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HomeMy WebLinkAbout1906 Main Street (4)Electric# tssti k,APPLICATION FOR BUILDING PEI{MIT Plumbing# Ito 1906 Main Street Date: — !(6 "®HVAC # I111L Sprinkler#30578 FINAL g Estimated Cost $ S 32Buildingl (9 COMPLETE RED BOXED AREAS Permit Fee Enginee n Occupancy Fee $1 Affidavit TYPE OR PRINT ONLY Eng. Insp.Fee $ Appr. for CO NO" SIGN ON REVERSE SIDETotal Fee TOTHEBG DEPARTMENT,TOWN OF SOUTH WINDSOR,CT Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant K, ,0/ir V l Q,_J " - Location of Work 19 0 o r0o_, rs S+re e,4--Lot No. Applicant's Address 7 5P,k N--c('S ',-ue,z Tel.# `f ` 3:35A_ Town 5 0 OTbA w nLos ,c-e7t' Zip n G cQ `Lic.# S a 7 Owner vc_ 6,o ttL4Architect Owner' Address 1q n (_ r\A t4 S Architect's Address Zip Zip Sq. Ft. New Area: 1st Fl.2nd Fl. 3rd Fl. Total New Area Purpose of this permit t 1 G.e D ONC I\ rn e City Water Well Septic System Sewer Ins: HO SP Cert. Area Basement Garage Approved by Date —z-toy Use Group Construction Type Revised W02 I hereby agree to conform to all the requirements of theSouthWindsorandtonotifytheBuildsIn Laws of the State of Connecticut and the Ordinances of the Town ofBuildingSpectorofanyalterationintheplansorspecificationsoftheBuildingforwhichthisPermitisasked,and agree that this building is to be kx:ated thedistancesfromallotherzonesandislocatedinichthisbuild' aril distancef is romall street lines,side yard lines,and required Signed I hereby apply for a Certificate of u y for th7 ribed in this application for the permit. Signed DO T WRITE BELOW THIS LINE INSPECTION COMMENTS INSPECTOR DATE 1 TIME LOCATION G 15-77- INSPECTION: E: RE UL (D/ e- tp,,o< wv BUILD G': 747 ELECTRICAL: PLUMBING: Ell- HVAC: OTHER: Inspection / Approval Date By Appl Code Description Due Whom Code Comment 30578-B 25,000 BO1 FOOTING 05/03/04 JFF A W/CONTRACTOR NEED TEMP SHORING OF EXISTING STRUCTURE B04 INSULATION 06/22/04 CJD A B10 FINAL 07/22/04 JFF D ROUGHS DONE BY CHRIS INSUL MISSING IN CELLAR INSULATE CELLAR HYDRONIC SYSTEM CALLED PUIDA B10 FINAL 11/09/06 JFF D N/A DOOR TAG ALSO VOICE MAIL B10 FINAL 11/13/06 JFF A 12228-H 3,000 11620-P 2,000 18966-E 2,000 r T R DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT Application'TOWN OF SOUTH WINDSOR PERMIT# BUILDING DEPARTMENT 1540 SULLIVAN AVENUE Bldg.Permit#644-2511 ext. 230 Date Buildi Inspector Application must be printed or typed FEE SCHEDULE Location of Job: s QO f9 c AI,, sl, 0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= 15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT C..0AJ STD APPLICANT ADDRESS 5-0 Er— Cep 2d r f 060 j APPLICANT PHO1NE# f 30 C 7 eehWz/y_ 5-0.3-7 O W N S OWNER /"U1 / ep >(//2) a o,)/i.0 r OWNER ADDRESS Fo o 6q /- 4 J jr Ca(A.1 Sow ry OWNER PHONE C ESTIMATED COST$ 200 G. IS THIS A CONTRACT COST? _Yes No FEE ENCLOSED$ JG, ® TYPE OF JOB: SOR CO New Installation LcAlteration/Addition/Repair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERNUT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION?A