
b. Plumbing ...................... w
c.Heating, air conditioning.........
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $ d da'v
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 0 SEWAGE DISPOSAL J. DIMENSIONS
30 sonry(wall bearing) 40 Public or private company
48• Number of stories................
31 VWood frame 41 Private (septic tank, etc.)
49. Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions .................... ep
33 Reinforc d concrete H. TYPE WATER SUPPLY
50. Total land area, sq.ft. ...........34 Other — Specify 42 t i Public or private company
43 Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL
51. Enclosed .......................
35 Was Will there be central air 52. Outdoors........................
3610Oil conditioning?L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 Yes 45 N 53. Number f bedrooms..............
38 Cal
39 Oth r— Specify Will there be an levat r?
54. Number of
Full..........
46 Yes 47 o bathr ms
Partial........ /
NOTES and Data — (For deportment use)
d
IV. IDENTIFICATION — To b c mpl t d by all applicants
Nam Mailing address — Number, street, city, and State ZIP code Tel. N
Owner or A Go.S s r 06Ioy s f 7/
Lessee
2. t
Contractor
3.
Architect or
Engineer
The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction.
Signatur o applicant Address Application date
DO NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By NotesFeeStrtedApproved
BUILDING v
PLUMBING
MECHANICAL
ELECTRICAL
OTHER s
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date
Obtained Number By Permit or Approval Check o
Date
ed 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 numb r 10744
Bui Iding
P rmit issu d Apr. 16 19 79
Building 420.00PermitFee
Approved by:
TITLE
VIII. Z'..NING PLAN EXAMINERS NOTES
REAR r
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TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date April 16 ig 79 x
Fee Paid $.420..00 Est, Value 70,,000.00
permit N° 10744
on the aide of
Lot #212 Evergreen Lane Street
Street No.17
l Owe! LaCava Construction Co.
Applicant George LaCava
I
CERTIFICATE OF OCCUPANCY ISSUED:
Date
No. 5316
Fee Paid $ 3.00
CLASSIFICATION
Dwelling.
I
BUILDING PEMbUr
N? 10744
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. APr i 1 16 1979
M4fz to to That Lacava Coflgtructlen Cn.
is hereby granted permission to Dwelling
at estimated value of $ 7 00
on the side of Lot #212 Everc re en Lane Street on land
owned by LaCava Conatruetio Co.
Said Wo rk to be as described in Application
No. 11044 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
Issue . April 16d 19 79
CBding 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."
6-13 -.1711Y11117fINECTION-REPORTS
Permit # Job
1 Footing ..
2 Foundation
3 FramingS-
4 Wiring --'
5 Plumbing
6 Heating
7 Lathing
8 C.O.
Pe mit No. TOWN OF SOUTH WINDSOR
SOUTH WINDSOR, CONN.
PermitU 5316
Certificate of Occupancy
T I IS TO CERTIFY that th
at No. in the Town outh Windsor, Connecticut, has
been erected and com eted in accordance with the Building Code and Zoning Regulations of
the Town of South Windsor, and is hereby approved for occupancy.
i InspectorZ'ay'd"
wne ,- Buirder
19FeePaidDate
25Q consulting engineers
4 V-4-4'-4A"E,
St,ttid`'N
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WRLEEN L&Il`/F
7 PROPERTY MAPPED FOR
LaCAVA CONSTRUCTION COMPANY
NO. EVERGREEN LANE SOUTH WINDSOR, CONN.
Being lot number 212 on a map entitled, "Subdivision Plan, Tudor Hill Section II,
Property of George Achenbach, South Windsor, Connecticut. . . . . . . . . .Scale: 1 11=401,
April 22, 1974. . . . . . ."
SCALE: 1 "=40'p,co' DATE: May 21 , --1979
CV
INN 1 hereby certify this map to beI; substantially correct and that no
zoning regulations are violated. .
29
210 main street/manchester, conn. 06M/(203)646.2469
A P P R O V E D
TOWN OF SC-?UTH V INDSOR
ENGINEERING DEPARTMENT
DATE:2z 9
SIG-: 3
6789
ELECTRICAL APPLICATION
Application No.7095
on the side of
Lot _#219 F3zeeen ane Street
Street No. 12
Owner s Larauasnns t - CA-
Electrician J. Zinizorelli
FILED IN OFFICE Or-
The Building Inspector
June 5 19 7 9
INSPECTION.
12D-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.
APPLICATION FOR PERMIT TO DO ELECTRICAI. WORM.
No. ...........7.09.5..................
Permit No. ......67.89...............
TO THE BUI[LDING INSPECTOR
of the
TOWN OF SOUTH WINDSOR, CONN.
hereby make application taq 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.
South Windsor, Conn., ........ 1J,fSign here
AddressL.
