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HomeMy WebLinkAbout21 Windy Hill DriveTO THE BUILDING INSPECTOR of the APPLICATION FOR PLAN EXAMINATION ANDTOWNOFSOITtHWINDSMCOriI. BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, Il, Ill, IV, and IX. o I• ZONING AT (LOCATION) t `-E[ !—' Q1'Y DISTRICT LOCATION NO.) STREET) OF BETWEEN AND BUILDING CROSS STREET) CROSS STREET) LOT J SUBDIVISION r4el_I s LOT BLOCK SIZE H II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D v A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use T M 1 New building Reside tial Nonresidential 2 Addition residential, enter number 12 One family 18 Amusement, recreational of new housing units added, if any, in Past D. 13) 13 Two or more Family — Enter 19 E] Church, other religious number of units— — — — --p- 20 Industrial3 Alteration (See 2 above) 14 Transient hotel, motel 21 Parking garage4 Repair, replacement or dormitory — Enter number 5 Wrecking (1/multifamily residential, of 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) 7 Foundoti n only 17 Other — Specify 25 Public utility 26 School, library, other educational B. OWNERSHIP 27 Stores, mercantile 8 Private (individual, corporation, 28 Tanks, towers nonprofit institution, etc.) 29 Other — Specify 9 Public (Fed ral, State, or local gov rnment) C. COST Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food 7 processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement,,,,,,,,,,,,,,,, 7/ /cv 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...................... 3 IJ b. Plumbing ................... 0c) c. Heating, air conditioning...... .. d. Other (elevator, etc.)............ 1 11. TOTAL COST OF IMPROVEMENT S '1 D I coo 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 OF SEWAGE DISPOSAL J. DIMENSIONS 30 Masonry (wall bearing) 40 Ff Public or private company 48• Number of stories................ 31 Wo d fram4 41 El Private (septic tank, etc.)49. Total square feet of floor area, all floors, based on exterior 32 Structural steel dimensions .................... •,©Q 33 R inf rced concrete H. TYPF OF WATER SUPPLY 34 Oth r — Specify 42 f Public or private company Total land area, sq. ft. ........... 43 Private(well, cistern) K. NUMBER OF OFF-STREET 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[2 No 53. Numb r of bedr ms.............. 38 Coal 39 Oth r— Specify WiII th re be an I vato? 54. Number f Full.......... 2 46 Y s 47 No bathro ms partial........ IV. IDENTIFICATION — To be completed by all applicants Name Mailing addr ss — Number, street, czty, and State ZIP cod Tel. No. al rz C0.1 r'Q e.cc° rzNn e 'r /Y.'.rT, 4 0 6 1,1 9 Owner or Q Lessee 2. i-1z' Contractor 3. Architect or Engineer The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction. Signature of appI* ant Address Application dot z:n 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plan Review Date Plans B Date Plans NotesPlansReviewRquiredCheckFeeStartedyApprovedBy BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Date Permit or Approval Check Obtained Number By Permit or Approval Check Obtained Jumber 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 r Permit number Building Permit issu d S 19 Building Permit Fee $ Ap ove at TITLE r TOWN OF SOUTH WINDSOR BUILDING PERMIT Date June 2 5 ig8 6 Fee Paid $5.4 0..0 0 Est. Value $.9 0,0 00 Permit N° 15 216 on the side of Lit 4A Wi ndy Hi 11 Dri vP Stveet Street No. 2 1 Owner U & R Construction Co. , Inc . Applicant U & R Construction Co. CERTIFICATE OF OCCUPANCY ISSUED: Date No. 7658 Fee Paid $ 1_n n CLASSIFICATION n;.,,-,1 1-in-Gj BUILDING PERNO T M 15216 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. jum 25 1986 this is to That u & R C0nstrnr-4ti0n c©_ is hereby granted permission to D l ' s ng at estimated value of on the side of Loth! Mindy Sill Dv 4 Xa Street on land owned by Tj r- 2 Con m6a vc*j aA--CO-. Said Work to be as described in Application No. t 5516 and to conform to specification and plans filed with said Application, and Building By- Laws of THE TOWN OF SOUTH WINDSOR. Issued jUn.s 25 1986 Building Ina ctor. 