YES NOQRESIDENTIAL BUSINESS CURRENT USE AND OCCUPANCYASSEMBLY MERCANTILE EDUCATIONAL FUTURE USE AND OCCUPANCY INSTITUTIONAL FACTORY ENGINEER'S NAME PHONE STORAGE GARAGE ADDRESS MIXED USE Other please specify) CITY STATE ZIP TYPE OF INSTALLATION/WMING METHOD JAI SIZE OF SERVICE SIZE OF MAIN CONDUCTORS 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 Q NUMBER OF LIGHT FIXTURES ` NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS — SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE 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. YPE ST E SIGNATURE OF APPLICANT r DATE q d U DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR I 1 p 2Z BUILDING DEPARTMENT VED 1540 SULLIVAN AVENUE Bldg.Permit# ii 644-2511 ext. 230 Date 14 or Application must be printed or typed Location of Job: FEE SCHEDULE 0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= 15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. 0,66 APPLICANT APPLICANT ADDRESS A C s , C))i)()--k n APPLICANT PHONE# Ow SF OWNER SC,V q OWNER ADDRESS S C l p OWNER PHONE ESTIMATED COST$ L U U IS THIS A CONTRACT COST? Yes —No G FEE ENCLOSED$ 6 0 TYPE OF JOB: OR-Co New Installation Alteration/Addition/Repair Revised 4/01//2002 APPLICATION FOR PLUMBING PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? Y"NO RESIDENTIAL USINESS CURRENT USE AND OCCUPANCYASSEMBLY MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL INSTITUTIONAL FACTORY ENGINEER'S NAME PHONE STORAGE GARAGE ADDRESS MIXED USE Other please specify) CITY STATE ZIP TYPE OF INSTALLATION \ V\A c, vn A V SIZE OF MAIN DRAIN to NO.OF TOILETS STYLE NO.LNALS 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 r CU 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 MANUFACTURER DESCRIPTION OF WORK 1V 1 IHE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESMOED 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 q Q Q DATE G T DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT# Application i eb :TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT P OVE `1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 jU57 ate ' T B g s ctor Application must be printed or typed FEE SCHEDULE Location of Job: 0\ U 6 /fin Q),\ 0-$1,000=$15.00 FTenant Street Lot No. Over$1,000= 15.00 per$1,000 or any fraction thereof gnation Apt.No. APPLICANT k C& C APPLICANT ADDRESS S a APPLICANT PHONE# k:M OW N 3F OWNER 0,\1Q, O a cl q< OWNER ADDRESS AN a 17 Ti O F OWNER PHONE 2g 0\ — L C UESTIMATED COST$ O IS THIS A CONTRACT COST? Yes —No fl G FEE ENCLOSED$_ To j11r s 0 TYPE OF JOB: OR-C New Installation ZAlteration/Addition/Repair Revised 4/01//2002 Heat Loss Details O Project#: 021204-032-ET uponor Date: Feb 12, 2004 Prepared For: Imperial Oil Manchester Winnelson 160 Hartford Rd Manchester, CT 06040 Prepared By: Ed Taylor Phone: 8606494563 Fax: 8606497529 Email: Heatmaster2000@Yahoo.com Project Summary Project#: 021204-032-ET Project Name: Samuel Webster house Design Data Location: User-Specified Location) Outdoor Temperature: 0 OF