HomeMy WebLinkAbout223 Brookfield Street (11)i
TO THE BUILDING INSPECTOR
of the APPLICATION FOR
TOWN OF SOUTH W INDSOR, CONN.
PLAN EXAMINATION A N D
BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, and IV. O
I.
ZONING
AT (LOCATION) I
DISTRICT
LOCATION NO.) STREET)
OF BETWEEN AND
BUILDING
CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
H
II. TYPE AND COST OF BUILDING — A11 applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use
1 New building Residential Nonresidential
2 Addition(//residential, enter number 12 One family 18 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— — —20 Industrial
3 Alteration (See 2 above) 14 Transient hotel, motel,21 Pocking garage
4fElRepair, replacement or dormitory — Enter number
5 Wrecking (If multifamily residential,o/units ——————— — •-i1 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 utility17Other — Specify
7 Foundation only 26 School, library, other educati no[
B. OWNERSHIP
27 Stores, mercantile
28 Tanks, towers
8 E] Private (individual, corporation,
nonprofit institution,etc.)
29 Other — Specify
9 Public(Federal, State, or
local government)
C.COST Omit cents) WORK DESCRIPTION:
10. Cost of improvement. . . . . . . . . . . . . . . $ S!R 0
a. El ctrical . . . . . . . . . . . . . . . . . . . . AQXYe. (Q. voo PCX--)
b. Plumbing . . . . . . . . . . . . . . . . . . . . S' b 67 1aA
c. HVAC . . . . . . . . . . . . . . . . . . . . . .
d. Sprinkl r . . . . . . . . . . . . . . . . . . . . .
Garog s. . . . . . . . . . . . . . . . . . . . .
f. Oth r oc.
11. TOTAL Fee: U CO Fee: Total:
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. PRINCIPLE TYPE OF CONSTRUCTION G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
40 Public or private company
48. Number of stories................
30 Typ 1: A B 41 Private(septic tank, etc.)
49• Total square feet of floor area,
all floors, based on exterior
31 Typ 2: A B C dimensions ....................
32 Type 3: A B
H. TYPE OF WATER SUPPLY
42 Public or private company
50. Total land area, sq. ft. ...........
33 Type A 43 Private(well, cistern) K. NUMBER OF OFF-STREET
3A Type 5: A B PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 Gas Will there be central air 52. Outdoors.......................
Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 El ctricity 44 Yes 45 No 53. Numb r of bedr oms..............
36 C al
39 Other— Specify Will th re be an elevator?
54. Number of
Full..........
46 Yes 47 0 N bothr me
Partial........
IV. IDENTIFICATION — To be complet d by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No,
Owner or r p 7{ 973
Lessee
2.
Contractor
3.
Architect or
Engineer
The owner of this building and t-h undersi ree to conform to all applicable laws of this jurisdiction.
Signat a plicant Address Applic tion date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Plan Review Date Plans By Date Plans By NotesFeeStartedApproved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval I Check Date Number B Permit or Approval I Check
Date
Number BppObtainedyppObtained y
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING I L USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building
Permit number
Building l 19Permitissued
Building C
Permit Fee $ 90 ,
Approved by:
TITLE
71z 1) k S C xS
INSPECTION REPORT
Permit # l.D Job SA
1 Footing
2 Foundation
3 Framing
4 Wiring g D697
5 Plumbing
6 Heating
7 Lathing
8 C.O.