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Home My WebLink About1002-1014 SANDSTONE DR BLDG 10 Electric # APPLICATION FOR BUILDING PERMIT Plumbing# 1008 Sandstone FDate: ____L0/Zl/l0 HVAC# Sprinkler# 1000545 Estimated Cost $ 19q 5 FINAL APPROVALS Building COMPLETE RED BOXED AREAS Permit Fee $ Occupancy Fee $ Engineering _ TYPE OF PRINT ONLY Eng. Insp. Fee $ Affidavit ► SIGN ON REVERSE SIDE 1 Appr.forCO. Total Fee 2✓" TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant i LocationofWork LotNo. Applicant's Address 3`15A C enu3iCod -Si-. UOOfCes4P—r, MA ot4o7 Tel # 40t-40-?U7— Town WCCC�2r, MA zip O l(e07 Lic.# 565522 Yk�r CD Owner \/Cxker ) i 3nL& Architect Owner's Address 100% ScefldSfOrle Dr Architect's Address zou+h Windsor,CT zip o Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. UAN1111, CLOSED Purpose of this permit =1rlsfQl fit rp kw—ewe( W[r1fkl m PER: cbanotea AND %J CGS r i City Water 0 Well ❑ Septic System 0 Sewer❑ Ins: HO SP Ce Area Basement Garage Approved by Use Group Construction Type loo(L( Revised 1108 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required distances from all other zones and is located in which this building and its use is allowed. Signed I hereby apply for a Certificate of Oc cy for thew escribed in this application for the permit. Signed DO RITE alS LINE INSPECTION COMMENTS PERFM T C! OSEQ PERK PP 17-176 AND -- ----- CGS 29,393 - INSPECTION FIELD SHEET 04/10/23 a Printed by Middleton, Morgan 11 55 22 INSPECTION: 85039 FINAL PERMIT: STATUS: APPLICATION: 201600471 LOC: SANDSTONE DRIVE SOUTH WINDSOR PROPERTY ID: 80100000 OWNER: PLUM RIDGE ASSOC CONTRACTOR: REQUEST BY: PROJ DESC: ROOF REPLACEMENT. WORK ORDER: INSPECTOR: WS-B RESULT: PASS REQUESTED: PRIORITY: SCHEDULED: COMPLETED: 04/06/23 UNPAID FEES: 00 Date Time MILEAGE: 00 TIME: TRAVEL ONSITE COMMENTS: INSPECTED BY ADAM CHROSTOWSKI TO CLOSE OUT OLD PERMIT RECORD 4116 LL >P-' -ays -w� �()Oa\S Electric # APPLICATION FOR BUILDING PERMIT Plumbing# HVAC# Sa�CIS rLe_ --1)0Ye P7 00. Iwo Date: Ak Sprinkler# v 0 2 32 Estimated Cost $ FINAL APPROVALS Permit Fee $ I�oa1 Building COMPLETE RED BOXED AREAS Occupancy Fee $ Engineering TYPE OR PRINT ONLY Eng. Insp. Fee $ Affidavit Appr.for CO. ► SIGN ON REVERSE SIDE Total Fee $ TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $#0001 s(�itr►�, The undersigned hereby applies to do work according to the following: Applicant �bC '1 Location of Work L n� Lot No. Applicant's Address Tel # nil 0712 (p Town ` -� Zi Lic.# 0 Owner V Architect Owner's Address ` Architect's Address V�,C� v✓\ C7 Zip000-14 Zip Sq. Ft.New Area: 1 st FI. 2nd Fl. 3rd FI. Total New Area Purpose of this permit 20CE� City Water'J Well J Septic System Sewer 1�01lD66qjj Ins: HO SP Cert. , - Area Base ent Garage Approved by � Date IX��lp Use Groupl�� Construction Type ' 1 Revised 1108 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required distances from all other zones and is located in which this building and its use is allowed. Signe '� 61 d( rn I hereby apply for a Certificate of Occupancy for the work described in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS APPLICATION FOR HVAC PERMIT DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: BUILDING DEPARTMENT i l/o U 27 APPR V 1540 SULLIVAN AVENUE 644-2511 ext. 230 Bldg.Permit# Date Building Inspecto Application must be printed or typed FEE SCHEDULE F Location of Job: $0-$1,000=$15.00 �G� vt� ��/i'I e Td,Over$1,000= Street Lot No. $15.00 per$1,000 or any fraction thereof ignation Apt.No. APPLICANT -j�/�.v� n, tl APPLICANT ADDRESS 1;7- 0 6 0- y APPLICANT'S PHONE# �2�'" 07 OWNER r f�G��-r /�' %,V q�W N SFq< OWNER ADDRESS /0/2 . � OWNER PHONE mac - � ESTIMATED COST$ �f g 3 �. o .2 n.