Total Area: 721 ft2 Construction Quality: Average Quality Total Floor Downward: 4,070 Btu/hr Total Ceiling Upward: 1,629 Btu/hr Total Infiltration: 3,594 Btu/hr Total Other Components:5,931 Btu/hr Net Heat Loss: 15,412 Btu/hr Net Radiant Load: 15,412 Btu/hr Total Supplemental Heat:0 Btu/hr Heat Loss Data mud (Floorplan 1) Total Area: 109 ft2 Infiltration: 544 Btu/hr Average Height:8 ft Floor Downward: 522 Btu/hr Volume: 874 W Ceiling Upward: 247 Btu/hr Perimeter Exposed: 21 ft Other Components:1,746 Btu/hr Air Changes: 0.5/hr Total Heat Loss: 3,059 Btu/hr RoomTemperature: 70°F Supplemental: 0)Btu/hr Total Radiant Load:3,059 Btu/hr Floor Unit Load: 28.1 Btu/ft2/hr Radiant Load to Room: 2,537 Btu/hr Floor Unit Load Load To Room: 23.3 Btu/ft2/hr Floor Total Area: 109 ft2 Downward Load: 522 Btu/hr Unheated Area: 0 ft2 Heated Area: 109 ft2 Construction: Joist(16"OC) Cover Rv: 0.6°F•ft2•hr/Btu Structure Rv: 1 °F ft2•hr/13tu Insulation Rv: 19°F•ft2•hr/Btu Space Below Heated: No Surface Temperature:81.6°F Page 1 of 5 Created using Wirsbo Advanced Design Suite-Version 5.0(Revision 9) @HeatLossDetails Project#: 021204-032-ET r uponpr; WIRBBO® Date: Feb 12, 2004 . Prepared For: Imperial Oil Manchester Winnelson 160 Hartford Rd Manchester, CT 06040 Prepared By: Ed Taylor Phone: 8606494563 Fax: 8606497529 Email: Heatmaster2000@Yahoo.com Ceiling Total Area: 109 ft2 Upward Load: 247 Btu/hr Unheated Area: 109 ft2 Heated Area: 0 ft2 Construction: Gypsum Wall board Cover Rv: 0°F•ft2-hr/Btu Structure Rv: 1 °F•ft2•hr/Btu Insulation Rv: 30°F•ft2•hr/Btu Space Above Heated:No Other Components Component Length(ft) Width/H,eight Area(ft2) Rv(OF-ft2-hr/Btu) Heat Loss(Btu/hr) Wall 1 21 8 168 19 1746 Door 21 1 21 2 735 Window 1 15 1 15 2 525 kitchen (Floorplan 1) Total Area: 162 ft2 Infiltration: 810 Btu/hr Average Height:8 ft Floor Downward: 501 Btu/hr Volume: 1,300 ft3 Ceiling Upward: 367 Btu/hr Perimeter Exposed: 13.5 ft Other Components:836 Btu/hr Air Changes: 0.5/hr Total Heat Loss: 2,703 Btu/hr RoomTemperature: 70°F Supplemental: 0)Btu/hr Total Radiant Load:2,703 Btu/hr Floor Unit Load: 25.0 Btu/ft2/hr Radiant Load to Room: 2,202 Btu/hr Floor Unit Load Load To Room: 20.4 Btu/ft2/hr Floor Total Area: 162 ft2 Downward Load: 501 Btu/hr Unheated Area: 54 ft2 Heated Area: 108 ft2 Construction: Joist(16"OC) Cover Rv: 0.6°F•ft2•hr/Btu Structure Rv: 1 °F•ft2•hr/Btu Insulation Rv: 19°F•ft2•hr/Btu Space Below Heated: No Surface Temperature:80.1 °F Page 2 of 5 Created using Wirsbo Advanced Design Suite-Version 5.0(Revision 9) Project#: 021204-032-ET Heat Loss Details uponori z, Date: Feb 12, 2004 WIRSBO Prepared For: Imperial Oil Manchester Winnelson 160 Hartford Rd Manchester, CT 06040 Prepared By: Ed Taylor Phone: 8606494563 Fax: 8606497529 Email: Heatmaster2000@Yahoo.com Ceiling Total Area: 162 ft2 Upward Load: 367 Btu/hr Unheated Area: 162 ft2 Heated Area: 0 ft2 Construction: Gypsum Wall board Cover Rv: 0°F•ft2•hr/Btu Structure Rv: 1 OF ft2•hr/Btu Insulation Rv: 30°F•ft2•hr/Btu Space Above