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HomeMy WebLinkAbout270 Lefoll Boulevard1 TO THE xJUILDING INSPECTOR of the APPLICATION FOR TO" (W SOUTH PLAN EXAMINATION ANDWSOR,BUILDING PERMIT 1 4PORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX.O E Fo L L j1p. ZONING AT (LOCATI ) i—1r DISTRICT LOCATION NO.) STREET) OF BETWEEN l fy7j/j7a cPGz D AND BUILDING CROSS STREET) CROSS STREET O /83.8 SUBDIVISIO n VnLLE L0T Z8LOCK SI E JX O x C N II. TYPE AND COST F BUILDING — All applicants complete Parts A — D o A. TYPE OF IMPROVEN ENT D. PROPOSED USE — For"Wrecking" most recent use T IT 1 New building Residential Nonresidential 2 Addition(1/resi ential, enter number 12 One family 18 Amusement, recreational o/new housing units added, i/any,13 Two or more family — Enter 190 Church, other religiousinPartD, 13) number o/units— — — — - 3 Alteration (See above) 200 Industrial 14 Transient hotel, motel, 21 E:] Parking garage4 Repair, replacem nt or dormitory — Enter number 5 Wrecking (l/mu i/amily residential, o/units ——————— — -i 22 Service station, repair garage enter number o) units in building in 15 Garage 23 Hospital, institutional Part D, 13) 16 Carport 24 Office, bank, professional 6 Moving (relocation) 17 Other — Specify 25 Public utility 7 Foundation only 26 School, library, other educati nal B. OWNERSHIP 27 Stores, mercantile 8 ;!5'Privat (individu I, corporation,28 Tanks, towers n npr fit institut on,etc.) 29 Other — Specify 9 Public(Federal, State, or local gov rnmen 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 improve ent................ dfoo 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 co st a. Electrical....................... b. Plumbing ... .................. c.Heating, air c)nditioning......... d. Oth r(elevat , etc.)............ 11. TOTAL COST OF IMPROVEMENT $ 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 b aring) 40 Public or private company 48• Number of stories................ 31.-®_Wood frame 41 Private (septic tank,etc.) Total square feet n floor area, all floors, based on exterior 32 Structural steel dimensions .................... 33 Reinf rc d concrete H. TYPE OF WATER SUPPLY 42 ublic or r°vate eom an 50. Total land area, sq.ft. ........... O 34 Other — Speci P P y 43 Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... as Will there be central air 52. Outdoors........................ conditioning36 Oil L. RESIDENTIAL BUILDINGS ONLY 37 El ctricity 44 Yes 45 N 53. Numb r f bedr ms... 38 C al 39 Oth r— Specil y Will th re b an elevat r? 54. Number f Full.......... 46 Y s 47 No bathrooms Partial........ NOTES and Data — (For department use) IV. IDENTIFICATIO — T be comp) t d by all applicants No me Mailing addr ss — Number, street, city, and State ZIP code Tel. No. Owner or 40 Lessee 060W 5 39—T 2. Contractor 3. Architect or Engineer The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction. ignatur of a licant Address Application dot DO NOT WRITE BELOW THIS LINE V. PLAN R EVI EW R CORD — For office use Plans Review R uire Check Plan Review Date Plans B Date Plans B NotesqFeeStartedyApprovedy BUILDING PLUMBING MECHANICAL ELECTRICAL OTHER 1$ T-1 VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval Check O Date bto ned Number By Permit or Approval Check Obtaateinedned Number By BOILER PLUMBING CURB OR SIDEWALK UT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GRADING USE OF PUBLIC AREAS OIL BURNER WRECKING OTHER OTHER VII. VALIDATION Building 13150Prmitnumber Bui Iding Permit issued Aril 11 1983 Bui Iding Permit Fee $ to 3, 00 C L 0 D C)d i prove TITLE ZONING FRONTDISTRICT SIDE - .SIDE YARD REAR YARD NOTES IX. SITE OR •T PLAN For Applicant s.rai. some w.w ....w... w....rw... w... w.... .rw. sea wrrsaftea wr w...rwrwr aaauup. r.1`rw\s N\.r.