�j �► U IS THIS A CONTRACT COST? Yes L-- o FEE ENCLOSED$ ° TYPE OF JOB: �QSI OR• ..co l/New Installation Alteration/Addition/Repair Revised 03/05/10 APPLICATION FOR IIVAC PERMIT(Continued from reverse side) TYPE OF SYSTEM: TYPE OF BUILDING: ❑ HEATING Z-T�T_SIDENTIAL oluC ❑ COMMERCIAL ❑ VENTILATION ❑ INDUSTRIAL HEATING ❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. ❑ HYDRONIC ❑ WARM AIR ❑ UNIT RADIANT HEATER EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.) GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT BTUH) TYPE OF FUEL ❑ OIL-GPM OIL TANK LOCATION: ❑ INSIDE ❑ OUTSIDE CAPACITY ❑ GAS-INPUT LPG TANK CAPACITY ELECTRIC-KW AIR CONDITIONING DESIGN TEMP: OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL COOLING EQUIPMENT(INC UDINAKE&MODEL NO.) rLG MAKE �tr-ca, C . TONNAGE COOLING CAPACITY(BTUH) VENTILATION DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT) TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM) (PLANS MUST ACCOMPANY APPLICATION) FURTHER DESCRIPTION OF WORK �`�G �h f CG �►'�S' ��s�s� �O� THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. CONTRACTORS LICENSE NO. STATE SIGNATURE OF APPLICANT TYPE DATE / DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR I �Q 2-2BUILDING DEPARTMENT y APPR v 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date Buildin or Application must be printed or typed Location of Job: FEE SCHEDULE [;ie—nant $0-$1,000=$15.00 o. Street Lot No. Over$1,000$15.00 per$1,000or any fraction thereof Designation Apt.No. APPLICANT nc1W�2 ___ APPLICANT ADDRESS 2 M,&lk S r 3401 " CGS (DoLOLD r� APPLICANT PHONE# O�gC91S—�J —(ZjC 1 OW N SF-4 OWNER �I CGV-t,, -4/-O✓1 OWNER ADDRESS S-r-t CO) cc) OWNER PHONE C ESTIMATED COST$ W, V — — ,� IS THIS A CONTRACT COST? —Yes _No FEE ENCLOSED$ S U S O�� TYPE OF JOB: _4 3(P OR•C Nye Installation Alteration/Addition/Repair .�-el y obc�f 3 Revised 4/01//2002 APPLICATION FOR PLUMBING PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? ❑YES❑NO ❑RESIDENTIAL ❑BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE FUTURE USE AND OCCUPANCY ❑EDUCATIONAL ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE ❑STORAGE ❑GARAGE ADDRESS ❑MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION SIZE OF MAIN DRAIN NO.OF TOILETS STYLE NO.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 TOII,ET 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 LEI-e�— MANUFACTURER w i IDDo ` DESCRIPTION OF WORK l Cc L THE UNDERSIGNO rMREBYS FOR A PERMIT TO PERFORM THEE AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK a>> s/L Q-�-I C-I CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE APPLICATION FOR HVAC PERMIT DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE 1�oho Bldg. Permit # 644-2511 ext. 230 Date Building Inspeltor Application must be printed or typed FEE SCHEDULE ff ocation of Job: C) SCLO cj ---rtv$0-$1,000=$15.00 I I �� L ('�iWe Over$1,000= I Street No. Street Lot No. $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT C,1 rJ W l4Qc-4 o.,jt Ct. �[ I�i71 l NC APPLICANT ADDRESS I&q APPLICANT'S PHONE# &&C - ?