Heated:No Other Components Component Length(ft) Widt h/H)eight Area(ft2) Rv(OF-ft2-hr/Btu) Heat Loss(Btu/hr) Wall 13.5 8 108 19 836 Window 1 14 1 14 2 490 foyer (Floorplan 1) Total Area: 136 ft2 Infiltration: 678 Btu/hr Average Height:8 ft Floor Downward: 579 Btu/hr Volume: 1,088 ft' Ceiling Upward: 307 Btu/hr Perimeter Exposed: 8 ft Other Components:893 Btu/hr Air Changes: 0.5/hr Total Heat Loss: 2,457 Btu/hr RoomTemperature: 70 OF Supplemental: 0)Btu/hr Total Radiant Load:2,457 Btu/hr Floor Unit Load: 18.1 Btu/ft2/hr Radiant Load to Room: 1,878 Btu/hr Floor Unit Load Load To Room: 13.8 Btu/ft2/hr Floor Total Area: 136 ft2 Downward Load: 579 Btu/hr Unheated Area: 0 ft2 Heated Area: 136 ft2 Construction: Joist(16"OC) Cover Rv: 0.6°F•ft2•hr/Btu Structure Rv: 1 OF ft2-hr/Btu Insulation Rv: 19 OF-ft2•hr/Btu Space Below Heated: No Surface Temperature:76.9 OF Page 3 of 5 Created using Wirsbo Advanced Design Suite-Version 5.0(Revision 9) Project#: 021204-032-ET Heat Loss Details uponor Cate: Feb 12 2004 , WI80® Prepared For: Imperial Oil Manchester Winnelson 160 Hartford Rd Manchester, CT 06040 Prepared By: Ed Taylor Phone: 8606494563 Fax: 8606497529 Email: Heatmaster2000@Yahoo.com Ceiling Total Area: 136 ft2 Upward Load: 307 Btu/hr Unheated Area: 136 ft2 Heated Area: 0 ft2 Construction: Gypsum Wall board Cover Rv: 0°F•ft2•hr/Btu Structure Rv: 1 °F•ft2•hr/Btu Insulation Rv: 30°F•ft2•hr/Btu Space Above Heated:No Other Components Component Length(ft) Width/Height Area(ft2) Rv(OF-ft2-hr/Btu) Heat Loss(Btu/hr) Wall 1 8 8 64 19 893 Door 7 3 21 2 735 family (Floorplan 1) Total Area: 313 ft2 Infiltration: 1,562 Btu/hr Average Height:8 ft Floor Downward: 2,468 Btu/hr Volume: 2,508 ft3 Ceiling Upward: 708 Btu/hr Perimeter Exposed: 35.5 ft Other Components:2,456 Btu/hr Air Changes: 0.5/hr Total Heat Loss: 7,193 Btu/hr RoomTemperature: 70 OF Supplemental: 0)Btu/hr Total Radiant Load:7,193 Btu/hr Floor Unit Load: 23.0 Btu/ft2/hr Radiant Load to Room: 4,725 Btu/hr Floor Unit Load Load To Room: 15.1 Btu/ft2/hr Floor Total Area: 313 ft2 Downward Load: 2,468 Btu/hr Unheated Area: 0 ft2 Heated Area: 313 ft2 Construction: Joist(16"OC) Cover Rv: 0.6°F•ft2•hr/Btu Structure Rv: 1 °F•ft2•hr/Btu Insulation Rv: 10°F•ft2•hr/Btu Space Below Heated: No Surface Temperature:77.5 OF Page 4 of 5 Created using Wirsbo Advanced Design Suite-Version 5.0(Revision 9) Heat Loss Details Project #: 021204-032-ET , p0nor Date: Feb 12 2004 WIRSBO® Prepared For: Imperial Oil Manchester Winnelson 160 Hartford Rd Manchester, CT 06040 Prepared By: Ed Taylor Phone: 8606494563 Fax: 8606497529 Email: Heatmaster2000@Yahoo.com Ceiling Total Area: 313 ft2 Upward Load: 708 Btu/hr Unheated Area: 313 ft2 Heated Area: 0 ft2 Construction: Gypsum Wall board Cover Rv: 0°F•ft2•hr/Btu Structure Rv: 1 °F•ft2•hr/Btu Insulation Rv: 30°F•ft2•hr/Btu Space Above Heated:No Other Components Component Length(ft) Width/H,eight Area(ft2) Rv(OF-ft2-hr/Btu) Heat Loss(Btu/hr) Wall 35.5 8 284 19 2456 Window 1 15 3 45 2 1575 Page 5 of 5 