HomeMy WebLinkAbout205 Orchard Hill DriveTO THE BUILDING INSPECTOR
APPLICATION FORofdw
PLAN EXAMINATION ANDTOWNOFSOUTHWIMSMCONK. BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in s ctions: 1, 11, Ill, IV, and IX.0
t ZONING
AT (LOCATION) DISTRI '
LOCATION NO.) STREET)
OF BETWEEN AND
BUILDING cRoss STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use
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Im
1 4 New building Residential Nonresidential
2 Addition(1/residential, enter number 12 One family 180 Amusement, recreational
of new housing units added, if any, 13 Two or more family — Enter 19 Church, other religious
in Part D, 13)
number of units— — — — --)P- 20 Industrial
3 Alteration (See 2 above)14 Transient hotel, motel, 21 Parking garage4 Repair, replacement or dormitory — Enter number
22
5 Wrecking (1/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 F-1 Carport 24 E] Office, bank, professional
6 Moving (relocation)
17 F1 Other — Specify 25 Public utility
7 Foundation only 26 Ej School, library, other educational
B. OWNERSHIP 27 Stores, merconfile
8 [K 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
V 1 processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement................ S-'a 00o 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
a. Electrical......................
b. Plumbing ....................
c. Heating, air conditioning.........
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $
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taDo e
III. SELECTED CHARACTERISTICS OF BUI DING — 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 OF SEWAGE DISPOSAL J. DIMENSIONS
30 Masonry(wall bearing) 40 Public or private company
48• Number of stories................
31 Wood frame 41 Private (septic tank, etc.)
49. Total square feet of floor area,
z'nallfloors, based on exterior f-
32 Structural steel dimensions .................... o
33 Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total land area, sq.ft. ...........
34 Other — Specify 42 Public or private company
43 Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 Gas Will there be central air 52. Outdoors.......................
36 Oil 140`T i_.0PTt conditioning?L. RESIDENTIAL BUILDINGS ONLY
37 Electricity 44 Yes 45 M No 53. Number of b drooms..............
38 Coal
l
39 Other— Specify Will there be an elevator?
54. Number f
Full..........
46 Yes 47® No bathrooms
Partial........
NOTES and Data — (For department use)
IV. IDENTIFICATIO — To b completed by all applicants
Name Mailin ddress — NumbX street, city, and State ZIP code T I. No.
Owner or
Lessee r
2.
Contractor
3.
Architect or
Engineer F7
The owner of this building and the undersigned agree to conform to all applicab laws of this jurisdiction.
Signature of applicant Address a Application date
x- r `
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plan Review Date Plans Date Plans
Plans R view R quired Check Fee Started By Approved BY Notes
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check Date
ObtaObtained Number By Permit or Approval Check Obtained
Date 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 8555Prmitnumber
Bui Iding
P rmit issu d 7-3-74 19
Bui Iding
P rmit F $ 198 00 Plug $3.00 for C.O.
Approved by: j
TLE
VIII. ZONING PLAN EXAMINERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
IX. SITE OR PLOT PLAN — For Applicant Use
P
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4 e{ s n Y r 2
S v s t$q _
K- -t-i a.4 ro,,,,,,..«,t xit- .,..b-a.;M >,.,y_p a-n s r a• rS`°<_. n
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1
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date July 3 19 74
Fee Paid $198.00 Est. Value $! 000
Permit N?8555
on t side of
Orchard Hill Drive Street
Street No. Lot #4.
Owner Herbert Wanza
Applicant Same
CERTIFICATE OF OCCUPANCY ISSUED:
Date
No. 4506
Fee Paid $ 3.00
CLASSIFICATION
Dwelling
BUILDING PERMIT
N?8555
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn.July 3, 1974
94is to to CErrttf1j, That Herbert Wanza
is hereby granted permission to
Dwelling
at estimated value of >$ 33.0000
on the side of Orchard Hill Drive, Dot #4. Street on land
owned by Herbert Wanza
Said work to be as described in Application
No. 8855 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
I July 3,
uil sng 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."
Pet it No.,.+ t t TOWN OF SOUTH WENDSOR
SOUTH WEN DSOR, CONN.
Permit l 450 6
I
Certificate of Occupancy
TffiS
10
IS 1 OiFii1T t ilJc '
r `• 7
thin own of South Windsor, Connecticut, hasatN0.f
been erected and completed in accordance with the Building Code and Zoning Regulations of
the Town of South Windsor, and is hereby approved for occupancy.
Bundingr
Owner, Builder
a,
Fee Paid,` _ Date 19,
i
5600
ELECTRICAL
APPLICATION
Application
No.
5911
on
the
side
of
Orchard
Hill
Drive
Street
Street
No.