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 cats and damages which it shall sustain, or be compelled to reason therefor." Dwelling - Lot #4 Rnbw.Hls. 6/25/86 U- & R Construction Co. 21 Windy Hill Drive Permit # 15216 Electrician Milton C. Plouff # 9345 Heating Contr. J. VedoVato 6613 Plumbing if Joseph Vedo vato # 7155 Oil Burner Certificate of Occupancy 7658 Sewer Permit Plot plan apprd. per Engr. F Permit No. ury TOWN OF SOUTH WINDSOR Y p SOUTH WINDSOR, CONN.r C Permit Certificate of Occupancy TH TO CEATIFY,that the at No.- z zr)5 r in the , can of South Windsor, Connecticut, has been erected and completed in accordance with a tuilding Code and Zoning Regulations of the Town of South Windsor, and is hereby approved f occupaney. A jAt-l1. Building Inspector Owner, Builder Fee Paid ' _ Date '' sty19 j I, 9345 ELECTRICAL APPLICATION Application No.10 R 5 7 on the side of Lot #4 Windy Hill Drive Stmt Street No. 21 Owner U & R Construction Electrician Milton C. Plouf f Jr. FILED IN OFFICE OF The Building Inspector Aug. 11 1g 86 INSPECTION. M 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. Electrical Permit No. ..... Master License No. ...... 0,, /7Co.............. TOWN OF SOUTH WINDSOR Building Permit No. ....,`./V............. ....... BUILDING DEPARTMENT Date Filed .......'91AI.Vl/....... ................................... Date Final Approval ................ ...................... APPLICATION FOR ELECTRICAL WORK Electrical Inspector JOB LOCATION: / o l .............................. JOB OWNER: D.s O.e Sideof . Between ......... and .............. .. Name of Building Owner Crl` "ie. Address Q.,.. cw • r ,xht3AL.......... If work is for Lessee—Give name Address ................... ...... .......................... ....... ...... ................... Building now occupied as (unless new) No. of family units now . ...... ............. Building to be occupied as .pert O 7"77!t` Number of family units to be .....90,-7Cr............... Is this work included in a Building Permit? Permit Fee . ...... . If no Building Permit) Permittee p/<<40"> C 10/"F7r aEe• Business Address IeFO'"` vt « o Telephone lrP 9..?S. . COST OF INSTALLATION: a?f"'d-o . ........................N. . ....vt oe.DAt-c 40....0 ...d......Z-S.. ........................................................ TO BE FILLED OUT BY PERMITTEE TO BE WIRED EXISTING APPLIANCES Number of light outlets to be installed 39 Number of convenience outlets to be installed - Number of present Appliance Circuits .......... .... .............. ........ Number of switches to be installed Do these include Range Water Heater Number of appliances to be installed as listed below) Dryer Air Conditioner Oil Burner TYPE RATING NO. Dish Washer Gas Burner Range Well Pump Elec. Heaters Range Top . . . . . . Oven . . . . . . . . REMARKS: Water Heater V S Clothes Washer . . . . Clothes Dryer . . . . . l Dish Washer . . . . . . Air Conditioning Motor . . Oil Burner Motor . . . . Gas Burner . . . . . . Circulator Motor . . . . l Attic or Large Fan , , , Well Pump . . . . . . Electric Heat . . . . . Other bsp sR L Number of new Lighting Circuits . . . . ........ ............ Number of new Appliance Circuits Number of Heating Circuits . . . . . . ........................... Number of Motor Circuits . . . . . . . ....-........—...— Size of present service ......... . Size of service to be . 7155 PLUMBING APPLICATION AppUm&m Nob 6 8 9 5_ on the ......_....... -- aide of Lot .#4 Windy Hill Drive Street No. ...... 21 Owner ....0_.& R Construction Plumber - J. Vedo vato Filed in Office of The Building Inrpecvor Oc t. 2 2 No person AA eons aq, add do a alder ay portion of the drainage Wee m of any bolding ezoept to repair lealm) una a A nit is gRa m d by the Building Inquaw. APPLICATION FOR PLUMBING PERMIT (Continued from R verse Side) TOWN OF SOUTH WINDSOR, CONN. 11. LOCATION OF JOB 7 '- NO. STREET FLOOR APT.NO. GENERAL PLUMBING 12. KIND OF INSTALLATION JGQrG 13. SIZE OF MAIN DRAIN T 14. NO. OF TOILETS •e STYLE L a- 15. NO. OF URINALS STYLE 16. NO.OF BATHTUBS 17.NO.OF LAVATORIES 18. NO.OF SINKS 19. NO. OF WASHTUBS 20. NO.OF CONDUCTORS SIZE 21. NO. OF STACKS _SIZE 22. AREA OF ROOF 23.NO. OF CATCH BASINS 24. NO. OF FLOOR DRAINS 25. NO. OF OTHER FIXTURES KIND ,V 26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW? 27. SIZE OF WINDOW 32 2 28. IF NO WINDOW,WHAT KIND OF VENTILATION IS THERE? 29. SIZE OF DUCTS 30. ARE SEWAGE AND WATER FACILITIES AVAILABLE? SIGNATURE(ADDRESS LICENSE NO. ESTIMATED COST TELEPHONE OWNER r ADDRESS WATER HEATER 31. TYPE 32. MANUFACTURER TANK SAFETY DEVICES 33. CAPACITY 37. TEMPERATURE RELIEF VALVE 34. TEST PRESSURE_ 38. MANUFACTURER— 35. WORKING PRESSURE 39. PRESSURE RELIEF VALVE 36. TYPE 40. MANUFACTURER ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE OWNER OF THIS PROPERTY AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE. CD962 DATE SIGNATURE OF APPLICANT PERMIT # Application For 6411 6613 DEPARTMENT DECISION Heating Permit o 3 APPLICATION IS HERESY: DEPARTMENT OF LICENSES AND INSPECTION N APPROVED DISAPPROVED TOWN OF SOUTH WINDSOR a 03 11/10/86 Thomas P D' A._uri a R[CIN WITH NUMNEN ONE DEL >•0 y DATE CHIEF INSPECTOR APPLICATIONS MUST DIE PRINTED ON TTI•ED. O 4j LOCATION OF JOS 21 windy Hi 1.4 NO.TR[[T 41 co93 v LOT NO. FLOOR APT. NO. 4 1 r ioOWNER a Z o 8. ADDRESS o 4 s.PHONE lob APPLICANT 0 goO, ADDRESS 7.PHONE v S. LICENSE NO. y/ l 3 6 / p' EXPIRATION DATE OF LICENSE O S 4j y 10. ESTIMATED COST f 41 0 g NOtt. Is THIS A CONTRACT COST?YES to Is. FEE ENCLOSED s P e Y;ri i t 15 216 t. TYPE OF BUILDING: RESIDENTIAL COMMERCIAL b0 INDUSTRIAL 14. TYPE of Jos: cc W IGIMAL ALTERATION oe.®-WAOP ATI N REPAIR N APPLICATION F HEATING PERMIT (Continued tr m Rev no Side) 11. LOCATION OF JOB 0 4 NO. iTRE[T Moon AFT.N 12. TYPE OF INSTALLATION: LL-'OIL BURNER ELECTRIC VENTILATIO SPRINKLER GAS BURNER STACK INCINERATOR MISCELLANEOUS loENnF SIZE 7 r LOCATION SIZE SIZE13. OF TANK J OF TANK OF FILL OF VENT /J 14. B.T.U. EQUIP. AT REGISTER UJINAC PKE 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. In DESCRIPTION OF WORK r G15. TO BE DONE. 16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS): O ROOM S)z[ WINDOWS AREA - SQUARE FEET Q.T.U. •.T.U. h DANDDOOtR! TOTAL TOTAL DISTRIBUTION INSTALLED ROOM L M N AND 3 Ono" 4LAf8 NeT WALL Ce1LING FLOOR CU.FT. AT 7o•F lcopenacTac t j R[613TCR TeMP. ^TO Tree AN Size RAD' OR LeADeRWALLf0INFILT.) 1T fIZ[ r• DIF/. F F 2O. FT. FR[[ AR[A a G 2 r4 -25/0 — Z ./ 3 0 83 o 5 000 voo Z o a /D- 3 0 0e L5r I / 8 vX o s a?0 0 1036 o V 3 g 0- 10 oo 3 /9 3194 oa o rv0 L4, yX 3 to 0 00 Sao C) 2 0 Lj Jy ,/ yc3 6 v o 8 s^av oho o? 706) W ? 7 3 0 3 00 S T 8 7 3-,La 00 0 0 sdo D TOTALS 4.. HEM I.