04LocationSideof
Nature of Building How many stories ............. ...............................................................................
New or old Building How many families ..............................................................................................
Kind of Installation ... .. l ? How many Stores ....................................................................................................
Owner ........................... ........................... .. .. .... ...... .............. ... _....... . Address
Architect Address . ...... ....
j........... ......................................._...................__....._....._
w....
Builder Address 7...
Electrician Address . .....
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 .................................
NoP 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 ......-5...... 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: F r other kind of Installation ...... . .. .. ......... .................. ............ ..................................... ..... ................................... . ............
Estimated Cost ....... .. ...... .................................
5381
PLUMBING APPLICATION
A— No, 6165
on the _---- .. of
Lot #212 Evergreen Lane Stl,,,-
Street i a
Owner ...._..k'k a s
Plumber
Filed in Office of
The BuildingIntpoc or
May 23 1979
n er crio.
No pea m shall emstruct, add to or alder arty
portion of the drainage system of ash beo-i&g
ezmpt to repair leans) until a Permit is grated
by the Building hupeaw.
Application No..........b.1.6.5................ Permit N . .....5.3.8.1................
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.
South Windsor, 7 .. Sign here
Address .........: - ............. o. d...................
Location .. ........ C. . '.'.' ..-........ '.. ........ side of .............. Street
Natureof Building ... ......... , arn..V............................................. How many stories ............. ............................... ..................................
Owner ..................?-d.....C4.r. . . .. ...................................... ........ Address......14-'...5:/or.. . . ......k lV.....................................
Architect .. Address .....................................................................................................................
rr
Y....................................
Address .................................Budder
Plumber .........b.,......8.4 k'.1....a.. ..g.......... Address -JP...ir....d..k...... .'1...... ..........................
DRAINAGE
CESSPOOLS, How many . ......................................... ................... Where located .....................................................................................................
Are they water tight .. Of what materials are they built........................................................ ..............
Sizeof pipe from house to cesspool . ...................... ..... ............ Kind of pipe ............... . ...............................................................................
MAIN DRAIN IN CELLAR, Material .....c. ...... .. .. Diameter .............Y ..........................................................................................
Aboveor below cellar bottom .. ....................................................................... ..................................................._....................................................................
SOILPIPES, Material .. 45... Diameter .. .... ... ..........3..... ... ..............
WASTEPIPES, 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
WATER CLOSETS, How many .....................3................... Where located .... .. .. ................................................................................
Distance from trap to vertical soil pipe ................................ Pattern
WASHTRAYS, How many .......................................................... Where located .. .. .........................................................................................
SINKS, How many .................................... ................................................. Where located ... ... ..........................................................................................
BUTLER'S SINKS, How many ........................................................ Where located......................................................................................................
REFRIGERATOR SINKS, How many....................................... Where located ................................................
LAVATORIES,How many 3...................................... Where located
BATH TUBS,How many...................... ............................................. 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
Estimated Cost .......... .3... ................
PERMIT #
Application For 6083 4982
DEPARTMENT DECISION HeatingPermitCo
n
c APPLICATION IS HEREBY:DEPARTMENT OF LICENSES AND INSPECTIONS
N 14 APPROVED DISAPPROVED
TOWN OF SOUTH WINDSOR
r
c p, S/23/79
00 O DATE NSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BEL W
O
en PC
o ^ 1. LOCATION OF JOB
e r rC'e h don C
td NO. STREET
O
s
W rn
O LOT NO. FLOOR AFT. NO.
O R
N
O
2. OWNER d _ d G
s. ADDRESS l
be 3
4.PHONE.6-6--3!3 7//
ao
S. APPLICANT 7 C /1P
aQ a~d
O e» s. ADDRESS c 9e a'K
ea +'
14 a 3/d'1T., bU y T.PHONE 6
w
S. LICENSE NO. 3o O Z
a
s. EXPIRATION DATE OF LICENSE a f
e
Ia. ESTIMATED COST
0 ^11. IS THIS A CONTRACT COSTY U YES NOb4
I a. FEE ENCLOSED :
PC x
E
9 av Is. TYPE OF BUILDING:
an IA
w beIJ RESIOEMTIAL COMMERCIAL
O
N 14. TYPE OF JOB: INDUSTRIAL
t
L7 INSTALLATI N ADDETION
RATION
REPAIR
APPLICATION FOR HEATING PERMIT (C ntinued tr m Rev rs Side)
11. LOCATION OF JOB jE Cf/ r c f 7 r 0\k, e
NO. TREET FLOOR APT.NO.