Created using Wirsbo Advanced Design Suite-Version 5.0(Revision 9) 1 PnOPERTY OF JOHN FITCH BOULEVARD MAIN STREET SOUTH WINDSOR, CO iNECTICUT SCALE: I INCH= 20 FEET MAY,1973 o- 1 HEREBY CERTIFY THAT THIS MAP 1S SUBSTANTIALLY q CORPECT .AND IN ACCORDANCE WITH CLASS A-2, CODE OF THE CONI`i. TECHNICAL COUNCIL, INN p.Q` t tp cc im w w tu cl V. 1 STORY F RAi1E so 0 LD N0.1905 r FEP.C€ i ep IICHWAY LINE M A I N 5TREET PROPERTY OF JOHN EITCH BOULEVARD MAIN STREET SOUTH WIND OR, CONNECTICU'f SCALE: I)NCH= 20 FEET MAY, 1973 p 1 HEREBY CERTIFY THAT THIS MAP IS SUBSTANTIALLY 0 CORRECT AND IN ACCORDANCE WITH CLASS A-2, CODE OF THE CONN. 7ECHNISAL COUNCIL, INCH.c. m i o re) cc W ttom. , f 0 N ct P' f - fo. I STORY FRAME 2 S7vr Y BRICK 50 1 bio z M O No-1906 I FENCE COX- 12 S.&_6'—x HIGHWAY LINE e AA I N STREET it o S p.N N SF4 Sou V&U&t m 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CONN. 06074w SOR-CO AREA CODE 860/644-2511 May 12, 2003 Mr. &Mr David Goslin ox 412 East Windsor Hill, CT 06028 Dear Mr. &Mrs. Goslin: Enclosed please find your copy ofthe Certificate ofAppropriateness that was issued following the May 6, 2003 regular meeting ofthe Historic District Commission for the installation of an ornamental metal fence on the north and east side of the existing in- ground swimming pool. As you know, your application for the proposed alterations to the ell of the house was tabled. The Commission would like to set-up a working session to review your plans with our consultant Edward Sunderland, a resident ofMain Street and principal of Sunderland Period Homes, specializing in period restoration and construction of reproduction 18th century houses. We would like to meet before our next regular meeting to expedite passage of your application. If you have any questions,please give me a call. My work number is 226-5611; my home number is 289-5075. Thank you for your cooperation and care of this property. We look forward to working with you. Sincerely, 6 ) Kathy Brady, Chair South Windsor Historic District Commission KB/dk Enclosure MAY 12 ZO TOW 4 Grl tis 1540 SULLIVAN AVENUE SOUTH WINDSOR, CONN. 06074 SOR•C0 AREA CODE 860/644-2511 CERTIFICATE OF APPROPRIATENESS Certificate Number 1.03 Date Issued 5/6/03 To: David &Ronna Goslin Applicant Name(s) of Owner- David &Ronna Goslin Address- 1906 Main Street,South Windsor, CT Address of proposed work_1906 Main Street,South Windsor,CT Contractor On 6/03 ,the Historic District Commission voted to grant this date Certificate of Appropriateness for work described in Application for a Certificate of Appropriateness Number 1.03 dated 5f 06/03 COMMENTS/STIPULATIONS: New fence should be: Williamsburg style, ornamental metal fence on North and East perimeter of pool. Clerk,Hi oric Distric Co ' sion For Building Inspector Use (when inspection is necessary) This certifies that the work herein described has been completed in compliance with the terms specified. Date of Inspection Attest Building Inspector Dated: APR 3 2003 t.J y 1540 SULLIVAN