\ \ .. 4\\• •.• a. S sMs"Ia:.aa:i:%a :r•:• •`"s:::•a:: a::•a::i:•,a•i:=.:i:: a::,s:s::.N•i:: gai:ri::N #w.Ms :: •.af; r #if• /.a. . : r MSirli w rw ia+ r/ i a :=.''a ' it:r. a;s *..r...iniiasis i ii=..«.i::Iiisisii"I!oHrs.rrN#•• 3N +•s. 'iir.ra,• fsa arm ••ur• sr e,+t g'r•::w••ra a.:::i i=i i'•:::usaiii•c #i yii::iii:i= ;;Gi::r:r'riZr• # f i.' r a H • :#•.N n:NN.: No s:„ra•iussr#i 3.i gror3•i .ir r• as r a.i,r "_ M.a:a :=,asl i• :.i i•#se.u!r u=a.r.#r.i#•r s. 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Inn s't:iai:s s es:s:?iCtil2t:s:..:s:s...ss........:s.......\s..•......................•i......s....ss::s::r•lsra..se sis i...ss,.s iu ...Na•.eo.....• tss=taie is sE issse=itroes=s== a eEes, : es is =:e=assa e==':=s:':sa=s;s=:so lotus: snips Jew asps of N:::Nir•a s.Ns= 1113\.s.s\a•ss r..ss.............s:.../.s...l...s..f.,.ss.........s...s!l...e:i lss•..ssas.tsis us .s:... 3 ..aai... an e:.4 THE_=.s:s =isss::::='==s:sse::::ss:ss•e=•ss•a:s:ss::::::::s'se:seise:esess?sssssees'sEungsere=e9'ssee=t=eswe=t asstDerr=s s==' s eas. g ig=ei=s'• r•asss'se:='s l:.isl:aHHH./t::l::::e:ss:e.s::et:s::s:s:i:::s............................... s r r •• . •. ..... g::s::------c:s::::--- ;------:;----------- air::::e:::::::;:: TOWN OF SOUTH WINDSOR BUILDING PERMIT Date Arai 1 11 19 83. Fee Paid $. .318.00 Fit, value s.5 31000 Permit N° 13150 on the side of Let #1-10 LeFolI Blvd_ Street Street No. 270 Owner Jean Marc Jacaue s Applicant -?pan Marc _7Acaple s CERTIFICATE OF OCCUPANCY ISSUED: Date No. Fee Paid $ 3-00 CLASSIFICATION Dwelling BUnDING PERMIT N° 13150 OFFICB OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. South Windsor, Conn. Ar i 1 11 19 83 i i That JMJ Cnnctr11CH 0n_1':0. is hereby granted permission to Dwe 11 ink i at estimated value of $ 5 3 v 000.00 i on the side of Lot #130 aFn 11 Blvd. Street on land i owned by Jean Marc ,JacgUe s Said Wo rk to be as described in Application No. 1 45 and to conform to specifications and plans filed with said Application, and Building By Laws of THE TOWN OF SOUTH WINDSOR. Issued ri 1 11 19 830 T ding Inspector. Streets and sidewalks, obstructed by ezcavations or budding materials, use 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, i town or borough all costs and damages which it shall sustain, or be compelled to reason therefor." 3 dayTNSAPiCTI0N!.qR EPORTPermit # Q Job 1 Footing 2 Foundation 47 3 Framing 4 Wiring 5 Plumbing 6 Heating 7 Lathing 8 C.O. 1j/3 Permit No. TOWN OF SOUTH WINDSORi SOUTH WINDSOR, CONN. i I 1 Permit N A 6 313 I M Certificate of Occupancy 2,16THI' TO CERT F that th at No. in the T of South Windsor, Connecticut, has been erected and completed in accordance with the ilding Code and Zoning Regulations of the Town of South Windsor, and is hereby ap rove fot occupancy, r7 Buildin g Inspector Owner, Builder Fee Paid do Date 9 19 r 3 vs6 Remo 2 Hyyppa & Associates Civil Engineers Gla stonbury, Connecticut U r f O O S 48o O3• 4D o N. rt N S• 1 a yN Q7 r 6'S• 4 f N 44 cJ o AREA.= 20,024 S.F. 01' gyp• ,' ?