2,12. TYPE OF INSTALLATION: OIL BURNER ELECTRIC VENTILATION SPRINKLER
GAS BURNER STACK INCINERATOR MISCELLANEOUS
IDENTIFY
SIZE LOCATION 3 SIZE e SIZE
13. OF TANK
7 OF TANK Qs'm e- T OF FILL P OF VENT
14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO. AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND NO.0 rIC4 -AP B.T.U. OR SQ. FT. NET vy3ao B.T.U. OR SO. FT. GROSFALv " FIRING RATE beer
FLOORS TO BE HEATED NEW OR OLD BUILDING Jyo''y INSULATED — YES OR NO
TYPE OF WALL INSULATION ROOF OR CEILING L INSULATION
AVG. SYSTEM WATER TEMP. .0e A;'y B.T.U./SQ. FT./HR. EMISSION /-s-o
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE 6 / s-o FAHRENHEIT
MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SO.
FT. OR B.T.U.
DESCRIPTION OF WORK Ale,44J r15. TO BE DONE:
le. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS):
RO M size WINDOWS AREA - SQUARE FEET E.T.U. E.T.U.DISTRIBUTION INSTALLEDANDDOORSVOLUMETOTALTOTAL
ROOM NO. GROSS GLASS NET WALL CEILING FLOOR CU. AT 70•F CORRECTED j t RAD.
REGISTER
L W N AND a TEMP. TO F a TYPE AND SIZE OR LEADER
SIZE < WALL 'Gt INFILT.)
DIFF. F I-m a SO. FT. FREE AREAP
TOTALS
A. HEAT LOSS FROM BUILDING 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
18. 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.
DATE SIGNATURE OF APPLICANT
Q1 dz..
8&A'L'AL!lLATION SHEFT I=(Madern Copyright 1977 by The onles Inst
tMNER AOOIREii 0"10N TEMIEItATUItE DIFFEIlENCL.fr DATE
COL.A COL.C COL.o COL.E COL.+F COL.•
1 RooM Q
water Tanp.N N L M w " M+
2 ROOM DttIIkENsIONS.Fy. y 6r ' ` 0 BTU"per Feet of
3 L M fttXPlO WALLS,IFT. 4 _ ItNla""fwetN
4 MINDOW aaOU2106 DOOR AREA IL It - 6
6
OTiIlt alum STUN ETU" ETU"
4 WALL ESMITOGS;0N or 40 _ ppN FT.or
tjd0$9.Lbw x H1 3 1 4 Q a TOTALS RAQIATIOM -
rROM LINE 1! fEt.SCTST'VPE Will:QL r q 6 ic
Noon Ot table WN fM LNa
7 C&LING CON:TAUCT10N C
TWMe 0,L x w1 Z W v
FLOG CONSTR T IONt
O
T4649,L x W or Lift.Ft.)
i-- - ...._.... E : o4A
9 COLD OARTITION CONSTRUCTION
10 _ 1 wall(With OpenlrMs) d o v 6
c'E 2 Wells(With Openings)x .O 1 ZOO O
M—^•.•,•.—«
D
3 Wells(With Oprningsl or'Ent.Hall
J 1
11 TOTAL STUN AT 70F TEMP. DIFFERENCE' 6 O Ly O D 0 0 y O Q 0 6' p 0
J
f2 TOTAL BTUH AT DESIGN TEMP. DIFFERENCE po O d VU 6 OV Z 60 K
COL.A COL.S COL.H COL.1 COL.J COL.K COL.L TOTAL STUN TOTAL
1 ROOM OF BUILDING RADIATI N
It AT SELECTED
O H L W H L w H L W H L W H L W DESI N TEMP.*
2 ROOM DIMENSIONS,FT. U
U
DIFFERENCE
3 LENGTH EXPOSED WALLS, FT. Q
4 WINDOW AND OUTSIDE DOOR AREA LL
STUN STUN BTUH STUN STUN
5 WALL CONSTRUCTION INC REASE•SATHROOM
Table 9, Line 3 x H) TOTAL 20%
6 TYPE OF GLASS
Gott m f table used f r Line 5)
7 CEILING CONSTRUCTION tFOR CONCRETE FLOOR ON
GROUND OR FILL AT
Table 9,L x W) GRADE LEVEL,USE LINEAR
9 FLOOR CONSTRUCTIONt FEET OF EXPOSED EDGE
Table 9,L x W or Lin.Ft.)
9 COLD PARTITION CONSTRUCTION
TsW 9,LxH)
10 1 Wall(With Openings) C;
2 Walls(With Openings)a X
3 Walls(With Op nings)or Ent.Hall H
1 TOTAL STUN AT 70F TEMP. DIFFERENCE-
STUN AT DESIGN TEMP.DIFFERENCE
FORM 1503
14 from The Hydr nice Institute,35 Russo Place,Berkeley H ights,N.J. 07922
s s A." r 771 . R ALULATI N SHEET 160Q INrtl od] Copyright is INI Hy
1
OWN SR ADORERS I CUION TSMPURATURS DIPFERENCIL P. OATS
C04.A B COL:C COL.Q COL.E COL.P COL.a
FI ROO M E t i
p I H W N 'oe W 14 H OMilw IMalor TssM.
