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Home My WebLink About1060 MAIN ST APPLICATION FOR ELECTRICAL PERMIT DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT# Applic is b : BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE l ADO Z�I W-2511 ext. 230 Bldg.Permit# Date u Iding Inspector Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000=$15.00 'o G a ZX A-i f✓ S i Over$1,000= Street No. Street Lot No. $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT E /01 i✓ 4C/-� 44:::�G 7-76Y%j APPLICANT ADDRESS /2- C, 45 O X Sy / s. �► c-7 y APPLICANT'S PHONE# _ A6 o- o2g a L r 9 OWNER Q�.,4 0 1 6 hn �-�r4-tTl\C�2e- '��W N S f 4< OWNER ADDRESS / 0 6 o 51- S cr--T-L L,v„v 0 504 Cn OWNER PHONE O F ESTIMATED COST$ 3 S� ••1 U IS THIS A CONTRACT COST? Yes No how FEE ENCLOSED$ TYPE OF JOB: �SOR•COS New Installation t�fAlteration/Addition/Repair 20 O DES y y Revised 03/05/10 APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH BUILDING PERMIT APPLICATION? ❑ YES ❑ NO ❑ RESIDENTIAL CURRENT USE AND OCCUPANCY ❑ BUSINESS ❑ ASSEMBLY FUTURE USE AND OCCUPANCY ❑ EDUCATIONAL ❑ INSTITUTIONAL ENGINEER'S NAME PHONE ❑ FACTORY ❑ STORAGE ADDRESS ❑ GARAGE ❑ MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD ► /P L -e*6-t e �•�/� SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBERS OF METERS NUMBERS OF DISCONNECTS AND RATINGS NUMBERS OF PANELS NUMBERS OF DISCONNECTS REQUIRED? ❑ YES ❑ NO NUMBERS OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS 6O NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A IC CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK t� A 1 e x TV-,4 0-A TZ e T 1 N e fK r-� Q Do j m t' N c Tb Nt✓-j c-itrtre-i- 2��c.►�c� S 17' NJ 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 PERFOR- MANCE OF SUCH WORK CONTRACTORS LICENSE NO. STATE SIGNATURE OF APPLIC DATE_ APPLICATION FOR ELECTRICAL PERMIT DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: BUILDING DEPARTMENT I y D b b is APP OV 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Mate Buildi g In ector Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000=$15.00 i L�64 /77/�i%� -s'ni ee 7— Over$I,000= Street No. Street Lot No. $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT ] /JJf?7i� C lyj/rG�i d7y O�lam"LLG APPLICANT ADDRESS APPLICANT'S PHONE# no - a-F.,2 OWNER 1-2/ SOWN $£-4< OWNER ADDRESS 172 V' +- OWNER PHONE -OW - 62-4 3 - 70 7 -Yrg'ao ESTIMATED COST$ S-V e o .•� U IS THIS A CONTRACT COST? XYes No FEE ENCLOSED$ ° TYPE OF JOB: 4- `j022- fN�SO R.C O New Installation --7e-Alteration/Addition/Repair ®� 3®IDS S 3 Revised 03/05/10 APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? ❑ YES ❑ NO O RESIDENTIAL CURRENT USE AND OCCUPANCY_ AeS ❑ BUSINESS❑ ASSEMBLY FUTURE USE AND OCCUPANCY ZIVI'v(, ❑ EDUCATIONAL —� ❑ INSTITUTIONAL ENGINEER'S NAME PHONE ❑ FACTORY ❑ STORAGE ADDRESS 'J 04 ❑ GARAGE ❑ MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD /hG z SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBERS OF METERS NUMBERS OF DISCONNECTS AND RATINGS NUMBERS OF PANELS NUMBERS OF DISCONNECTS REQUIRED? ❑ YES ❑ NO NUMBERS OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES 'd, NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK DLD <ti�r,e,�c 6s �v;6 f/'l L;G�-frS ra £'� .;� fe�/1 ea.-� /�1c�o,e�.•cr 6 N 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 PERFOR- MANCE OF SUCH WORK 3 F',?& 7— CONTRACTORS LICENSE NO:, TYPESTATE SIGNATURE OF APPLICANT r DATE /-2 -2/- -/3 • Electric # APPLICATION FOR BUILDING PERMIT Plumbing# 1060 Main Stree HVAC# 14000041 FDate: -TQ L Sprinkler# Estimated Cost $W. 5 O 0 FINAL APPROVALS Permit Fee $ 021 Building COMPLETE RED BOXED AREAS Occupancy Fee $ Engineering — TYPE OR PRINT ONLY Eng. Insp. Fee $ Affidavit A r.forCO. ► SIGN ON REVERSE SIDE Pp Total Fee $ I U21 tyoo TO THE BUILDING Dt,P RTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work accprdi)�p¢ to the following: ,Ds' ��C l Applicant_-fin__�0oc vcct4%0(%S C Location of Work_ _10(pQ l'1 Q�n �_ _r_ __- Lot No. Applicant's Address _ga -Ttvp )Yx 1 dr\,— �2,� Tel # C-(?)_ fST Town S-f- 45'sff - - -Zip-CXOOfS Y'. ._Lic.# 1 7 d j_ bfi7 93G3 Owner 'i (-lit �1�Q11/" _Architect_ Owner's Address (0 Con /-4 u',,l s ( Architect's Address _ Zip_ _ _ Zip Sq. Ft. New Area: 1 st Fl-C�1 0 1.1 7 2nd FI. _rr _ _ 3rd FI. Total New Area Purpose of this permit _ (�p(K� City Water Well ❑ Septic System 'J Sewer J a0151U O O/a Ins: HO S 4— Cert. Area Base t Garage Approved by Date — '/ Use Grouo5n� Construction Type �— Revised 1108 r 1 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 a prop r dista fro 11 street lines,side yard lines,and required distances from all other zones and is located in which th uildin d its a is wed. Signed I hereby apply for a Certificate of Oc pancy for the work described in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS INSPECTION FIELD SHEET 02/07/17 Printed by Foreshaw, Dayshell 08 49:22 INSPECTION: 64191 U.-FINAL PERMIT: STATUS APPLICATION: 201400010 LOC: 1060 MAIN STREET SOUTH WINDSOR PROPERTY ID 54901060 OWNER: CONTINUING CARE OF S WINDSOR INC CONTRACTOR: REQUEST BY: PROJ DESC: 380 SQUARE ROOF REPLACEMENT. WORK ORDER: INSPECTOR: ROSE RESULT: PAS3�'' W REQUESTED: %04/22/14 PRIORITY: SCHEDULED: 04/22/14 AM COMPLETED: 04/22/14 UNPAID FEES 00 Date Time MILEAGE: 00 TIME: TRAVEL ONSITE COMMENTS JOHN m 860-881-3123//discussed with worker procedure taken �•b .a..a�n...Q � m.aieR�" o.n.e a wnrcw.w,.n..o £ �� r ItlOOt N�10�A�f � \ IPWM■ e ij iji tIP�M "Pam pw .000 J /� Q ioeR aa,.c pz Wsi NW W. VJ 1 \ tl2 s , am= • �� rwo 0 amp f i ¢ ��„ ..� ^^ ��•.R- ,,gin.�; .�\ ^4 w C-DM1 /0(o0 VIC-iV, SL U Gt ad�- l N-50-15' —00"W 1008. 14 ' /-- BITUMIN S o �- 1 / `♦ Z SHEDS ATTACHED 14 `� ♦ ul SHIECDK 9' x BITUMINOUSco \`\` 1 1 ��...., 4' S`T. WALK i' ♦♦ \ i ` rn 74 1 % i 3' BIT. WALK `♦ \\ \ 1 j CONC. PATIO !' -� ♦♦ \\ '�/ `\ C v� � I SLA�PID 1 1 \ BITUMINOUS `\ 1 GRASS CRASS COURT �..� �� YARD ; 253 . 23 ' N 5 0-5 7 ' —00"E )� U� t 1 y. 4.5' BIT. WALK 1 j ``♦`1 �1 `,\ '� r+ ' r0 �� -.�v BITUMINOUS 1 � N \\ \ \ .� co \ N/F 3%AMES LK 1\ 1 0de \\` :� n•Y 4.5' BIT. WALK 00 \\ \\ ID60 nAA►a s r �`♦♦♦ ; t 11 50 ! gym{ WlnvsoK N/F THOMAS SMITH \ 1 r — i DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT APPR vE 1540 SULLIVAN AVENUE Bldg. Permit# �, 644-2511 ext. 230 �1 Date Building lnspecto Application must be printed or typed FEE SCHEDULE Location of Job: F $0-$1,000=$15.00 Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof gnation Apt.No. APPLICANT �• L ,LIu�c; E Sa�Sh L -- _- - APPLICANT ADDRESS 3? tAj,tiC(sor< Lucks' CT- ocvy(: APPLICANT PHONE# (�ZG C) 3- Ci 4.4 SOW N S OWNER S. W. Rel,c,b �,;�'U" 4Sk.11ec� ��,TtS�� C.etile►� OWNER ADDRESS /C (.cu �— tG�"� ", son OWNER PHONE CS 60) O / = ESTIMATED COST$ � .SS U. U U •� * IS THIS A CONTRACT COST? Yes _No p x �� FEE ENCLOSED$ -/S, U 0 r+DSO .CO TYPE OF JOB: R _New Installation X Alteration/Addition/Repair Revised 4/0 V/2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? 