*A& - <&ft OWNER C,AN` I Tyr e N At OW N St q< OWNER ADDRESS 10 /O aaSp�"<0 S"VP �R OWNER PHONE Cy a ESTIMATED COST$ d 0 C) o " V IS THIS A CONTRACT COST? s No FEE ENCLOSED$ �� TYPE OF JOB: �3 �S01 CO New Installation Alteration/Addition/Repair Revised 03/05/10 APPLICATION FOR HVAC PERMIT(Continued from reverse side) TYPEYSTEM: TYPE OF VILDING: EATING RESIDENTIAL ❑ A/C ❑ COMMERCIAL ❑ VENTILATION ❑ INDUSTRIAL HEATING ❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. ❑ HYDRONIC WARM AIR ❑ UNIT RADIANT HEATER EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL HEAPNG EQUIPMENT(INCLUDING MAKE&MODEL NO.) v FCaWr y 3 GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH) �d2 N�Y3(J TYPE OF FUEL oiL -GPM OIL TANK LOCATION:,2<NSIDE ❑ OUTSIDE CAPACITY ❑ GAS-INPUT LPG TANK CAPACITY ELECTRIC-KW AIR CONDITIONING DESIGN TEMP: OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.) TONNAGE COOLING CAPACITY(BTUH) VENTILATION DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT) TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM) (PLANS MUST ACCOMPANY APPL(I�CSATION) FURTHER DESCRIPTION OF WORK 6QUA4 THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. CONTRACTORS LICENSE NO. �Q TYPE STATE SIGNATURE OF APPLICANT CGS DATE ! Z DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR D�D BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# J 1� K4-- 644-2511 ext. 230 Date Buildi g lnsp—W Application must be printed or typed FEE SCHEDULE Location of Job: E S.0,^j S4.nc$0-$1,000=$15.00 Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof gnation Apt.No. APPLICANT M i Kt- �7'►d`r'M APPLICANT ADDRESS --All-Plumbing R per Imo. P.O. Box 85; APPLICANT PHONE# Tolland, CT 06084-..,"'1. O W N S F,q OWNER C.V r � 1 - a r I c/1 OWNER ADDRESS j S[L T1t c- r 1 V S. Nxf A ej — Gt 0 6 a7 ,r OWNER PHONE 86 0 - 7$a! 3 S 1 D C ESTIMATED COST$ - .� IS THIS A CONTRACT COST? Yes —No T >�� FEE ENCLOSED$ f�d TYPE OF JOB: �2 SOR CO New Installation Alteration/Addition/Repair Za12o ( l�2`� Revised 4/01//2002 APPLICATION FOR PLUMBING PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A `Ia RESIDENTIAL BUILDING PERMIT APPLICATION? ElYES ❑ NO ❑BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE❑EDUCATIONAL FUTURE USE AND OCCUPANCY ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE ❑ STORAGE ❑GARAGE ADDRESS ❑MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION WC&t--t A lz u—t Vr SIZE OF MAIN DRAIN NO.OF TOILETS STYLE NO.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 !"ej te. WATER HEATER: TYPE MANUFACTURER DESCRIPTION OF WORK �c/+4 4L r P_ �('44, VC, 9al(eA F 1 c,J'I G LAP Ct}Cr itCAJ (A THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DrSCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. .2A�l 19 5 I P -I c.+ CONTRACTORS LICENSE NO. I TYPE STATE SIGNATURE OF APPLICANT '�"� _� ^^ DATE �e APPLICATION FOR HVAC PERMIT TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 (PHONE) 860-644-2511 EXT. 230 DEPARTMENT DECISION PERMIT NUMBER: APPLICATION IS HEREBY: 'q00 t 1 NU APPROVED: BLDG.PERMIT (MBER: DATE INSPECTOR LOCATION OF WORK: Ic�,� scnas-�b- APPLICANT: OWNER: TYPE OF STRUCTURE: r — o NEW BUILDING NAME: I�H 2 ;n I-[P�q r NAME: U�1� 1 z '�f l l / ❑ADDITION PHONE NUMBER 9 t 3- T Z 7' Y 7?S PHONE NUMBER: q 3 25 T STING BUILDING ADDRESS: (�U �J DX 35 V ADDRESS: /o 0 8 , 4 Lz e-- '�✓)�� hid. O I&3? u, .SJ-I k LV 1,, d TYPE OF USE: )ENTIAL ❑COMMERCIAL HVAC INFORMATION: FURTHER DESCRIPTION OF WORK: TYPE OF SYSTEM: j&zATING r tdc HEATING: TOTAL HEAT LOSS(BTUH) 'F (HEAT LOSS SHEET REQUIRED) DESCRIBE ALL HEATING EQUIPMENT(INCLUDE MAKE AND MODEL NO.): O, 1 f-J��HG(� lilt (27j ESTIMATED COST: v AIR CONDITIONING: DESIGN TEMP:OUTSIDE °F INSIDE °F DIFFERENCE F" FEE ENCLOSED:S I .� TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET REQUIRED) DESCRIBE ALL COOLING EQUPMENT(INCLUDE MAKE AND MODEL NO.): s FEE SCHEDULE:$IS PER SI,000 OF THE ESTIMATED COST. 2�•�-'�7 ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS S 1 ��' OF THE PERMIT FEE)OVER. (.26 CENT EDUCATIONAL FEE INCLUDED AS PART THE UNDERSIGNED NEARBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFOMANCE OF SUCH WORK. CONTRACTORS LICENSE NO.: 3 1 I �o� TYPE: ;S- 1 STATE: CT SIGNATURE OF APPLICANT: ilia DATE: 3' DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR CC)C� BUILDING DEPARTMENT APPROVE 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date Building Ins for Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000=$15.00 FTenant Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof nation Apt.No. APPLICANT MANT DRESS 136 X APPLICANT PHONE# _O7G C�, W N S OWNER -t/167,01 e-s 'k;Vq S�A, .�✓) O �q� OW14ER DRESS OWNER PHONE t!�5 CO ESTIMATED COST$ J �9!1-1 G• C/O IS THIS A CONTRACT COST? r Yes FEE ENCLOSED$ O • p� 1��5 �O-•//�� TYPE OF JO �R C New Installation Alteration/Addition/Repair Revised 4/01//2002 a 00 � APPLICATION FOR HVAC PERMIT (Continued from reverse side) TYPE OF SYSTEM: TYPE OF Bj!jLDING: OlfEATING WKESIDENTIAL ❑A/C ❑COMMERCIAL 3-VEENTILATION ❑INDUSTRIAL HEATING ❑STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. ❑HYDROMC QlfAARM AIR ❑UNIT RADIANT HEATER EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT LOSS(BTUH) °F(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION) (DESCRIBE ALL HEATING EQUIP N INCLUDING MAKE&MODEL O.) GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH) /Q� Ac 0 TYPE OF FUEL 91'OIL—GPM OIL TANK LOCATION :❑ INSIDEO OUTSIDE CAPACITY ❑GAS—INPUT LPG TANK CAPACITY ELECTRIC—KW AIR CONDITIONING DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.) TONNAGE COOLING CAPACITY(BTUH) VENTILATION DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT) TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM) (PLANS MUST ACCOMPANY APPLICATION) FURTHER DESCRIPTION OF WORK /Ls<i Y� r�s /f+!-C THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. 3c,3 ;7,9Z CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT Z— �0' 67 APPLICATION FOR HVAC PERMIT TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT 1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 (PHONE) 860-644-2511 EXT.230 DEPARTMENT DECISION PERMIT NUMBER' APPLICATION Y: P BLDG.PERMIT NUMBER DATE ECTOR LOCATION OF WORK: /D�T 5nojf/i'I-e- APPLI ANT: OWNER: TYPE OF STRUCTURE: / / �-�r ❑NEW BUILDING NAME:/�i'K/cwf O• ! 5 j -1 r NAME: , y� ll�s//1 / O ADDITION PHONE NUMBER PHONE NUMBER d(9� IOti�b(� Z W,6�S-TING BUILDING ADDRESS: /Z s'�, ADDRESS: /o/er- 117 TYPE OF USE: C—/o � dRESIDENTL4L ❑COMMERCIAL HVAC INFORMATION: �p FURTHER DESC/RIPTION OF WORK: TYPE OF SYSTEM: o HEATING eZ/ /� S+�^� "'a/ aG-1-e-5S X, HEATING: /'tA O'C Co." TOTAL HEAT LOSS(BTUH) T (HEAT LOSS SHEET REQUIRED) DESCRIBE ALL HEATING EQUIPMENT(INCLUDE MAKE AND MODEL NO.): �G G GG ESTIMATED COST:f AIR CONDITIONING: DESIGN TEMP:OUTSIDE °F INSIDE 'F DIFFERENCE F° FEE ENCLOSED:S TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET REQUIRED) DESCRIBE ALL COOLING EQUPMENT(INCLUDE MAKE AND MODEL NO.): �L FEE SCHEDULE:$18 PER S1,000 OF THE ESTIMATED COST. SIJ`.'sli; u yGdob,L /IA S 7- ,,,oZ '�d AV,4�-!•I/ ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS 1115z -Gl 9X0- 4- Z GL! A) S1.00 OVER (26 CENT EDUCATIONAL FEE INCLUDED AS PART s�— OF THE PERMIT FEE) THE UNDERSIGNED HEARBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PEERFOMANCE OF SUCH WORK. CONTRACTORS LICENSE NO.: 2jd 37 6� TYPE: STATE: ' SIGNATURE OF APPLICANT: DATE: ��D