AVENUE SOUTH WINDSOR, CONN. 06074 SOR.C. AREA CODE 860/644-2511 To: Historic District Commission Date: 3- D APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application is hereby made for issuance of a Certificate of Appropriateness under an "Ordinance Establishing an Historic District within the Town of South Windsor", Ordinance 100, for proposed work as described below and as shown on photographs and plans or drawings (where applicable) , accompanying this application. Name of Applicant: Da y Address: Name(s) of Owner(s): Tm L) I. O's 1M e;1 ty-) Address of Owner(s) : P D /?-vx `t l a , (,l . i C I 6, Address of proposed work: '! Meet- Agent or Contractor: Address: Nature and description of proposed work: (include plan, photo(s) if possible, and elevation drawing where necessary. ) Enclosed is a copy of Ordinance and applicable Statutes which you should review in filling out this Application. Use reverse side hereof and/or additional pages if needed. You will be notified of a hearing date. 60or-k s1-6q1l /Ajvr"e Re h4ce'l,'j- ' 010 2.xu4p,6 moot) Pic P xe CXIOYG 4-wo Sl ues Poo'. ex15'7ix Pike 4-, IZ040, Wo wojb l ke T lN5 l pexi Mergj orztIA '1 e j l.izOU y1T r oN gINCc_, flNl coiq% To Fbol Gone. Proposed date of commencement of work: Estimated completion d e: 21 Signature of Owner Signature of Applicant Signature of Owner a Approved: FOR COMMISSION USE ONLY: Application No. Date Received:Denied: Date: S N SEq` i 1540 SULLIVAN AVENUE SOUTH WINDSOR, CONN. 06074 sox•co AREA CODE 860/644-2511 To: Historic District Commission Date: 3-/ --U APPLICATION FOR CERTIFICATE OF APPROPRIATENESS Application is hereby made for issuance of a Certificate of Appropriateness under an "Ordinance Establishing .an tHistoric District within the Town of South Windsor", Ordinance 100, for proposed work as described. below and as shown on photographs and plans or drawings (where applicable) , accompanying this application. Name of Applicant: Det v I 1,,,C, Address: 19 (fib Mej S ' Name(s) of Owner(s): A- y i cd horn toe yYl e,; c)Address of Owners): p O fix-l C roc) 1 6 Address of proposed work: 1 0A Mq, i /I cS} Agent or Contractor: Address: Ji Nature and description of proposed work: (include plan, photo(s) if possible, and elevation drawing where necessary.) Enclosed is a copy of Ordinance and applicable Statutes which you should review in filling out this Application. Use reverse side hereof and/or additional pages if needed. You will be notified'of a hearing date. Work 514A11 /Wjvt,-< Re cewle,W ° 2xt5T1. GVoop p c CdOPG 4ZA40 sr ryes C-P FID1. ex,4 x Gv, t,0(V I N 75W/ r Ijec.J McTnlov G- f Fop 16 Fbot Co e. Proposed date of commencement of work:IS?C, ? Estimated completion d e: 2yh+(© zonz Signature of Owner Signature of Applicant a.-.Pe Signature of Owner A roved;------ FOR COMMISSION USE ONLY: Application No. f3 p Date Received: 0 Denied: Date: o D S dMf 4W AWO M low it mw law, buy A' jd: e .. 4 • eA. d. I I F'. Y ., k f r tee yR• C fA m y.. y r Y y ve Ol OVAL, 7F.rp r