0 YES 0 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/WIRING METHOD SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? O YES O NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK "Alke) d"h oeg s -�09, P IC U h t. Vs 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. TYPE STATE SIGNATURE OF APPLICANT DATE I o DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR M�® � BUILDING DEPARTMENT APPROVE 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Elate Building lns Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT APPLICANT ADDRESS I!jyjq Qtl f APPLICANT PHO� 0 W N S f,4 OWNER A OWNER ADDRESS l U 6,0 /'f q/fy 0 .a OWNERPHONE — 7,81 —7 7 7 j C ESTIMATED COST$ Z 2 , 7 * IS THIS A CONTRACT /COST? Yes _No FEE ENCLOSED$ ! / SO Co TYPE OF JOB: R New Installation _Alteration/Addition/Repair aol2�doao3 Revised 4/01//2= APPLICATION FOR HVAC PERMIT (Continued from reverse side) TYPE OF SYSTEM: TYPE OF BUILDING: 0 HEATING 13.4ESIDENTIAL, U A/C WCOMMERCIAL 0 VENTILATION ❑INDUSTRIAL HEATING ❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LB41T LBS. ❑HYDRONIC 0 WARM 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 EQUIPMENT(INCLUDING MAKE&MODEL NO.) GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT BTUH) TYPE OFYIJEL M OIL-GPM OIL TANK LOCATION:O INSIDE OUTSIDE CAPACITY O 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) j L FURTHER DESCRIPTION OF WORK .; l 6 l� 1/� :LQ ISIQR 4 6 f.� 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. 3a -(o& 7 5 - CT CONTRACTORS LICENSE TYPE STATE SIGNATURE OF APPLIC DATE 6 Electric # 1060 Main streetAPPLICATION FOR BUILDING PERMIT Plumbing# 12000242 HVAC# FDate: Sprinkler# Estimated Cost $ 5-0, (kid FINAL APPROVALS Permit Fee $ 8c5c> Building O S- y- Z, COMPLETE RED BOXED AREAS Occupancy Fee $ Engineefini TYPE OR PRINT ONLY Eng. Insp. Fee $ Affidavit Appr.forCO. SIGN ON REVERSE SIDE / Total Fee $ TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ 12�4. The undersigned hereby applies to do work according to the following: Applicant Cv n n . C6004AW&tionof Work a'^n + Lot No. _. Applicant's Address q 2 Soo i5 n 4 o n 17.6 f:6- ,o A-0r c :I Tel # SCE o 1-30 Town A*4 c-4 Zip owiff Lic.# 0629960 Owner �ejlQ cn a Le- Architect Owner's Address fM 42 Architect's Address Zip Zip Sq.Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area _ Purpose of this permid'33{"P�C�("A WIn CtJ Ot,t/ S City Water J Well LJ Septic System J Sewer❑ Ins: HO SPt�Date Area Basement Garage Approved by Use Group Construction Type 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 a plans or s ifications of the Building for which this permit is asked,and agree that this building is to be local the pr distanc all street lines,side yard lines,and required distances from all other zones and is located in which buildi nd its u allowe . Signed 1 hereby apply for a Certificate of O cupancy for the work described in this applic ion for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS INSPECTION FIELD SHEET 05/18/12 'Printed by Peart, Dayshell 10 26 25 INSPECTION: 48414 FOOTING PERMIT: STATUS: APPLICATION: 201200539 LOCATION: 1060 MAIN STREET SOUTH WINDSOR PROPERTY ID: 54901060 OWNER: CONTINUING CARE OF S WINDSOR INC CONTRACTOR: REQUEST BY: DESCRIPTION: 133 REPLACEMENT WINDOWS. WORK ORDER: INSPECTOR: ROSE RESULT: N/A REQUESTED: PRIORITY SCHEDULED: COMPLETED: 05/18/12 UNPAID FEES 00 Date Time TIME: TRAVEL ONSITE COMMENTS ALL INSPECTIONS: INSPECTED INSPECTOR RESULT INSP DESCRIPTION 05/18/12 ROSE N/A B002 FOUNDATION 05/18/12 ROSE N/A B003 FRAMING (ROUGH) 05/18/12 ROSE N/A B004 INSULATION 05/18/12 ROSE N/A B005 FIREPLACE / CHIMNEY 05/18/12 ROSE N/A B006 WOOD / GAS STOVE 05/18/12 ROSE N/A B009 OTHER 05/18/12 DOUG PASS BO10 FINAL APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? ❑YES D NO ❑RESIDENTIAL 0 BUSINESS❑ASSEMBLY CURRENT USE AND OCCUPANCYGA / ❑MERCANTILE FUTURE USE AND OCCUPANCY S�m O EDUCATIONAL ❑INSTITUTIONAL _ ❑FACTORY ENGINEER'S NAME PHONE ❑ STORAGE ❑GARAGE ADDRESS ❑MIXED USE _ CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD Irl S 1 S T" JV (- SIZE OF SERVICE (51 Shim OF MAIN CONDUCTORS NUMBER OF METERS - NUMBER OF DISCONNECTS AND RATINGS — NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? 0 YES NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES - NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK �PIJ A 2',;u c, 6;-xle.-e- 71%,- C�/�of �/1ffSN-s::f'/L '54u/fZ Lj O14 (,Ue t.S A10 (rao j) AdI9 A"i-I 4,vNvvC14L7-0,Z A4 IVVYZSC Sk+-o ju . �e 4,, ICirP c4lain 4D 51. vA duWAI .3Six,99C 4 J' 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. IVFgo?9/ r— ) CONTRACTORS LICENSE NO. TYPE STATE L SIGNATURE OF APPLICANT /'Cyl.G1//. �G1�0 DATE P-1 U-09 f - DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Applica ' is hereby: ' 3 BUILDING DEPARTMENT �`� P 1540 SULLIVAN AVENUE Bldg. ('ermit# 644-2511 ext. 230 Date Wiling Inspector Application must be printed or typed FEE SCHEDULE Location of Job: /UFO rylA .^/ S 7-rz r f T $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt. No. APPLICANT (r l oaf C L Fc T�i C_ APPLICANT ADDRESS 6 V/- (3 diR t Ai S'T f45'T /14ti37,u e? ai6 6-12 APPLICANT PHONE# SOWN Sf,q OWNER CoAlT1 r/ Ut,njCr (',ArLt: 62 ��r uT 1-� LTJ/.i✓OS£_/� tNC C OWNER ADDRESS N C,- /4/� D MI OIJL-c 7'rr i. j iv S- 7 OWNER PHONE C ESTIMATED COST$ 3 O0 O •s, IS THIS A CONTRACT COST? Yes _No to �G FEE ENCLOSED$ l��sO. •CO TYPE OF JOB: W 7q (p R New Installation �Alteration/Addition/Repair Revised 4/01//2002 DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT Application is hereby: TOWN OF SOUTH WINDSOR PERMIT# BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000=$15.00 StreKN��. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof l'enant Designation Apt.No. APPLICANT nn/� APPLICANT ADDRESS _300 le 5aVbf07o1G �d 0�i4nur» 67. C.W/ . 6. boot 1!)0-7 APPLICANT PHONE# g 6-3 V S-3-23 6 oW N St OWNER (Jan Allcr) Til, i9te vnn bi �1 < OWN 7,DDRESS 30 o Q Sety t�t�a a Qd 1144nvm 671, 644AII a O , �, OWNER PHONE $`0 -0) a7- /9Z$ Ce/J) C ESTIMATED COST$ a.S lop oU x * IS THIS A CONTRACT COST? Yes _No FEE ENCLOSED$ 415 TYPE OF JOB: R C _New Installation p _ Alteration/Addition/Repair I C Revised 4/01//2002 APPLICATION FOR HVAC PERMIT (Continued from reverse side) TYPE OF SYSTEM: TYPE OF BUILDING: ❑HEATING ❑RESIDENTIAL ❑A/C 0 COMMERCIAL ❑VENTILATION ❑INDUSTRIAL HEATING 0 STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. 0 HYDRONIC 0 WARM 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 EQUIPMENT(INCLUDING MAKE&MODEL NO.) GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH) TYPE OF FUEL ❑OIL--GPM OIL TANK LOCATION :0 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) S*(,c k(� I P'a, (PLANS MUST ACCOMPANY APPLICATION) ap /�•�O FURTHER DESCRIPTION OF WORK �/rCc f" !r Fite►rt.•�" a,Ean e"� 44 y S Iirl9 N 44,3 Prt v t S r h c.✓ q �4 -L A. / O.12 arc.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. 3037341 s1 H74- cT CONTRACTORS LICENSE NO. ' > TYPE STATE SIGNATURE OF APPLICANT / DATE �� J Model: 100RZG KOHLERPOWER SYSTEMS 190_600 V Gas 09001 Standard Features 14 "YsTm • Kohler Co. provides one-source responsibility for the generating NATIONAW REGISTERED system and accessories. • The generator set and its components are prototype-tested, Ratings Range factory-built,and production-tested. 