= FRAR tvW&ING 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 VAL E OF FUEL (A B C) FACTOR. 17. ELECTRICAL WORK BY: r zL NAME ApORESs SUBCONTRACTORS AND 19. THEIR TRADES ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILLBEDONEINSTRICTACCORDANCEWITHTHBUILDINGCODE. APPLICATION TO BE COMPLETELY FILLED IN. DATL l6NAT1JRE OF APPLICANT TO THE BUIEUDING INSPECMR of rw APPLICATION FOR 1'OWl i OF SOUTH W110GM C )IM PLAN EXAMINATION ANO BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. ZONING o I• AT (LOCATION) it y A DISTRICT LOCATION NO.) STREET) OF BETWEEN ii G 4AA10S L, /C_ AND /V-T4 BUILDING CROSS STREET) J LOT BLOCK CROSS STREET) SUBDIVISION 4- J X0 204 X/( s LOT SIZE II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D X A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use 1 w building R idential Nonresidential 2 [dditi n(if residential, enter number 12 One family is Amusement, recreati nal o/ new housing units added. if any. 1fnPartD, 13) 3 Two or more family - Enter 19 Church, other religious number o/ units- - - - - 3 Alt ration (See 2 above) 20 Industrial 14 Transient hotel, motel, 21 parking garage4 Repair, replacement or dormitory - Enter number 5 Wrecking (if multifamily residential, o/ units ------- - i Service station, repair garag enter number of units in building in 15 Garage 23 Hospital, institute nal Part D. 13) 16 Carport 24 Office, bank, professional 6 Moving (r location) 7 Foundation only 17 Other - Spec:/y 25 Public utility 26 School, library, other educati nal r'SB. OW gf,/Tj a` SW1r fv%IA, 27 Stores, mercantilenNESHIP 8 Privat (individual, corporation, f-Icn G tl r q Tanks, towers nonprofit institution, etc.) F1=1VC I_ 29 Other - Speczfy 9 Public (F deral, State, or Cal g vernment) 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,,,,,,,,,,,,,,,, S 000 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. El ctrical...................... b. Plumbing ...................... c. Heating, air conditioning......... d. Other( levotor, etc.)............ 11. TOTAL COST OF IMPROVEMENT s 04C? 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 OF SEWAGE DISPOSAL J. DIMENSIONS 30 Man my(wail bearing) 40 Public or private company 413• Number of stories................ 31 W d frame 41 Private (septic tank, etc.) 49• Total square feet of floor area, all floors, based on exterior 32 Structural steel dimensions ..................... 33 Reinforced concrete H. TYPE OF WATER SUPPLY 50. Total land area, sq. ft. ...........34 Other - Specify 42 Public or private company y v«va/ sr.e//u.,,c•• 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. Outd es........................ le 36 Oil 4)0t, c nditi ping? L. RESIDENTIAL BUILDINGS ONLY U37 El ctricity n 44 Yes 45 No 53. Numb r f b dr oms.............. 36 C el - 39 Other- Specify Will th r b an elevator? 54. Number f Full.......... 46 Yes 47 N bathrooms Partial....... IV. IDENTIFICATION — To b complet d by all applicants Nam Mailing addr ss - Number. street, city, and State ZIP cod Tel. No. 1. Owner or Y1le /119&6-1jz42A10e j • so e,ZX If .J 7 Lessee dST/Z u c T/o. 3 3 O y e1?11A-1 2. a Contractor 3. Architect or Engineer Tl,e owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction. Si n t r of applicant Te i co,r Adsfress /3( J 3 u., N Application date o 6/ , R tea 00 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 NotesFeeStartedApproved BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check ate ObDained Number By Permit or Approval Check Obtained Number i 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 1 L l 14 Bui(ding r Permit issu d L2 19 Building Permit Fee a A ov d y: r r TITLE TOWN OF SOUTH WINDSOR BUILDING PERMIT Date 7121 , 19 87 Fee Paid $. .66.00 Est. Value $. 