Lot #
4
Owncr
Herbert
Wanza
Electrician
Francis
Ashmore
FILED
IN
OFFICE
OF
The
Building
Inspector
Sept.
23
1g
77
INSPECTION.
ry
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.
n
APPLICATION FOR PERMIT TO DO ELECTRICAI. WORM.
No. .59. .....11
5600PermitNo. ......... ............... ...............
TO THE BUILDING INSPECTOR
of the
TOWN OF SOUTH WINDSOR, CONN.
hereby make application to. 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.
q
South Windsor, Conn.. ............. 1EY.1 4ign here
Address ...,1 ., .....
Location ....04i l... .hN4--ed.. Side of ..............................
Nature of Building A Vr q, - How many stories 0
Newor old Building .............AEU................................. .................. .. How many families ......../...._................................._............................_...........
Kindof Installation .............Ae.......................................................... How many Stores ......................................................_..............................................
Owner .....................116,66........ Address .............eo. x...!.1..E.............rGSallf ., ......
Architect ..................................................................... .... .............................. ...... Address ............................................................./../............_..............._......._.._.._..........
Builder fVt .. ....................... .............. Address 7, .......... ! ..... V.................
Electrician iG'-I /1'L ........../ J Address , , ........& ....
Size of Main Wires ...
No. of Light Loops ............ ......... .. ......... No. of Heat Loops No. of Power Loops
No. of Light Outlets ......Z_7. . .......... No. of Heat Outlets ...... ..... ... .. No. of Power Outlets ....................................
Nod of Light Circuits ........ ................ No. of Heat Circuits ... . ... . . .. .......... No. of Power Circuits ................ ..................
N . of Sockets ...................../......... .. ... ....... No. of Heat Receptacles ... . ... .. ...... No. of Motors .....................................................
No. of Panels ..................../............................... Size of Heat Circuit . ... ..... . ... . ...... No. of Power Receptacles ........................
No. of Switches ............................... ... .... .... 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: For other kind of Installation ...... ../. ... ..... fit. f....... ....
14e...///l . ...... ......................................................... ..............._.................................................................................................................................. .............. ...
Estimated Cost ..............
4614 1.9
PLUMBING APPLICATION
j Applirition N . 4403
i
on the ....__...._.._ of
Orchard Hi 11 ' Dri ve Sheet
Street Na ......__Lo.. t #4 b,57
i
Owner Herbert Wanza
plumber Herbert Wanza
Filed in Office of
The B1uld6g bWecwr
w
Sept, 23 19 74
No person shall a sstcuct, add to cr abler MW
portion of the drainage :'wean of any bu
except to repair leaks) until a Permit is gemmed
by the Building Inspeci)w.
zti i
Application No. ........4403................. Permit No. ... 6.14...................
TO THE BU WING INSPECTOR1ofthe
TOWN OF SOUTH WINDSOR, CONN.
hereby make application to p form 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, . s T Z3 Sign here t-...............................,................ 9 ...... r...................
Address......7...19r .......P., 'K.......
Location .. ... U C? '/ /32tl iG. ....,D/2 side of ............) .0.'e ..z ......................................................... Street
Nature of,Building 5"qeq:.....4.Es ....... How many stories .........T.. Q.......................... ..................................
Owner ......... C:::O J.S—/C- I.. ................ Address........7...&U......Pnz !.K..........Aiv '..........eu./ SG
Architect .. ................................. . ............................................................... Address ........................................................................................................................
Builder .......G.1/tN...Z ..... ...a.. sT cTI G I.............. Address ......7.e 2........ ' .2.'......... v.......c.J.l.ti.6.
Plumber ...A Zr....... /3 c.Z. ......,,%/. -........ Address ...... U..........1.0 ......,4........G
DRAINAGE
CESSPOOLS, How many ..................Where located ........................ .Q •".....................................................
Are they water tight . . ...........................(l rat............................ Of what materials are they built ............Nod...........................
Size of pipe from house to cesspool ... .........0A?.. ................ Kind of pipe .......lv o4.f;.......................................................................
MAIN DRAIN IN CELLAR, Material .....0 .,......... Diameter ..........IV...:'...... '/S'. ............k/Z- AJ................................
Aboveor below cellar bottom ... ....'8.k u"I............................ .... ......... ...............................................................................................................I..........
SOIL PIPES, Material . . C/ S.......... 90.,4................... Diameter ............(Ir.y....................................
WASTE PIPES, Material ..../ A.V!17 Diameter .........8fz..... Z
TRAPS,Type proposed to use is .......N./"'.........1..) 7-/' ... ........................................................................................................................