60 Hz 50 Hz • The 60 Hz generator set offers a UL 2200 listing. Standby: kW 80-100 69-88 * The generator set accepts rated load in one step. WA 80-125 69-110 • A one-year limited warranty covers all systems and components. Prime: kW 71-94 62-80 Two-,five-, and ten-year extended warranties are also available. kVA 71-118 62-100 • Alternator features: o The Fast-Response" III wound field (WF) design alternator I provides excellent voltage response and short-circuit capability using an auxiliary power brushiess exciter. o The unique Fast-Response- II excitation system delivers In II excellent voltage response and short circuit capability using a I I�I permanent magnet(PM)-excited alternator. I�I o The brushless, rotating-field alternator has broadrange reconnectability. • Other features: i_ 0 o Controllers are available for all applications. See controller O �J features inside. -_ ----- o The electronic, isochronous governor incorporates an integrated drive-by-wire throttle body actuator delivering Generator Set Ratings precise frequency regulation. Natural Gas LP Gas 130'C Rise 105°C Rise 13WC Rise 105'C Rise Standby Rating Prime Rating Standby Rating Prime Rating _Alternator Voltage Ph Hz kW/kVA Amps kW/kVA Amps kW/kVA Amps III Amps 120/208 3 60 90/113 312 81/101 280 100/125 347 91/114 316 127/220 3 60 90/113 295 81/101 265 100/125 328 91/114 299 120/240 3 60 90/113 271 81/101 243 100/125 301 91/114 274 120/240 1 60 80/80 333 71/71 296 80/80 333 71/71 296 139/240 3 60 90/113 271 81/101 243 100/125 301 91/114 274 220/380 3 60 88/110 167 81/101 153 88/110 167 82/103 156 277/480 3 60 90/113 135 81/101 121 100/125 150 91/114 137 4S9W/ 347/600 3 60 90/113 108 81/101 97 100/125 120 91/114 109 4S9 110/190 3 50 76/95 289 69/86 261 80/100 304 73/91 277 115/200 3 50 76/95 274 69/86 248 80/100 289 73/91 263 120/208 3 50 76/95 264 69/86 239 80/100 278 73/91 253 110/220 3 50 76/95 249 69/86 226 80/100 262 73/91 239 110/220 1 50 69/69 314 62/62 282 70/70 318 63/63 286 220/380 3 50 76/95 144 69/86 131 80/100 152 73/91 138 230/400 3 50 76/95 137 69/86 124 80/100 144 73/91 131 240/416 3 50 76/95 132 69/86 119 80/100 139 73/91 126 120/208 3 60 100/125 347 91/114 316 100/125 347 911114 316 127/220 3 60 100/125 328 91/114 299 100/125 328 91/114 299 120/240 3 60 100/125 301 91/114 274 100/125 301 91/114 274 120/240 1 60 90/90 375 82/82 342 94/94 392 85/85 354 139/240 3 60 100/125 301 91/114 274 100/125 301 91/114 274 220/380 3 60 100/125 190 91/114 173 100/125 190 91/114 173 277/480 3 60 100/125 150 91/114 137 100/125 150 91/114 137 4S13W/ 347/600 3 60 100/125 120 911114 109 100/125 120 91/114 109 4S13 110/190 3 50 80/100 304 73/91 277 88/110 334 80/100 304 115/200 3 50 80/100 289 73/91 263 88/110 318 80/100 289 120/208 3 50 80/100 278 73/91 253 88/110 305 80/100 278 110/220 3 50 80/100 262 73/91 239 88/110 289 80/100 262 110/220 1 50 72/72 327 65/65 295 81/81 368 74/74 336 220/380 3 50 80/100 152 73/91 138 88/110 167 80/100 152 230/400 3 50 80/100 144 73/91 131 88/110 159 80/100 144 240/416 3 50 801100 139 73/91 126 88/110 153 80/100 139 4V11W/ 120/240 1 60 86/86 358 77/77 321 95/95 396 85/85 354 4V11 110/220 1 50 72/72 327 65/65 295 78/78 355 70/70 318 RATINGS All three-phase units we rated at 0.8 power factor. AA single-phase units are rated at 1 0 power factor.standby Ratow. Standby ratings apply to installations served M a reliable utility source. The standby rating is applset>le t0 varying loads for the duration of a power outage Thera tnordanPoweintallations we utiowersunN ty is a br one hour in twelve. Ratings areaccor -8524/1,ootingsttiorbWleti101)on rat gudetines for the complete rfltings tlefinitions.The generate set menulacturer reserves the right to change the spetifianablpetbnrayr Gee:Dre abov 25°C(77•F).For unite hav ng m the primary fuel(nffiurd gee)and,as a resuR,the LPG rdirgs may rtd be dtened. For dud tuBl engines,use the rtdurd gas ratngs for both the prsrwy and seoorWerY fueb. G4-79 (100RZG) 1/0as DEPARTMENT DECISION D WvI)tk N FOR PLUMBING PERMIT L� PERMIT# T OF SOUTH WINDSOR Application is hereby: � 5 2008 DEC ILDING DEPARTMENT APPRO ED South Windsor N540 SULLIVAN AVENUE Bldg.Permit# BUILDING DEPWTMEN 644-2511 ext. 230 DaW Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: fp S T Sc✓i'.z�.�so61 . $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT P&p4h -c. APPLICANT ADDRESS 4/ SLJ C / APPLICANT PHONE# d bO v2�� U 14C . OWN SF OWNER eSl�GttCt G % S;lw//h�So/� q� OWNER ADDRESS c, /nU i" S 7- OWNER PHONE 0 � . C ESTIMATED COST$ IS THIS A CONTRACT COST? _,�.Aes _No e �G FEE ENCLOSED$_�6 '1 SCO TYPE OF JOB: / C� OR C New Installation Alteration/Addition/Repair Revised 4/01//2002 APPLICATION FOR PLUMBING PERMIT (continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A ❑RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑NO ❑BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE❑EDUCATIONAL FUTURE USE AND OCCUPANCY ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE El 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 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 MANUFACTURER DESCRIPTION OF WORK )j 90 4 Ae c THE UNDEI=ED HEREBY APPLIES FOR A PERM—IT 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. %LT03979yy—LTj -/ CT CONTRACTORS LICENSE NO. E STATE SIGNATURE OF APPLICANT DATE 1 � a q oyth or Rehabilitation and Long Term Care Community PROPOSED PROPANE TANK INSTULATION FOR NEW GENERATOR (See attached drawings) To be done by J.D.C. ENTERPRISES: • Obtain a permit from South Windsor Building Department • Pour a 161x 121x 6 — 8" concrete pad, 12" thick at tank sites • Install a 6' high stockade fence around pad with locking entrance door • Dig a trench approximately 18" deep and 110' long from pad to generator and backfill after pipe install and inspection To be Done by PROPANE GAS SERVICES: • Obtain a permit from South Windsor Building Department • Install 2 reconditioned 1,000 gallon propane tanks on new pad • Run approximately 110' 1" plastic gas line with steel risers • Install new gas regulators, I at tanks and 1 at generator • Pressure test and connect after inspection * NOTE: New Tanks To Run Generator ONLY! Building Services To Stay On Existing Propane Tanks p,��, Jo\n Yk-,PC\ 4 Spr nkl,.•.. Main 0.- Water r' ` v ■ = Main Power O' - Circuit Hreskers 't0- A = Propane Shut Offs• A = Oil Shut Offs Paved Parking Area Paved Parking Area MecAcm- R4c¢ea•cot - I l . � �iNlaC�r„pJcr� O C Loser Fore Sept O ♦ '13o,ler. p Tank Gross Court Yard 15 'o,e—mounted Backup " ra Generator ronsforme Monitoring Well �� c(qu.�ecL- p I c toSET 8.000 Gallon J #1060 Main Street Fuel oil UST Q SITE . BUILDING Fill Pipe Shed (2) Propane AST a Shed n - Wolkwa -------- — Sri nkl--- Main Now _ — o = water F. ® = Main Power Q = C: rcult Breakers , 0 A = PrQpane Shut F- Offs, - = Oil, Shut Offs Paved Pc Paved Parking Area y Mev SOW, C�ose;i 0 CIA Grass Court Yard 3) Backup - Iola—mounted r� Generator roneforme Q Monitoring Woll 1 C4 QU4146rt- p 5.000 Gallon�� Fuel Oil UST J # 1050 Main Street Fill .Pa SITE . BUILDING Shed (2) ropana AST ?r Shod - Walkway 1 h! PA 1) ISO SDcJieG /�I �p �o� /yo �i''%ram �jy /g x X 6 ' 8 � 000 (a,.4,t .kDnl PAS rc? /j�d .. vN ve.K Electric # E r F � V r PPLICATION FOR BUILDING PERMIT Plumbing# i;0 Main S reet Date: HVAC # Sprinkler# BUILDING DEPAR FINAL APPR VALS _- Estimated Cost $ Building ' E� t PLETE RED BOXED AREAS Permit Fee $ Occupancy Fee $ Engineering YPE OR PRINT ONLY Eng. Insp. Fee $ Affidavit CO. ON REVERSE SIDE — - - - -- Total Fee $ TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant's .1 C ccM /tic Location of WorII/aGo ~14.)S11- Lot No. Applicant's Addressf� 77r--A tJ d'(.Lb Tel.