HomeMy WebLinkAbout20 Benjamin Way (7)TO THE BUILDING INSPECTOR
of the APPLICATION FOR
TOWN OF SOUTH WINDSOR, CONN.
PLAN EXAMINATION ANDBUILDINGPERMIT
IMPORTANT — Applicant to complete all items in sections: 1, It, III, and IV. O
ZONINGI• AT (LOCATION) vJ Q DISTRICT
LOCATION NO.) V STR ET)
OF BETWEEN 09ct ham A cad AND fC V/l> e,
BUILDING CROSS S REET) CROSS STREET)
J LOT nn II
SUBDIVISION LOT BLOCK SIZE O.
N
11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D v
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use Itfl
1 New building Residential Nonresidential
2 Addition(If residential, enter number 12 One family 18 Amusement, recreational
of new housing units added, i/any,13 Two or more family — Enter 19 Church, other religi usPartD, 13)
number of units— — — — --
3 Alteration (See 2 above)
20 Industrial
14 Transient hotel, motel, 21 Parking garage4 Repair, replacement or dormitory — Enter number
5 Wrecking (If multifamily residential, of units ——————— — i Service station, repair garage
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13) 16 rport 24 Office, bank, professional
6 Moving (relocation)
17 Other — Specify a 25 Public utility
7 Foundation only 26 School, library, other educational
B. OWN SHIP
14 S R PLa)>— PL9W 27 Stores, merconfile
8 Private(individual, corporation,
28 Tanks, towers
nonprofit institution,etc.) 29 Other — Specify
9 Public(Federal, State, or
local government)
cents)Omit cC.COST
p
RK DESCRIPTION:
10. Cost of improvement. . . . . . . . . . . . . . . $1 O '20ID De% v T
a. El ctrical . . . . . . . . . . . . . . . . . . . .
b. Plumbing . . . . . . . . . . . . . . . . . . . . .
c. HVAC . . . . . . . . . . . . . . . . . . . . . . .
d. Sprinkler . . . . . . . . . . . . . . . . . . . . .
Garages. . . . . . . . . . . . . . . . . . . . .
f. Oth r Od Op
11. TOTAL f 0 Fee: CO Fee: — Total: p y
III. SELECTED CHARACTERISTICS OF BUIL ING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPLE TYPE OF CONSTRUCTION G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
40 Public or private company
48• Number of stories................
30 Type 1: A B 41 Private(septic tank,etc.)
49• Total square feet of floor area,
all floors, based on exterior
31 Type 2: A B C dimensions .....................
32 T e3: A B H. TYPE OF WATER SUPPLY
YP 50. Total land area, sq. ft. ...........
33 Type 4
42 Public or private company
yP 43 Private(well, cistern) K. NUMBER OF OFF-STREET
34 Type 5: A B PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
51. Enclosed .......................
35 Gas Will there be central air 52. Outdoors.......................
36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 Yes 45 No 53. Numb r f b dr oms..............
36 C al
39 Other— Specify Will th re be an elevat r?
54. Number f
Full..........
46 Y s 47 No bathr ms Partial........
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, c:ly, and State ZIP code Tel. No.
Owner or
dstqLessee7O
O67O741 7
2. oA 8 r8
Contractor ocvoc(o 1lot
3.
Architect or
Engineer
The owner of this building and t-he undersigned agree to conform to all applicable laws of this jurisdiction.
Signature of applicant ssAddre Application date
J`
DO NOT WRITE BELOW THIS/LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By y
Date Plans B Notes9FeeStartedApproved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER is
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check ObDa ned
ate Number By Permit or Approval Check ObDained
ate 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 T
Building
Permit issued o 19
Building 4/
Permit Fee
Approved by:
r O
V w
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