RAIN WATER LEADERS, where do they run to S'P..I:44... ...7.. .............`t.e e............................................................
REFRIGERATOR WASTES, where do they run to . 1.0.N.'`'..........................
TANK OVERFLOWS, where do they run to NC..................................................................................................................
FIXTURES
WATER CLOSETS, How many .....................3............ Where located .1W.4I'J.3 T%r LA v4 m Rs re x
Distance from trap to vertical soil pipe ..........r. ...................... Pattern L v . ..r1................ ...............................................................
WASH TRAYS, How many AI ....................... Where located .... .tv d tA. .
SINKS, How many ..................f................................................................... Where located .. T..e//
erBUTLER'S SINKS, How many .........,c4 Nam...................... Where located........./Vo ..................................................................
REFRIGERATOR SINKS, How many....... 0 .... Where located .....NN
LAVATORIE How man Where located .../yblz......6,472!......
BATH TUBS,How many ................/................................................... Where located .....lnrtl. .......... T.1. ........................................
How many ..................... '!v ......................................... Where located ........./?t./tS,Tl........
Are water closets and urinals to be local vented `r S ... If not,is there a window in outer wall
of room where same are to be located .........../ SS
Estimated Cost..../ .'.... .v.
Application For 4495
x DEPARTMENT DECISION Permit- 427
1
4J o
APPLICATION IS HEREBY:DWARTMEM QF j,jC"Eg AND IN WMNS <
O O
CFAPPROVED DISAPPROVED TOWN OF SOUTH WINDSORNO
LL11/4/74
00
Co.
DATE CHItPWWCTOR APPLICATIONS MUST BE PRINTED OR TYPED. BECNI WITH NUMBER ONE BELOV
1. LOCATION of .Ios
O Lot #4 Orchard Hill Driv
1~
A STREETMO. BTRE
C v
LOT NO. FLOOR APT. NO.
4-3 O
N
5 OWNER
Herbert Wanzacc
s. ADDRESS 780 Park Avenue
3 Windsor PHONE
B. APPLICANT Herbert Wanza
o s. ADDRESS Same
a 7.PHONE
LICENSE NO.
a
B. EXPIRATION DATE OF LICENSEF. w
l
10. ESTIMATED COST s 500,OO
11. IS THIS A CONTRACT COSR 13 YES 0NS
ao
FEE ENCLOSED * Permit 8555
is. OF BUILDING:
BSN/ENTIAL COMMERCIALbe
1 TYPE r Joe: INDUSTRIAL
3 ownwa ALTERATION1+
ca
l INSTALLATION ADDITION
I REPAIRI
APPLICATION FOR HEATING PERMIT (C ntinued tr m Reverse Sid
11. LOCATION OF JOB
Lot #4 Orchard Hill Drive SouthWinddsor
N0. STREET FLOOR AFT.NO.
12. TYPE OF INSTALLATION: OIL BURNER ELECTRIC VENTILATION SPRINKLER
GAS BURNER STACK INCINERATOR MISCELLANEOUS
IDENTIFY
SIZE LOCATION SIZE SIZE
13. OF TANK OF TANK OF FILL OF VENT
14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO. AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND NO. B.T.U. OR SQ. FT. NET B.T.U. OR SQ. FT. GROSS FIRING RATE
FLOORS TO BE HEATED NEW OR OLD BUILDING INSULATED - YES OR NO
TYPE OF WALL INSULATION ROOF OR CEILING INSULATION
AVG. SYSTEM WATER TEMP. B.T.U./SQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE FAHRENHEIT
MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ.
FT. OR B.T.U.
DESCRIPTION OF WORK
15. TO BE DONE:
SEE ATTACHED
16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS):
R OM SIZE WINDOWS AREA — SQUARE FEET B.T.U. O.T.U. f D
AND DOORS voLUME DISTRIBUTION INSTALLED
NO. ``
TOTAL TOTAL
R OM
L W N AND W GROSS GLASS NET WALL CEILING FLOOR CU. AT 70•F CORRECTED t j RAD. REGISTER
TEMP. TO i TYPE AND SIZE OR LEADER
SIZE WALL to INFILT.) OIFF. F ,Sl SQ. FT.N FREE AREA
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 9 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
APPLICATION FOR HEATING PERMIT (Coutfuued it m Reverse•8f&)
11. LOCATION OF JOB Lv r if-
N0. STREET FLOOR APT.NO.