#J'60 "7Pe_ 'Od _ Townsi✓r;V- Zip Lic.# Owner, �zefr 41,10,6ro t. Architect Owner's Addres;/aGr� Architect's Address Zip Zip Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area Purpose of this permirlo l�sryc.� h// / /0L/j7c�� Of �i�✓' T '/�-f4S �.^PA.✓F it S v,eC.0 f S. w•Alt-,rjV R • a c=�c ylc{ 04-D wi r7l G S-M a444-t cT City Water❑ Well❑ Septic System❑ Sewer❑ t Ins: HO SP Area Basement Garage Approved by ' Cer .41 Date .1 a� Use Group Construction Type Revised W02 -^ n/ -- tv�, 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 loc a prope distance from all street lines,side yard lines,and required distances from all other zones and is located in which is buil i its a is allowed. Signed I hereby apply for a Certificate of Occupanc r the work de ribed in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS Electric # APPLICATION FOR BUILDING PERMIT Plumbing# Date: H VAC # 60 M.iin Street - CJ Sprinkler# 8 0 0 7 3.9 Estimated Cost $ C FINAL AP OV --- - -- - --- - -- - --- -- -- - ------- - - - - ----- -- --- Permit Fee $ Building / COMPLETE RED BOXED AREAS Engineering TYPE OR PRINT ONLY Occupancy Fee $ Affidavit iIj I Eng. Insp. Fee $ A r. for C 11100- SIGN ON REVERSE SIDE i Total Fe $ PP - TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: ApplicantTc�,,,-e A[ A S J?�E-oJu SLocation of Work /060 /M 4,tj S' l Lot No. Applicant's Address (6 zeo f Naoc> d R . Tel.# ,4 0 3- .,2 3 q— /O O Z Town /l/o 2 kt-. 1-lPru Q+v Zi Lic.# e s — 6 00 S-S 8 Owner A/Au a,.r kv/* 14 Architect Owners Address /60 A7 4: J S,T Architect's Address --56 Lf K Lu; ►d SaV2 Zip Zip Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area Purpose of this permit At '.N sAA l I -r yq 4a IIJ N Q S'�o QddM w kooM iS N Fp A eonniel AN A—. City Water❑ ell❑ Septic System❑ Sewer❑ Ins: HO SP Cert. ea Basement Garage Approved by Date 4Use Group�onstruction Type �— Revised 6/02 1� 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 Occupancy for the work described in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS APPLICATION FOR ELECTRICAL PERMIT DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT# AprAPPR0 n i ere y: BUILDING DEPARTMENT 1540 SULLIVAN AVENUE 644-2511 ext. 230 Bldg. Permit# Date Bu Iding Inspector Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000= $15.00 l y�`' /N N7A--' ,S i f Over$1,000= I Street No. Street Lot No. $15.00 per$1,000 or any fraction thereof Tenant Designation Apt. No. APPLICAN"T APPLICANT ADDRESS APPLICANT'S PHONE # ,_� Z ��( ? ae OWNER ..Sca/� lt.'l�r•� �.c�� ['r,c��✓ - WN S •� Fq� OWNER ADDRESS /(J too toc"( S4- OWNER PHONE ESTIMATED COST$ U IS THIS A CONTRACT COST? comes No FEE ENCLOSED $ TYPE OF JOB: h, ��f mi l�bSO R -,. Q New Installation � der. C u*-s R C vol :::Alteration/Addition/ Repair /,,(a Revised 03/05/10 APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED 14rtH A BUILDING PERMIT APPLICATION? WYES ❑ NO ❑ RESIDENTIAL CURRENT USE AND OCCUPANCY day,,& Cyr ❑ BUSINESS T ❑ ASSEMBLY FUTURE USE AND OCCUPANCY -5�+ - ❑ EDUCATIONAL ❑ INSTITUTIONAL ENGINEER'S NAME ��/�- PHONE ❑ FACTORY ❑ STORAGE ADDRESS ❑ GARAGE ❑ MIXED USE CITY -A�1 rt STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBERS OF METERS NUMBERS OF DISCONNECTS AND RATINGS NUMBERS OF PANELS NUMBERS OF DISCONNECTS REQUIRED? ❑ YES ❑ NO NUMBERS OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK �T Sal � /��✓ ,,//�, c� ,�� c��j� cr�.�Q 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 PERFOR- MANCE OF SUCH WORK 4F�- /w W 9-1/ C7-- CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE t43 DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Applicati s ereby: Q BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE Bldg. Permit# 644-2511 ext. 230 Date ing Inspector Application must be printed or typed RESCHEDULE Location of Job: FYe�nant $0-$1,000=$15.00 Street Lot No. Over$1,000$15.00 per$1,000 or any fraction thereof gnation Apt.No. APPLICANT /—-T 1 o ar o A e c C A- L ?A APPLICANT ADDRESS 3 3 Sou 4 h M 4 , ,,, `S �-r c c -� (,J i ►.J Y> -SO 2 L t3 C k S' �' + n APPLICANT PHONE# 76 G /(0 2 3 — 4 Cr 9 l 0 W N S f,q OWNER S o v f A L,/ i-+ O S O iZ /? OWNER ADDRESS /U 6 Q S'C U t /11 .4 . /J f r e e -+ A S o Q C 0 OWNER PHONE C ESTIMATED COST$ 7 S o U o •s IS THIS A CONTRACT COST? _Yes X No FEE ENCLOSED$ TYPE OF JOB: yC DSO R C�� _New Installation ey l VfAlteration/Addition/Repair Revised 4/01//2002 �1�0C�}33 APPLICATION FOR ELECTRICAL PERNIIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? ❑ YES LN NO 0 RESIDENTIAL ®BUSINESS CURRENT USE AND OCCUPANCY ee h G ❑ASSEMBLY ❑MERCANTILE FUTURE USE AND OCCUPANCY Re A G ❑EDUCATIONAL 0 INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE O STORAGE O GARAGE ADDRESS U MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES 0 NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCREPTION OF WORK p I a C P �- �2F (i ire G P N �� 4�y •2 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. to1(6W � - l C -f CONTRACTORS LICENSE NO. � �TYPE STATE SIGNATURE OF APPLICANT DATE KINSLEY POWER SYSTEMS DATE 6/25/2010 WORK ORDER NUMBER 100822-0034 NAME CT HEALTH OF SOUTH WINDSOR ORESS 1060 MAIN ST S.WINDSOR STATE CT ' 06074 N.MODEL t00REOZJD NGINE MODEL 4045HF285 C # GM51053 3.SER.# PE4045L10758 E 2282D01 CONTRACTOR BEN KW 100 100 psi Amps@ =P5� Amps FILL INFORM COMPLETELY 100°h = 278 80% = 222 75% = 206 50% = 139 START 16 30 46 1HR 16 30 45 2HR 16 30 46 3HR TIME HR METER 0.3 0.5 0.8 1.1 1.3 1.6 1.6 2 2.2 VOLTS L1-L2 209 209 210 209 209 209 209 209 209 AMPS L1 70 141 142 272 273 273 273 273 273 VOLTS L2-L3 209 209 209 209A209209 209 209 209 AMPS L2 71 139 140 272 274 274 274 VOLTS L1-L3 209 209 210 209209 209 209 AMPS L3 69 140 140 275 275 275 275 FREQUENCY 60 60 60 60 60 60 60 POWER FACTOR 1 1 1 1 1 1 1 1 1 KW 100 1D0 100 100 100 100 100 100 100 %OF LOAD 25% 50% 51% 98% 99% 99% 99% 99% 99% IlDIV/01 #DIV/01 MDIV/0! #DIV/01 BATTERY VOLTS 14.1 14.2 14.2 14.2 14.2 14.2 14.2 14.2 14.2 OIL PRESSURE 60 55 SO 50 50 50 50 50 50 COOLANT TEMP 130 170 175 180 190 190 190 190 190 RPM FREQ/60 1800 1800 1800 1800 1800 1600 1600 1800 1800 'EXHAUST TEMP 275 470 585 683 662 683 678 673 679 'OIL TEMP 'FUELUSEAGE 'AMBIENT TEMP •FUEL USAGE IF APPLICABLE 'HYDROSTATIC TEST RESULTS TECH PRESSURE P.S.I. PASS/FAIL WITNESSED BY CAP RELIEF P.S.I. PASSIFAII 1 �l y DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: BUILDING DEPARTMENT APPR V 1540 SULLIVAN AVENUE 644-2511 ext. 230 Bldg. Permit# D to Building Inspectot Application must be printed or typed FEE SCHEDULE Location of Job: F:TenantDesignatjion a%14 - V $0-$1,000=$15.00 Street Lot No. Over$1,000 _,tJ 1)—�'� 1Ar($15.00 per$I,000or any fraction thereof Apt.No. APPLICANT , 1 s� �y�r(,` - G�> APPLICANT ADDRESS APPLICANT PHONE# OW N St OWNER l?T' -{ Tom- vrr!