11 t000.00 Permit NQ 16114 on the aide of Street Street No. 21 VIGO i3.1.1 Hriw Owner Jain Lfi VAMti- Applicant QMQ,t. XMMMI RAJaza JC wtr. Pool Cost I=. CERTIFICATE OF OCCUPANCY ISSUED: Date No. Fee Paid $ CLASSIFICATION BUILDLNG PERMIT N° 16114 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. 7/21 19 87 jr4ja T flt QrPr1ify, That r_rp, rt T. MnnrnoWzgg Congt- urtion Pool Co. , Inc. is hereby granted permission to Build an inground pool & fence at estimated value of 11 s-000.00 on the side of -21 wlady H111-Drive Street on land owned by James LaMontagne Said Work to be as described in Application NO.16412 and to conform to specifications and plans filed with said Application, and Building Br Laws of THE TOWN OF SOUTH WINDSOR. Issued 1 19 87 Building 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 plue 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 coats and damages which it shall sustain, or be compelled to reason therefor." INSPECTION REPORT Permit # 1 4 ) ) y Job Z 1 Footing 1-7 2 Foundation lar c EsTiacA1 3 Framing 4 Wiring 5 Plumbing 6 Heating 7 Lathing 8 C.O. 9842 ELECTRICAL APPLICATION Application No. 11-1 46 on the eide E 21 Windy Hill Drive Sttyet Street No. 21 Owntr F. Tames LamnntagnP Electrician Carlos A. Pina FILED IN OFFICE OF The Building Iarpector 8/7 1987 1N SPWfIONI. rt No Electrical Work shall be started until a Per- mit is `ranted by the Building Inspector. In New Buildings no wiring shall be started until the plumbing and heating pipes. and the Are stops lit of wood) are installed. without a special permit from the oMee of the Building Inspector. Fleariesl permit Ida Master License NM ..,..! . TOWN OF SOUTH WINDSOR Building Permit No. l '1 1• -•®---••- Date Filed BUILDING DEPARTMENT Date Final Appr val ........ •.•.. APPLICATION FOR ELECTRICAL 'WORK Electrical Inspector B LOCATION: v?q ........4.x.-.A1L JOB OWNER: Be een ...............................~.........~.......................~.........~ and Side of ................ w.f Address .......... . .1.....1.......~................ ~._...... Name of Building Owner . .., If work is for Lessee--Give name .-......._ ------.•.•-....------- Address Building now occupied as (unless new) ..........._ .. No. of family units now _._... s:i. ied as r. ..--.•••--•••••--•-.-....~•-- Number of family units to be Buildiag to be occup Is this w rk included in a Building Permit? .._.. ._...._.•.......--••--. Permit Fee If no Buiding P L . r .. .. Bnsiaess Address T Permittee COST OF INSTALLATION . TO BE FILLED OUT BY PERMrrrEE TO BE WIRED EXISTING APPLIANCES Number of light outlets to be installed Number of present Appliance CircuitsNumberofconvenienceoutletstobeinstalled ...... •.-••• Number of switches to be installed . . • ••-•• . Do these include Range Water Heater Number of appliances to be installed . . •--~ •-••••••~•-•-- as listed below) Dryer sir Conditioner Oil Burner TYPE RATINIG NO. Dish Washer Gas Burner Range • • • • • • • . 00M.NonoWell Pump ElM Heaters Range Top . . . . . . Qv Water Heater U Clothes Washer . . . . Clothes Dryer . Dish Washer . . . . . Air Conditioning Motor . . Oil Burner Motor Gas Burner . . . . . . Circulator Motor . . . . Attic or Large Fan Well Pump . . . . . . Electric Best . . . . . Other . . . . . . . . Number of new Lighting Circuits Number f new Appliance Circuits . . . Number f Heating Circuits . . . . . . Number of Motor Circuits . . . . . .• • _- Size f present service .....—•••---•