/ ii 1 N <DSo 2S' SO"W tiff 1b kIV NNjF E.WAI fl HYSOIJ etQ1 - FouNDATlatJ %.00ATED AS SMrWN 4 TI-a3 1 No -C-OWOG VIDLA 0 S FD=FOUNDMICR4 DRAIN IFREQUIRED X=s Lot lines fimn snap on file in Tow Cl rk's Office entitled, "Plot P2= Section -1 Pleasm it Valli Homes i South Windsor, Conn " Scale 1"m hOl Da 6-Co-82 A-20 --ONE Map No 220-76-17 by Reino E. Hyyppa & Associates Glastonbury, CT. pQEPAREO FOR I htrreby certify th-it this map and survey were prepared iri PLE A54 girt- VALLEY uO M ES eeordance with the stands ds of a Class A-2 survey as defined n the existing Code of Pra . ice for Standards of Accuracy of 50 UTla W I NDSO R, C ON N• surveys and Maps, adoptec I by the Connecticut Association of SALE I''.a.0' p ATeowStJrVeyOfs, If1C. e 2!664ai91 = 10 ---- UU4 43-130 1115 R 0 V A ' re :T {TOWN 6 - r ri;NT ENG1 f 3,-a3 DATE: SIG.: 7931 ELECTRICAL APPLICATION Application No. 9042 on the side of Lot #130 LeFoll Blvd. Street Street No. _ 270 Owner _TM_T den g rti r tti on Electrician R i Shard BA t t FILED IN OFFICE OF The Building Inspector May 4 1983, INSPECTION. t)No Electrical Work shall be started until a Per- mit is granted by the Building Inspector. In New Bulldings 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. APPLICATION FOR PERMIT TO DO ELECTRICAI. WORK. No. ...9.04.2..................... Permit No. . ..7 9.3.1.. ...... ...... TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR, CONN. hereby make application tq perform Electr cal Work according to detailed description below. All provisions of the Rules for Electrical Installation, Section 48, Building By-Laws, shall be compI with whether specified herein or not. South Windsor, Conn., 1X—?Sign her Le Address i IG'C pp Location I I1.4J Side of .. j.// Nature of Building .. .. .'... i +C.1u.'V.... .... .... .. .. How many stories ............ .....I New or old Building . How many families ...............24........................................................ .......... .. Kind of Installation How many Stores Owner ........ .. ................... .. ... ... . ............... _............ Address .. Architectt ` Address 1 AddressBuilder . .. . . l i ... .. 1.I ..... 1..1....c. .. .. ................. _......Electrician Address Size of Main Wires 1// L.................................- No. of Light Loops .. .. . .... No. of Heat Loops .. ..,. No. of Power Loops ......................... No. of Light Outlets . . ...... ... ....... No. of Heat Outlets . No. of Power Outlets ................ ......... .. Nog of Light Circuits ... ... .. . .... ... ... No. of Heat Circuits No. of Power Circuits . No. 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 .. . A6....... .... .. ... .. .•.... •.1.... ......•••••.......OEIL Estimated Cost .... .Ce........ 6136 r vo&md ,Q No. 6915 on the M.__._ side of Lot #130 LeFoll Blvd, Suet Street No. ._. 2 7 0 C n truc Owner ... 8 xaxx x a. plumber South Windsor Plbg. & Htg. Filed in Office of The Bwl&ftInspector Mav 4 19-JU• 4 Mc nW. No Person shall 11,Mt add 0 cr alder ay portion of the dminege "mm of nay 6u'Wmg ezoept to repair leala) umg a A - its gmmd by the BuMn Impeaw. Application No. .6-91-5...................... Permit N . . .....6.1-3.6........... TO THE BUILDING INSPECTOR of the TOWN OF SOUTH WINDSOR. CONN. hereby make application to perform 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. 00ck. ... 19 .0j. Sign here 1, 49:;-*-F- 0/..... South Windsor,4 ......... Address ...o*....0141/.....iz lie i 7 ... .......... Location side of . ........... 9AA0....................... Street jr44 ro — ......... . ...... How many storie . ............. ....V. ......Nature of Building I AddressOwnerVAr 4.d . S-W...... Architect ................. ....... Address .. . ....... ........................................................................................... Budder ................Address . ........... .... .. .. ......................... ................................. .......... 6PlumberJc-4: t Address - 1"',( 4........I-w-,- DRAINAGE CESSPOOLS, How many Where located Are they water tight Of what materials are they built ............................. ... .