(1 ) I.J L cJ OWNER ADDRESS ��'J (Q{;L �"r �, W(/ 0 r fi E" OWNER PHONE C ESTIMATED COST$ OCJ .� IS THIS A CONTRACT COST? Yes _No FEE ENCLOSED$ /12�tv if00 ,SO- 0 TYPE OF JOB: O I I l /� R C _New Installation , Irj XAlteration/Addition/Repair Revised 4/01//2002 ) �' r APPLICATION FOR HVAC PERMIT (Continued from reverse side) TYPE OF SYSTEM: TYPE OF BUILDING: ❑HEATING RESIDENTIAL XA/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) °F(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 EQUIPMEN';(INCLUDING MAKE&MODEL NO.) -LA �L.5� let 504 ► � TONNAGE A- 1 a U COOLING CAPACITY(BTUH)`4`!01Qp VENTILATION DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT) TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM) (PLANS MUST ACCOMPANY APPLICATION) eoo L-}t rc4 Oft- k1 A'1.t--i Acv; FURTHER DESCRIPTION OF WORK "' Gov d �� 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. TYPE STATE SIGNATURE OF `-�- NT1 DATE KINSLEY POWER SYSTEMS DATE 6/25/2010 WQRK ORDER NUMBER 100622-0034 NAME CT UFALTH OF SOUTH WINDSOR DRESS 196 MAIN ST S.WINDSOR PTATgC1 26274 E(i MODEL_ _10QREOUO NGINE MODEL 40451-11`285 SPEC.iF GM51053 3.SER # PE4045LIQ7589 282001 CONTRACTOR �E�K11Q 100 100 Amps@ Amps@ Amps* E]j� F/LL/A(fQRhf COMPLT 1100% = 278 80% = 222 7b% START 16 30 46 1HR 16 30 45 2HR 15 30 48 3HR TIME HR METER 0.3 0.5 0.8 1.1 1.3 1.5 1.8 2 2.2 VOLTS L7-L2 209 209 210 209 209 209 209 209 209 AMPS L1 70 141 142 272 273 273 273 273 273 VOLTS L2-L3 209 209 209 209 209 209 209 209 209 AMPS L2 71 139 140 272 274 274 274 274 274 VOLTS Li-L3 209 209 210 209 209 209 209 209 209 AMPS L3 69 140 140 275 275 275 275 275 275 FREQUENCY 80 601 60 Sol 60 Sol 60 60 60 POWER FACTOR 1 1 1 1 1 1 1 1 1 KW 100 100 100 100 100 100 100 100 100 %OF LOAD 26% 50% 51% 98% 99% 99% 99% 99% 99% #DN/01 #DIV/01 I NDIV/01 *DIV/01 BATTERY VOLTS 14.1 14.2 `14.21 14.2 14.2 14.2 14.2 14.2 14.2 OIL PRESSURE 60 55 50 501 50 50 50 SO 50 COOLANTTEMP 130 170 175 180 190 190 190 190 190 RPM FRE0160 1800 1800 1800 1800 1500 1800 1600 1600 1800 •EXHAUSTTEMP 275 470 585 683 682 683 678 873 679 *OIL TEMP *FUEL USEAGE .AMBIENT TEMP •FUELUSAGE •IF APPLICABLE TECH 'HYDROSTATIC TEST RESULTS WITNESSED BY PRESSURE P.S.1. PASS/FAIL CAP RELIEF P.S.i. PASSMAIL 1 TOWN OF SOUTH WINDSOR AFFIDAVIT OF ACTUAL COSTS PERMIT NO: ?OO 3 q 7 DATE f Zoj /o g The undersigned, being a duly authorized representative of, ts� do by this statement, certify that the actual costs shown below, of the project referenced by the Permit Number shown above,are true and accurate. This statement is being made pursuant to the Town of South Windsor Ordinance, Article 11, Section 14-31, (a)thru(e), (see attached). I understand that verification for accuracy of actual costs may be made at any time by the Building Official through an appraisal of the work at the expense of the property owner. hereby certify that the actual cost of the work performed under this permit is: $ Signature of Permit Holder. Name(Please Print) Date: �29'1-g ................................................................................. State of Connecticut] ] ss South Windsor Date: County of Hartford] Personally appeared , as aforesaid, Signer and sealer of the foregoing instrument and acknowledged 'the same to be his/her free act and deed, before me. Notary Public Commissioner of the Superior Court My commission expires on DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE 0 644-2511 ext. 230 Bldg.Permit# Date Building Inspector Application must be printed or typed I FEE SCHEDULE Location of Job: I� p• $0-$1,000=$15.00 Street No. Street Lot No Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant De,�ignation Apt. No. APPLICANT Low eenCe D. t t t gy0AI — 6 1 Dbe e l'er-4-yiC, LIG APPLICANT ADDRESS (041 8 I I I Q L4 S-+Kt-e4 E'A 5+ 14o yen C-" O b 512 APPLICANT PHONE# 203 q-1z> a--n $-7 W N S f,q OWNER --r—or J em oha--� OWNER ADDRESS 13 /yei- &)014 C �, r OWNER PHONE Z d 3• L/S'3 74/5' 01 (!! ESTIMATED COST$ t �, 7 S�5—- O IS THIS A CONTRACT COST? Yes _No FEE ENCLOSED$ IBD, OO SOR CO TYPE OF JOB: � )< New Installation _Alteration/Addition/Repair Revised 4/0I/N2002 IS►I APPLICATION FOR ELECTRICAL PEFMT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH BUILDING PERMIT APPLICATION? ElYES i3 NO ❑ RESIDENTIAL ❑AS INESS CURRENT USE AND OCCUPANCYMBL ❑MERCANTILE FUTURE USE AND OCCUPANCY ❑ EDUCATIONAL STTIUTIONAL O FACTORY ENGINEER'S NAME PHONE 0 STORAGE ❑GARAGE ADDRESS ❑ MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF SERVICE SIZE OF MAIN CONDUCTORSNUMBER OF OF METERS _ NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS — REMOTE DISCONNECT REQUIRED? ❑YES 0 NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS //Z H,,9N.Oe F-,Z,S NUMBER OF SWITCHES NUMBER OF OUTLETS' NUMBER OF LIGHT FIXTURES /l NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS •vG/Y7 SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK 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. ISg2gi EI OT CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT 1 DATE 9 2 g D 8 Department of Public Safety Division of Fire,Emergency&Building Services Office of State Fire Marshal { Fax Note 7671 Dater LJ paoes� 1 Post it Fa > � ,/ t l To FromW aL e,� !1- CoMept. Co. Phone# Phone# STATE OF CONN Fax# Fax# On 3-8-06,the South Windsor Office of the Fire Marsnat conducted an inspection of Haven Health Center of South Windsor located at 1060 Main St.in the City/Town of South Windsor to determine the degree of compliance with the fire safety requirements of Connecticut General Statutes Chapter 541 as authorized by Section 29-305 of the statutes. This facility was evaluated as a existing Nursing Home as classified by the COAWECTICUT FIRE SAFETY CODE. As a result of this inspection,the following conditions were found: ❑ I. At the time of inspection,no code violations were identified, Certificate of approval recommended. ® II. At the time of inspection,conditions were discovered to be contrary to the minimum requirements of these codes. An acceptable plan of correction was submitted. (See attached information) Certificate of approval recommended. ❑ III. At the time of inspection,conditions were discovered to be contrary to minimum requirements of these codes. No approved plan of correction was submitted. (See attached information) Certificate of approval NOT recommended. ❑ IV. Based on the extreme hazard to public safety discovered at the time of inspection,this office is currently seeking an injunction from the court through our Town/City Attorney for the purpose of closing or restricting usage of this facility by the public. (See attached information) Certificate of approval NOT recommended. March 8,2006 Walt Summers,Fire Marshal Date City or Town: South Windsor IN FIRE PROTECTION EXTINGUISHERS, LLC REPORT FOR EXTINGUISHER (INSPECTION/SERVICE r SITE NAME W6?1/GV\ GQ l�G� ADDR S��,C10. ..