12. TYPE OF INSTALLATION: IJ OIL BURNER ELECTRIC VENTILATION SPRINKLER
GAS BURNER STACK INCINERATOR MISCELLANEOUS
IDENTIFY
SIZE LOCATION SIZE SIZE13. OF TANK OF TANK OF FILL OF VENT
14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO. AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND NO. B.T.U. OR SO. FT. NET B.T.U. OR SO. FT.GROSS FIRING RATE
FLOORS TO BE HEATED NEW OR OLD BUILDING INSULATED — YES OR NO
TYPE OF WALL INSULATION ROOF OR CEILING INSULATION
AVG. SYSTEM WATER TEMP. B.T.U./SQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE FAHRENHEIT
MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS. OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ.
FT. OR B.T.U.
DESCRIPTION OF WORK
15. TO BE DONE
is. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS:
r
R Ow size AND DOORs AREA — SQUARE FEET e•T•U. e•T•U.DISTRIBUTION INSTAt_LEDVOLUMETOTALTOTAL
j RO M NO' OROsa OLAss NCT HALL CUILIN0 FLOOR CU.FT. AT 70•F CORR[CT<D <j A
MAD. 11ROIST[R
L M N AND ` TEMP. TO .F TVFe AND size OR L[ADeR
size < WALL
f
t0 INFILT.)
OIFF. F 1: so. FT. rRee AR[A
I
041
p
z.1(o0 366 Lp _. 3a<O to
and 7'L 10 c L -_—o 2.873 3.7
of o s3F
6 a
8 -- 0 let(0 is Z if
1
r
I
l T07AL5 77 la7 e /1
f A. HEAT LOSS FROM BUILDING B.T.U./HR.—
B. DOMESTIC HOT WATER DEMAND B.T.U./HR.Zl . gS7
C. PIPING.OTHER THAN NORMAL B.T.U./HR.
ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR r % 8
f
17. ELECTRICAL WORK BY:
MANE ADDRESS
SUBCONTRACTORS AND
1s. THEIR TRADES
l
f
t
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 814MATURE OF APPLICANT
M
APPLICATION FOR HEATING PERMIT (Continued it m Reverse Side)
1 11. LOCATION OF JOB L'nT *' 09C-HAAD lGL D2
N0. STREET FLOOR AFT.NO.
12. TYPE OF INSTALLATION: 1 o1L BURNER ELECTRIC VENTILATION SPRINKLER
GAS BURNER STACK INCINERATOR NISCELLANEOUB
a Q
IDENTIFY
SIZE LOCATION BAST s SIZE SIZE
13. OF TANK _d OF TANK 0 eJ s V 21 OF FILL 2 OF VENT
14. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO. O NEY FIRING RAT
TBOILERORFURNACEMAKEANDNO. B .U. OR SO. FT. NET U3
AT
OR 00. FT.GROSS JLQ_FIRI G RATE ILL
FLOORS TO BE HEATED Tj y NEW 00-9tO BUILDING WLO -INSU TED - YES OR-"
TYPE OF WALL 3 I Z INSULATION E 1 f1MC.L 2SSROOF OR CEILING INSULATION FLI MAUlSS
AVG. SYSTEM WATER TEMP. g G o B.T.U./SQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE d o
FAHRENHEIT A0d 1 LDS l Q(C
MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS.OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SO.
FT. OR B.T.U. ST''>rZ L:! t.G -7 A O my-L)1 T
DESCRIPTION OF WORK
15. TO BE DONE:
16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS);
r
Room SIZE WINDOMS AREA - SQUARE FEET E•T•• DISTRIBUTION STALLEDANDDOORSVOLUMETOTAL
GLASS NET MALL CEILING FL0011 CU.FT. AT 70•R CORRE FD J j REGISTERkROM
I. M N AMC GRLL TEMP. To H d TYrE AND SIZE R OR LEADER
SIZE MALL
f'ctG INFILT.) Corp. 0 •F 1 SD' ', I<REE AREANo,
r
to 4 1 O 1 O
V:Am i IV4 Z.7Z oa
R,, 24 14 8 L8 o Z o '0
P_ 4 0 S s
cr nL 4 <0 8 D 000
n S (0 F' so 0 4
v®1
1 Kir 6"2 21 us I zza I Zo fSf 8 .3u19 Z 8 2 p 2
IS o 4 rQ r
D 13 1Z 8 Ok 0 6 ' p
LI Wfj 3ogi8R o Z
3u 00
lai Loc. 14 10 $ µar 1410 Zo Q
a 0 7 0 v O o 0SU 1 '
I M A$r lV9, 2 -40S to
eco 16 13 7.c 8 c1
3e-0 0 2 v
O Oz. )4F 10 $ Y o 0 o _ L O B Z q .Z
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.
r
ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR
I
17. ELECTRICAL WORK BY;
NAME ADDRESS
SUBCONTRACTORS AND
is. 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. j
DATE SIGNATURE OF APPLICANT