- -.... .. Size of pipe from house to cesspool . ...... Kind of pipe . -... .. .. ............................................................ ................. MAIN DRAIN IN CELLAR, Material Diameter ......................*................................................................................. Above or below cellar bottom . ... .....&-19-kv...... SOIL PIPES, Material 7. f c .. ..... Diameter 2...................................................I........I...... WASTE PIPES, Material / ds Diameter ........... ....7.........3.............................................. ............... TRAPS,Type proposed to use is . ..... ......... .. RAINWATER LEADERS, where do they run to .. .... ..... ... ................................................................................................................. REFRIGERATORWASTES, where do they run to . ... .. ................................................................................................. ............................... TANKOVERFLOWS, where do they run to FIXTURES WATER CLOSETS, How many . .... ............a......... ........ Where located 0. e:............................ Distance from trap to vertical soil pipe ....................................... Pattern WASHTRAYS, How many .. .. ...... .................................... Where located . . ............... ............................................................. SINKS, How many 0.......................... .. Where located . . .....&.sz........Fl000 BUTLER'S SINKS, How many ........................................................ Where located.. ................................................... ...... REFRIGERATOR SINKS, How many. ................................... Where located ................................................................................................ LAVATORIES,How many ...................................A...................... Where located ............r"J r.........Flb.a. ...................................... SBATHTUBS, How many........................................./.......................... Where located ............x, I......'r ........................................... 10WC/-t71tfNAf:t,-How many ............ ... ...... ....................f.......................... Where located .........Fijr..... ................................................. Are water closets and urinals to be local vented Ke j . If not, is there a window in outer wall ofroom where same are to be located ....... Ye I... .................................................................................................................................. Estimated Cost .. ......Y/0-C?t 0-0................. PERMIT # Application For 6744 5643CDEPARTMENTDECISION o 0 Heating Permit 3rz APPLICATION IS HEREBY: DEPARTMENT OF LICENSES AND INSPECTIONS N +-APPROVED DISAPPROVED TOWN OF SOUTH WINDSOR 0 a 6/1/83 v O DATE F INSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BELOW to p w 1. LOCATION OF JOB O 270 Z. 4pNO. STREET CD 10Cd G LOT NO. FLOOR APT. NO. 0 O lV d O 2. OWNERccf//r/G J dr.e 1.4cc0O3 S. ADDRESS Pn t s 4.1'HONECc 0-4 S. APPLICANT cc C a. ADDRESS Jf ox /a n y, ld/ 7.PHONE S. LICENSE NO. 570 p w B. EXPIRATION DATE OF LICENSEv g 10. ESTIMATED COST :o 0, v E po 11. IS THIS A CONTRACT COSn YES NO 12. FEE ENCLOSED :- Permit #1315 0 x IS. TYPE OF BUILDING:rn p RESIDENTIAL COMMERCIAL C13 14. TYPE OF JOB: INDUSTRIAL3 RIGINAL ID ALTERATIONINSTALLATIONADDITION REPAIR APPLICATION FOR HEATING PERMIT (C ntinued it m Reverse Side) 11. LOCATION OF JOB D zc Kf/` el" w NO. 