✓�-- C CITY�Ol��1, (�y10')Q� STATEZIP 7 INSPECTION-ANNUAL �T �Z FIRE EXTINGUISHERS TAGGED & INSPECTED ❑ INSPECTION - MONTHLY ALL MEET NFPA 10 CODES AT TIME OF INSPECTION ❑ RETURN - INSPECTION ❑ SERVICE CALL IN elf (YEAR) A MAJORITY OF EXTINGUISHERS ❑ OTHER WILL BE IN NEED OF MANDATORY SERVICING Non-compliance issues: ❑ Fire Extinguishers Obstructed ❑ Improper Coverage [] Unprotected Areas ❑ No K-class Extinguisher in Kitchen ❑ Other Notes/Comments: DRY CHEM/CLEAN AGENT CO2 SERVICE/PARTS EXTINGUISHERS T Seal Cabinet REMOVED FOR SERVICE Pull Ring Valve Stem Hose Horn Hose Guage Continuity Test TOTAL# Band Handle Band Cover Wheeled Cover Other # ABC/ BC Cartridge # # CO2 # CLEAN AGENT INSTALLATION # K-CLASS r Extinguisher Fire Extin SIGNS& LABELS g � # H2O DOT Door Sticker Cabinets # OTHER Operating Pole Wrap Bracket # OTHER M.S.D.S. PlasticArrow Beam/Steel installation # OTHER Wall Arrow 3-D Sign On-site minor repair Authorized By Date/41A C.S.# < P.O.# EXT TYPE RECHG ONLY 6 YR MAINT HYDRO TEST CONDEMNED NEW LOANERS OTHER ABC/BC 2.5# 5# 10# 20# HALON 9# HALON 13# Coe # N/A # N/A H2O N/A K6/K2.5 N/A Au horizeu oSignatjite SITE Phone(860)289-7771 r Phone(860)704-8400 ext 254 i! Fax(860)289-3761 Fax(860)704-8088 /�i carmichaelCahavenhealthcare.com Lit iL1YEii 11E'•!I11G1S1 Cellular(860)301-9058A�/ 7 jblomgrenCahavenhealthcare.com r Joel Camikh�wl,M.Y.S. John Bkwrigmn AdlininWrator Senior Facility llanager t tAN'IiN f II:AL7'F f(:ARL'p1A1VACEDII's1`T 1 I.aVL:�t II;.aI,TH(:G;�"I'I:K of sot rl'H��'I:�Uti<)R low MAIN STREET 245 LONG HILL ROAD SOUTH WINDSOR.CONNECTICUT ON)74 MIDDLETOWN,CONNECTICUT 06457 w µ w.havenhealthcare.com w w w.havenhealtheare.com FIRE PROTECTION ALARMS LLC. FIRE ALARM TESTING AND INSPECTION REPORT NAME OF FACILITY J-Iayrr 11M1'kh GinXG p.R gOC (,- tg xnT ADDRESS Jof o itccIn 1:1 CITY nth w fnaSor STATE/ZIP FACILITY TYPE Mgy«i ncj lntnC DATE a/9 l a& INSPECTION CYCLE/ QUARTERLY_ SEMI-ANNUAL ANNUAL_ OTHER_ SYSTEM TYPE/ PROTECTED PREMISES—/ AUXILIARY_ REMOTE STATION_ EVAC_ STATUS OF SYSTEM PRIOR TO INSP. AeOr a, COMPLETION OF INSP. &o-y MGx,I INITIATING DEVICES INDICATING DEVICES INSTALLED TESTED FAILED INSTALLED TESTED FAILED SMOKE DET. 91 27 -4 HORN/STROBE A HEAT DET. 1 SPEAKER/STROBE _ PULL STATION HORN DUCT DET. _ _ _ VISUAL BEAM DET. _ _ _ SPEAKER FLAME DET. _ _ _ BELL CONTROL FUNCTIONS MISC. DOOR HOLDER 13 _ SYSTEM ON GENERATOR YES NO DOOR REL. _ _ _ SYSTEM VOLTAGE PRI.126_ SEC.2wc AC SHUTDOWN _ _ QUANTITY OF NAC PANELS_ MONITORED BY n. CONTROL PANEL MONITORING ACCT. # :1 7 3 9 SYSTEM MAKE/MODEL Fi TC I i:4,- Mi n% Se-Ajn lI o' AJ.A QTY OF ZONES 14 ACTIVE_ SPARE_ 0 ADDRESSABLE/CONVENTIONAL Gan QTY OF SPARE ZONES Q QTY OF NAC PANELS QTY OF NAC CIRCUITS I BATTERY QTY. Q AMP/HR 7-,Jr DATE INSTALLED ACTUAL AMP/HR PASS t" FAIL COMMENTS AND OR FAILURES l2i[2 zv crk tC5 t- h a rn/s+rob c S AUTHORIZED � T CI�M�T�ICC � A � ./Liv.n FP PEF i �•.,J FIRE PROTECTION ALARMS LLC.• 1701 HIGHLAND AVENUE• CHESHIRE,CT 06410.203-250-1115 CTTV FIRE PROTECTION TESTING,INC. REPORT OF INSPECTION 3 TESTING OF FIRE SPRINKLER SYSTEM Z �� Inspection Report No. Contract No. Information on this form covers the minimum requirements of NFPA 25-1999 for fire sprinkler systems connected to distribution systems without _supplemental tanks or fire pumps. PORT FOR E Aj ADDRESS Date of Inspection: Z I E3 All responses refer to the current inspection performed on this date. This inspection i416 Quarterly;Q Semiannual;0 Annual;0 Third Year; 0 Fifth Year PART I - Owner s Section A. Is the budding occupied? ID Yes ❑ No ❑ N/A B. Has the occupancy classification and hazard of contents remained the same since the last inspection? O)(as ❑ No ❑ N/A C. Are all fire protection systems in service? Ef as ❑ No ❑ N/A D. Has the system remained in service without modification since the last inspection? d Yes ❑ No ❑ N/A E. Was the system free of actuations of devices or alarms since the last inspection: eYes ❑ No ❑ N/A PART If - Inspector's Section A. Inspections G. Fire Department Connections: 1. Daily, or weekly if low temperature alarms are installed 1. Visible and accessible? Yes ❑ No ❑ N/A Enclosures around dry-pipe, preaction or deluge valves maintaintn 2. Couplings and swivels not damaged and minimum of 40°F? ❑Yes ❑ No N/A rotate smoothty? as ❑ No ❑ N/A 2. Weekly Inspection Items 3. Plugs or caps in place and undamaged? es ❑ No ❑ N/A A. Preaction and Deluge Vatves: / 4. Gaskets in place and in good condition? Ves ❑ No ❑ N/A 1. Free from physical damage? ❑Yes ❑ No /A 5. Identification sign(s) in place? 0 Yes ❑ No ❑ N/A 2. Trim valves in appropriate(open or dosed) position and no lee 6. Check valve is not leaking? ZYes ❑ No ❑ N/A from valve seat? ❑Yes ❑ No fl/A 7. Automatic drain valve in place and 3. Electrical components in service? ❑Yes ❑ No 8 N/A operating property? eYes ❑ No ❑ N/A B. Dry-Pipe Valves: / (Note:If plugs or caps are not/n place, inspect the interior for 1- 1. Free from physical damage? ❑Yes ❑ No ❑ N/A obstructions and verify that the valve clapper/s operational over Its full 2. Trim valves in appropriate (open or dosed) ran9e 1 position? ❑Yes ❑ No /A S. Quarterly Inspection Item 3. No leakage from intermediate charnber? ❑Yes ❑ No �/A Hydraulic nameplate, if provided, securely attached to nser end Relief port on reduced pressure backdlow prevention assemblies firitp of legible? ❑Yes Ef No ❑ N/A onbnuous discharge? ❑Yes ❑ No C N/A eekly Inspections items which can be performed monthly if the 6. Annual Inspection Items items are electrically supervised or secured with locks A. Visible sprinklers: 1 A. Gauges on dry, preaction and deluge systems in good condition a 1. Free of corrosion? i[J Yes ❑ No ❑ N/A showing normal air and water pressure? ❑Yes ❑ No 0 N/A 2. Free of obstructions to spray patterns? 11 lkes ❑ No ❑ N/A B. Control valves: ` 3. Free of foreign materials including paint? A3 Yes ❑ No ❑ N/A 1. In normal (open or dosed) position? 1O Yes ❑ No ❑ N/A 4. Free of physical damage? �iYes ❑ No ❑ N/A 2. Sealed, locked or supervised? as ❑ No ❑ N/A B. Visible pipe: 3. Accessible? Yes ❑ No ❑ N/A 1. In good condition? Yes ❑ No ❑ N/A C. Isolation valves on backflow prevention assem- 2. Free of mechanical damage and not leaking( Yes ❑ No ❑ N/A blies in open position? 1`Yes ❑ No ❑ N/A 3. No external corrosion? -{ Yes ❑ No ❑ N/A 4. Monthly Inspection Items 4. Property aligned? ��Yes ❑ No ❑ N/A A. Proper number and type of spare sprinklers? �1Yes ❑ No ❑ N/A 5. No external loads? Wes ❑ No ❑ N/A B. Sprinkler wrench with spare sprinklers? 1L Yes ❑ No ❑ N/A C. Visible pipe hangers and seismic braces not C. Gauges on wet-pipe system in good condition and,showing normal damaged or loose? Yes ❑ No [I N/A water supply pressure? -d Yes ❑ No ❑ N/A D. Adequate heat available to areas where wet sprinkler piping is located? D. Alarm devices free from physical damage and all electrical connections (Must be done before cold weather.) tJ Yes ❑ No ❑ N/A secure? f]Yes ❑ No ❑ N/A 7. Annual, or every fifth year for valves which can be roast without E. Alarm Valves: opening: 1. Gauges indicating normal supply water Interior of dry-pipe, preaction and deluge valves passed internal f pressure? as ❑ No ❑ N/A inspection? ❑ Yes ❑ No 6 NIA 2. Free from physical damage? Yes ❑ No ❑ N/A S. Fifth Year Inspection Items 3. Valves in appropriate (open or dosed) A. Alarm valves and their associated strainers, filters and restriction position? dYes ❑ No ❑ N/A orifices passed internal inspection? ❑Yes ❑ No I!1�N/A 4. No leakage from retarding chamber of alarm B. Check valves internally inspected and all parts operate properly, m e drains? U1 Yes ❑ No ❑ N/A freely and are in good condition? ❑ Yes ❑ No 0 /A F. Sprinkler Pressure Regulating Control Valves: / C. Strainers, filters, restricted onfices and diaphragm chambers on dry- 1. In open positron? [3 Yes ❑ No f'J�I/A pipe, preaction and deluge valves passed 2. Not teal king? ❑Yes ❑ No N/A intemal inspection? ❑Yes ❑ No ESN/A 3. Maintaining downstream pressure per design / criteria? ❑Yes ❑ No d�/A In good condition w/handwheels not broken?