2 ROOM DIMENSIONS.FT. 7 I r6 I •L BTU"fla/Feet of 1
u
3 LENGTH EXPOSED WALLS,FT. t
i o sr..>
4 WINDOW AND OUTSIDE DOOR AN
BTthf BTUM
S WALL CONSTRUCUON a _V- Cf - v ftO LIM.PT.OR
Table S.Lino 3 x HI 97 J. O J TOTI IE IIA0N1TUDf1
f TYPE f atAsfj
FROM LINE f= StLIt 19D
60"00 N%d0e w01or LipsN 7 a7CiU
L
T ION
FLOOS CONSTRUCTIOK!IrTable9.L x W of Lin. Ft.)
9 COLD PARTITION C NSTRUCTION
Table 9.L x H) O y
1
s c I Wall(With OpeningQ d/ 8 Z O 00
c M 2 Walls(Wfth Opening.)Ix I jr is a
3 Walls(With Openings)or"Ent.Hall i-
J
8 •3` 0 6
11 TOTAL BTUH AT 7OF TEMP. DIFFERENCE' O O d O a O 0
3
12 TOTAL BTUH AT DESIGN TEMP. DIFFERENCE
7
p d d 3 $'O G f'O O KO O IK ,
LLJODa
ao 73
COL.A COL.B COL.H COL.I COL.J COL.K COL.L TOTAL BTUH TOTAL
1 ROOM ll:
p ,r L, , V.f `"( OF BUILDING RADIATION
AT SELECTED
O H Va N `/ W H H H w DESI N TEMP.•
2 ROOM DIMENSIONS,FT. U t, 4-47117 1"z 7Ile a Vg
DIFFERENCE
3 LENGTH EXPOSED WALLS, FT. Q 2d
4 WINDOW AND OUTSIDE DOOR AREA LL 6 2 7 O
BTUH BTUH BTUH BTUH BTUH
5 WALL CONSTRUCTION INCREASE BATHROOM
Table 9, Line 3 x H) 7 3 d " d 0 Z 0 U a TOTAL 20%
6 TYPE OF GLASS
Bottom of table used for Line 5) fJ 7 Q OQ
tFOR CONCRETE FLOOR ON
7 CEILING CONSTRUCTION O GROUND OR FILL AT
Table 9,L x W) O S Q GRADE LEVEL,USE LINEAR
B FLOOR CONSTRUCTIONt FEET OF EXPOSED EDGE
Table 9, L x W r Lln.Ft.)
9 COLD PARTITION CONSTRUCTION
Table 9,L x H)
10 c I W 11(With Openings) O/1 d 6 O O c+
2 Walls(With Openings)IX 0 00
L 3 Wells(With Openings) r Ent.Hall F
J
O V a. d 0
11 TOTAL STUN AT 70F TEMP. DIFFERENCE' Q v 3 O 6 6 a o 0 0 0
12 TOTAL BTUH AT DESIGN TEMP.DIFFERENCE a Y6 3 O O O 0 6 2 t
FORM 15W4
This form is available fr m The Hydronics Institute,35 Russo Place,Berkeley Heights,N.J.07922
Electric# APPLICATION FOR BUILDING PERMIT
Plumbing# 17 EVERGREEN LANE
WAC # 25670 Dat : fU 122 Its
Sprinkler# N0•
FW Estimated Cost $ .276oBuildiCOMPLETEREDBOXEDAREASPermitFee41E'g'"ALTYPE OR PRWT ONLY Occupancy Fee $davit SIGN ON REVERSE SIDEAppr.for CO.Total Fee
TO BLALDWG DEPARTMENT,TOWN OF SOUTH WI DSOR,CT Additional Cost) $
The undersigned hereby applies to do work according to the following specifications:
Job Location 1-7 ..cry rGt.^ Lc,.,a Lot No. Side of Street Zon
Applicant DseIt 990 F,'^5 Tel# SLS-W[o
Addr ss `7 /?4n^ay 5+. 1 Zip c-Nbto? Lic.# Will
Own r e+e/- Pe Lry Address tc
Architect Address
Sq.Ft.New Area: 1st FI. 2nd Fl. 3rd FL Total New Area
Rooms Lavatories Bathrooms Garages
Purpose of this permit:Rsroif o..,cr e)v}f,%•I lez
City Water k44 Well Septic System Sewer
Ins. H.O._ S.P. Cent. Area Basement Garage
Approved by Date /0/,),-I& Use Group Construction Type
Rev6ed 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 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