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 ^400K.B.T.U. OR SQ. FT. GROSS FIRIN _RATE FLOORS TO BE HEATED 71,J 9 NEW OR OLD BUILDING ,41 244) INSULATED - YES OR NO I TYPE OF WALL IVD010 j2ftM INSULATION 6Se I ROOF OR CEILING ' s INSULATION AVG. SYSTEM WATER TEMP. 1 U o B.T.U./SQ. FT./HR. EMISSION INDOOR-OUTDOOR TEMPERATURE DIFFERENCE O ez`1 FAHRENHEIT MAKE OF RADIATION: ASEBOAR COPPER CONVECTORS. OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SO. FT. OR B.T.U. h'ffY,er"1f DESCRIPTION OF WORK f Z12 7-Z/ 15. TO BE DONE: J/li L f d.. too- 16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS): WINDOWS e.T.u. e.T.u. ¢¢ D DISTRIBUTION INSTALLEDROOMSIZEANDDOORSAREA - SQUARE FEET O VOLUME TOTAL TOTAL 4 ROOM NO'Ggpgg GLASS NET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED -J j RAD. REGISTER L W N AND C INFILT.) TEMP. TO F F(i TYPE AND SIZE gQ FT OR LEADER SIZE < WALL 'Lt0 DIFF. P F diN FREE AREA f TOTALS T_ A. HEAT LOSS FROM BUILDING B.T.U./HR. B. DOMESTIC HOT WATER DEMAND "r1 ((r- B.T.U./HR. C. PIPING. OTHER THAN NORMAL B.T.U./HR. ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR 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 IN632f , 1 DATE WGNATIJ AF LICANT 1,(;W$TRUCTION: WALL y IIC / WINDOWS AAA S Dr W,S ROOF OR CEILING BASEMENT HEIGHT: ABOVE GRADE BELOW GRADE DESIGN WATER TEMPERATURE DESIGN TEMP. DIFF COL.1 2 1 3 j 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 AND DOORS CU. FT. TOTAL TOTAL SEE NOTE) CORRECTED ACCESSORIES ROOM NUMBER GROSS GLASS NET WALL CEILING I D`,p AT 70 F TO WATER LENGTH Q TEMP. AMP ns. L W H ON AREA WALL c O ' DIFF. F ENCLOSURE FIN L R S I.0 MISC.SIZE O I O TEMPODIFF. FT TUBE 131 k Iv — 30q 36 6 8, 26ss I i RM aI/ 00 1300 3Yoo S00 8 3000 /SOO 6noa 10500 02000 Z q g Soo 600 1300 15A6'u DO 130 Soo 15300 17600 3 j A s 2 V 126 IS 13 0 900 7o9noboo3900 O.eb ,6 1700 500 50o 600 .51 `lo D 6 4 )o 200 0 t oD S co 600 !Y o D /6 0 0 i 300 h2oo 3oo o 300 11110 i 3 33 3 5 15 s + b a 0 0 0 0 0 oa /I V o o 13050 2 y o Soo OD l-/5 0 i NOTE: FOR CONCRETE FLOOR ON GKOUND OR FILL AT GRADE LEVEL.USE LINEAR FEET OF EXPOSED EDOE. TOTALSiFORALLOTHERFLORSUSESQUAREFEETO*AREA. O O I y s DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby:TOWN of SOUTH WINDSOR BUILDING DEPARTMENT Bldg, 44 APPRO 1540 SULLIVAN AVENUE 7 K, - 644-2511 ext. 230 Date Building Inspector Application must be printed or typed Location of job 7 9 L.v j, Street No. Street Lot No. FEE SCHEDULE Floor Apt. No. 0 - $1,000 - $12.00 Over $1,000 12.00 per$1,000 OWNER S f.A,j Le!joranyfractionthereof ADDRESS Z, L 4e L V J, A,cx.a2 Cf o(o? OWNERS PHONE# APPLICANT M,ke i4jAAANo w OW N SF ADDRESS All P I UM ,A•!3 VA A 14 c., 7oJQC-l 06 Lf g o- 5 S ESTMATED COST$ y C IS THIS A CONTRACT COST? x YES NO FEE ENCLOSED $ 1 ,3 f.• TYPE OF JOB:S R•C Original Installation Alteration/Addition/Repair Revised 10/96 APPLICATION FOR PLUMBING PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION YES / RESIDENTIAL BUSINESS CURRENT USE AND OCCUPANCY ASSEMBLY MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL INSTITUTION FACTORY ENGINEER'S NAME PHONE STORAGE GARAGE ADDRESS MIXED USE CITY STATE ZIP Other please specify) TYPE OF INSTALLATION W''-t CR SIZE OF MAIN DRAIN NO. OF TOILETS STYLE NO. OF URINALS 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 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 k,4Toe4L V-f MANUFACTURE TANKS SAFETY DEVICES TEMPERATURE CAPACITY o RELIEF VALVE TEST PRESSURE 30 WORKING PRESSURE 75 PRESSURE RELIEF VALVE TYPE MANUFACTURER w S DESCRIPTION OF WORK lAcp Ex ls1(ti" 9.A /tam, C-j/+3 6vA c2 c4 teR THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN. BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT PHONE NO. 9 7`' :S3 5 DATE 6 (3