❑Yes ❑ No C N/A Authorized S nature Inspector Date ` License No. FIRE PROTECTION TESTING, INC. • 1701 HIGHLAND AVENUE • CHESHIRE, CT 06410 • 203-250-1115 SHEET 1 OF 2 Rev.10/02 CUSTOMER DISCLAIMER The Fire Protection team,Fire Protection Testing, Inc., Fire P'irotection Alarms,LLC, Fire Protection Suppression, LLC and Fire Protection Extinguisher,LLC,hereinafter collectively"Fire Protection",and the Customer agree that it is impractical and extremely difficult to fix actual damages which may arise due to the faulty operation of the system(s)or failure of any Fire Protection device or failure to perform,damage to the customer's system(s),or negligent performance of services; if, notwithstanding the above provisions,there should arise any liability on the part of Fire Protection,such liability shall be limited to an amount equal to the price of services performed pursuant to this Agreement. Where this Agreement covers multiple sites, liability shall be limited to the amount of the Agreement price allocable to the site where the incident occurred. Such sum shall be complete and exclusive and shall be paid and received as liquidated damages and not as a penalty. If the Customer desires Fire Protection to assume greater liability, the parties shall amend this agreement by attaching a rider setting forth the amount of additional liability and the additional amount payable by the Customer for the assumption by Fire Protection of such greater liability, provided however that such rider shall in no way be interpreted to hold-Fire Protection as an insurer. IN NO EVENT SHALL FIRE PROTECTION BE LIABLE FOR ANY DAMAGE, LOSS, INJURY OR ANY OTHER CLAIM ARISING FROM ANY SERVICING, ALTERATIONS,MODIFICATIONS,CHANGES,OR MOVEMENTS OF THE SYSTEM(S) OR ANY OF ITS COMPONENT PARTS BY THE CUSTOMER OR ANY THIRD PARTY. IN ADDITION, FIRE PROTECTION SHALL NOT BE RESPONSIBLE FOR INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES OF ANY,KIND INCLUDING BUT NOT LIMITED TO DAMAGES ARISING FROM THE USE,LOSS OF USE,PERFORMANCE OR FAILURE OF THE SYSTEM(S)TO PERFORM. The Customer does hereby, for itself and all others claiming for it under this Agreement, • release and discharge Fire Protection from and against all hazards covered by all of the Customer's insurance, it being expressly agreed and understood that no insurance company or insurer will have any right of subrogation against Fire Protection. It is understood and agreed by the by the Customer that Fire Protection is not an insurer and thahnsurance covering personal injury and property damage on the Customer's premises shall be obtaihed by the Customer;that the Customer agrees to look exclusively to the Customer's insurmto recover for injuries or damage in the event of any loss or injury;that the amounts payable to the Fire Protection hereunder are based upon the value of the services and the scope of liability set forth hereini.that Fire Protection is not guaranteeing that no loss will occur; and Customer agrees that Fire Protection is not responsible for any losses which Tay occur. EXCEPT AS EXPRESSLY SET FORTH HEREIN,FIRE PROTECTION DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED. INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT TO THE SERVICES PERFORMED OR THE.PRODUCTS, SYSTEMS OR EQUIPMENT SUPPORTED HEREUNDER. y~ • Contract# ��N #of Systems This Sys. # F. Preaction and deluge valves full flow trip test: (except deluge valves Wet Dry Other where water can't be discharged) B. Testing 1. Water discharge from all nozzles unimpeded?[] Yes ❑ No I4A The following tests are to be performed at the noted intervals. Report 2. Pressure reading at hydraulically most remote nozzle i y failures on Part III of this form. 3. Residual pressure reading at valve psi. Quarterly Tests Was flow observed? ❑ Yes ❑ No f�/A A. Sprinkler system main drain 4. Are above readings comparable to design? ❑ Yes ❑ No A 1. Static Pressure / ! psi and Resi al Pressure 5. Manual activation devices passed test? ❑ Yes ❑ No NIA psi. Was flow observed? PrYes ❑ No ❑ N/A 6 Automatic air pressure maintenance devices I 2. Are results comparable to previous tests? es ❑ No ❑ N/A passed test? ❑ Yes ❑ No ❑ NiA P B. Waterflow alarm devices passed tests? �' es ❑ No ❑ N/A G. Dry-pipe valve partial flow trip test: Last tested_ 1. Record initial air pressure t. Inspectors test connection opened. (wet-pipe wh not in freezing p ssu a psi and water pressure psi. weather) Yes ❑ No ❑ N/A 2. Record tripping air pressure psi and tripping time (sec.) 2. Bypass connection opened? (wet-pipe systems in treeziny weather, 3. Are above results comparable to previous dry-pipe, preaction or deluge). []Yes PlNo ❑ N/A tests? ❑ Yes ❑ No rT N/A 3. Alarms actuated? 01Yes ❑ No ❑ N/A H. Automatic air maintenance devices on dry-pipe and preaction systems 4. Was flow observed? P111(es ❑ No ❑N/A passed test? ❑files ❑ No Cf N/A C. Control Valves (except OS&Y and gear-operating indicating butterfly I. Backflow devi7uu be5ackflow test? Yes ❑ No ❑ N/A valves)opened until spring or torsion is felt in the rod, then closed Last tested back one-quarter turn? [] Yes ❑ No P�f4/A J. Backhow devices passed main drain test? ZYes ❑ No ❑ N D. Priming water level passed test in dry-pipe and K. All sprinkler pressure regulating control valves —` preaction systems? ❑ Yes ❑ No }X'N/A passed full flow test? ❑Yes ❑ No I2'N A E. Low air pressure signal in dry-pipe and 4. Dry-pipe full flow trip test to be done every third year: preaction systems passed test? ❑ Yes ❑ No ❑N/A A. Dry-pipe full flow trip test: Last tested 2. Semiannual Test / 1. Record initial air pressure psi and water pressure psi. Quick opening devices passed test? ❑Yes ❑ No f7 N/A 2. Record tripping air pressure psi and trapping time (sec 3. Annual Tests i 3. Was water delivered to inspector's / A. Are all sprinklers in service dated 1920 or later? Yes ❑ No ❑ N/A test connection? ❑ Yes ❑ No FI N:A B. Fast Response sprinklers in service for less than 20 years? , 4. Are above results comparable to previous (If'no'test sample now and every 10 years.) ❑ Yes ❑ No E3 N/A tests? ❑ Yes ❑ No J!1'N/A C. Standard sprinklers in service for less than 50 year 5. Tests to be done every fifth year. (If"no'test sample now and every 10 years.) El Yes ❑ No ❑�ItA A. Extra High, Very Extra High and Ultra High Temperature sprinklers D. Specific gravity of antifreeze correct? ❑ Yes ❑ No N/A tested? ❑ Yes ❑ No �UA E. Fire pump full flow test last tested NoN� B. Gauges checked against calibrated gauge or / replaced? ❑ Yes ❑ No f� A C. Backflow full flow test? ❑Yes ❑ No BZA See Control Valve Maintenance Table. CONTROL VALVE MAINTENANCE TABLE control valves Number Type Open Severed Closed Signs Explain Abnormal Conditions City Connection Control Valve Tank Control Valves Pump Control Valves Sectional Control Valves . r System Control Valves Other Control Valves Test Header Bypass Water Flow Test at Sprinkler Riser Water Supply Source: C Tank Pump Test Pipe Size of Static Residual(Flow) Date Location Test Pipe Pressure Press r Last Water Flow Test 1 i This Water Flow Test Adjustments or corrections made during this inspection: Comments: Signature Date: Is separate form being used for multiple valves? ❑ Yes 1121"No Is separate form being used for monthly or weekly inspections?❑Yes O/o SHEET 2 NEWFORM5.FPT CUSTOMER _ _ �� • • i� i I i I i C'I K— R 0000 , i vROE AFri o. +~r P,v /3g.")K-7 . 0 �Q - � vi �T/4,A/7— C�e j O IA) Ci/ k �Zc9it�C i4L G i �{FR4-7.f G�4�?E C74M MR oO a ♦N I 76 �� 1," �_� i rt C I =Y � fl Zt- I t i4Y i C n r^ f �3L 7 0/Z 7,4Ai lr ' � AoM�u I � d f oFF EEcPI.� t 77 o 0,9 �;1 Q-ENFR,4lo,p r3. PA'�ff NT pp { { Kit�irtN I � rY J A B C N - - y � W E �R HILL AL PO ELLSNORiH •R.. �?;; . «� r,', .''•� J SCHOOL � 7 V, ,e-x; ;t.•:�, -._` + � S by- ' ' P.S.MACHINE CO. SpwWbW4 in LWw Wort %_+F 4 Nzat dad 74" - 7.. ? Z -�sv �' •�,. i ^rea 1. LAVOIE TRUCKING CO. NEAVYHAULING Is rRo S �• ,> iunob"owl.lew SaM Wlndwr Office Supply �rx Ole"M4pIM GLFN�LF4c NEW ENGLAND _ MACHINE A TOOL CO J 3 L MACHINE CO. 3 gaa- �� T p� a O��EC.yO cv I>01>:lTOa1LIOl1LI [S EIW F SOUTH 1AlINDSOR g�DVF ` CONVALESCENT HOME r RO ahay v t11111 ML 00LEM u „ "v _ •fa:Win-rj�-a��''. - `. 4�1 - } tw WINDSOR STEEL CORP. PO tMSCO10 R4 w n a y.1f� qs�T � UNION 5LH00L �'O - • . . - • - CERTIFIED 1060 SOUTH WINDSOR MAIN STREET URSING CENTER _ IIII I III II I II II I I U.S. POSTHGG PMIO SOUTH WINDSOR, CT 06074 �so='4"�' Z 024 133 637 OCT 1s. 98 �nour<- $3.00 06G7-1 Chief William Lanning Fire Marshall ` Town of South Windsor 4 II 1175 Ellington Rd. South Windsor, CT 06074 T 1 1 SOUTH WINDSOR NURSING CENTER 1060 MAIN STREET (860)289-7771 SOUTH WINDSOR,CONNECTICUT OW74 FAX#(860)289-3761 I October 16, 1998 Chief William Lanning Fire Marshall Town of South Windsor 1175 Ellington Rd. South Windsor,CT 06074 Dear Chief Lanning: Enclosed is a copy of a letter to the State of Connecticut Bureau of Waste Management concerning our underground storage tank on the property. The instructions were to send you Copy#2 of the form. I am also including copies of other material we provided to them. Sincerely, Albert P.Mislow,Sr. Administrator enc. I i Dol �pquyy"pr:,� 'o / and Museum IY \ f.C_ANDL[YI tiR[R %tt 7.i.H..�.CN1NDl[R l II fyl :.J 2 3•X�ID J i. 1 f �q` sIssec .. Bancroft ►"t�° l Air Strip / h N 4�rt C? •.,- - • . I Rive, R Sill House \ Fvier House m East v Milo Peck i 9�y Community Center \� V1 ridso iii fall 6095 194 ►7-1. Nil Qj Johnthan r �% } Edwards Cem. 4 w ar oe o O d v� Ba�c�o/t l '0 �9h F o sp ,-`QP Brickyard �•1 Pond 06MI .oar V o r � t D�C,hQ, i ��I•!O �' r?0 h1 RD f R1'°,p W3 tp O Center r I '•F'�r 0{C• ` e\DME�t ite Boat �p ndu = I inching Park ��E ` i 1 y \he��f�+r '*O R D •� ~ � Osttt met \•,/ S O U t h �� •o Gr`- \ `r r Windsor ��_ �"buN enrK�w OCornRo�rt»�f Location Map f i N '•ri' v '�� fit•• `/: s / A d� / �F , ;// `7/ r,' ✓ 4�N .%' '`• '.!�^ jam.:•,• '•_. �ONN c � r o 0 •C A SKi �•• fFFA gro d /'. / 0 r 4 0 M m Y C'• o Cr, i p` QO i o • , �. �• TE S /• -�.� l i � d d d0 �UTN' N t /i / % •/ h�' Op oT We- - d N 0 f � , i O • ELOON / :a Mitchell Fad C0, 111c. 1209 SULLIVAN AVENUE SOME M114D.130H, Cr 06074 Phone 644r-2561 f1AME UAI ' nDnllEss — r QhtA�S •�•� vMxe- ,rye PIIONE 11EClOITIED ..Y6'S'11Q+ :01co .r It(U 5 SEnVICEMAN TIME SI I11ED A M IIME FINISHED A M P M I kl MI SIACK tf klP UITAFT O D COr SMOKE OFIAFT O F. COMBINED F—d F I EFfIC1E11CY Service I orlormed: ❑ Cleaned Smoke Pipe U Checked Thormoslel ❑ Oiled MO., ❑Cleaned Conhols ❑Cleaned Clmmney nag" ❑ Checked Pump ❑ Oiled nhrwels ❑ Cleaned Butner ❑ Changed Nmele •G Cheeked Drell ❑ Orled 0w.lelor ❑ Cloened Boller ❑ Changed Filler ❑ Adlusled Flan, PATHS and MAMMALS: � r I r>> J COST OF PAI11 S 101AL TINE OL PE Fe I1011T1 C11S1 or LA8011 TAX TIIIS IS YOUR INVOICE PAY TINS AMOUNT CUSICIMEIT•S SIONATUFIE I X J/ �1 •; �i.�r�7• •It•••t• fir'•' .�1� I!'•, .'tr• "� ••F� I • "•r • i.. -0. UNDERGROL1 D STORAGE f PG of —� STATE Onvir Environmental or�+{n 7r ' EPHM-6 Rev 5i94 A DATE ENTERED 2. Department of Environmental Proteu,on FOR STATE Q FACILITY NOTIFICATION UNDERGROUND STORAGE FACILITIES PROGRAM � A 3' AGENCY USE ONLY Management Bureau of Waste Z � 9 � B FEE BILLED C.FEE RECEIVED O 79 ELM STREET. Hartford,CT 06106-517., E FIRST U a ❑ NOTIFICATION g TEL.(860)424-3374 '— w OR SITE I D C;. D.GRID COORDINATES E.DOES FACILITY MEET NEW REOUIREMENTS� cn PLEASE TYPE OR PRINT.ALL THREE COPIES MU LEGIBLE _ �/ �/ b ❑ SUBSEQUENT (rl',checked X T ❑ YES ❑ NO NOTIFICATION .! ef.,Ch cke '� Refer to INSTRUCTIONS FOR FILING NOTIFICATION b Meting for�- LOCATION `T E NO AND STREET NEAREST INT G STREET CITY OR T WN STATE 5 LATIo DE r I LONGITUDE 4, OF FACILITY J BUSINESS NAME AND O. ND STREET rC7 CITY OR OWN TE ZIP CODE TELEPHONE 6. MAILING ADDRESS I V�r Jam^ O--r ( Gvl, �71L A D STR { � Y OR TOWN ST TE ZIP CODE TELEPHONE n0 f % -�I�� Z 7. FACILITY OWNER IQ ( 0 ) 0 �i-- .�— p ir _ U 8. TYPE OF OWNER PRIVATE ❑ STATE ❑ MUNICIPAL LJ FEDER . NO. ). w OPERATOR/CONTAC `_, 1`/ n I NO AND STREET CIT OR T WN STATE ZIP C(ZE TELEPHONE 9. PERSON # :4`'c' r-lr I✓ t! ? 7/ - 10. 91a. "11 12a. 12b. ry13 P OF 5' ""' } '' 15.CONSTR ION 16.PROTECTION - 17. NTE�kRAb 18. 1 -FAILURE CONTENTS MATERIALS a.INTERNAL b.EXTERNAL PIPING SYSTEM DETERMINATION b. CONDUCTED? } o o z z z„ DATE OF MONITORING TANK I.D. DATE OF TOTAL EST.QUANTITY DATE c� CHEMICAL NAME OF PRINCIPAL E E z z N ww I o rnw o 0 00 o UO o 4� om INSTALLATION A CAPACITY w z O LEFT STORED w TANK o a o SUBSTANCE ¢U O ¢_ o w o o w p ¢ G y INSTALLATION SYSTEM (If`YE$ enter"DATE" Mo./Yr. " rn O > . o v— w -¢- w a w z 0 0 w o O v w in Q N ( ) a r (Gals.) 0 c a (If arty) O LAST W cc (not trade name) w 0D+n ==y z =w <a =w ==H wo OR and attach results)- W ? z a I Gals. USED .a w (Enter C.A.S.No.,if known) r~i? wz a 4� G z F o d REPLACEMENT (Specify type (If"NO".enter"NO") W— az I ( 1 w _ Y Qoa ao O ao on ow 0=N c— Q (Mo.Nr.) J O w¢ rn c�a c�a¢ u� �a a (Mo.Yc) from list B) Example 5/75 39 5000 X Heating fuel#2 ka, X H 3 H -5/75 U - NO Example 7/60 — 8000 X 8/78 X 1,1,1,-Tricloroethane X X E 7 -W "7/60 U — CAS#79016 1/07 0 Dtrf. 01 z .J , L o ti X to to T { i i 20.HAVE YOU ATTACHED SKEIN OF TANKS AND LOCATION? YES 22.CERTIFICATION:I certify under penalty of law thAf I.have personally,examined 22a.SI TURE 22b.DATE SIGNED r) I and am familiar with the information submitted In this and all attached documents and that Z 21.COMMENTS: O based on my Inquiry ofthose individuals immediately responsible for obtaining the information, X 7 11 11VAR I believe that the submitted infonnabon Is true,accurate and Lomplete. 22 y Pr „ 22d.OFFICIAL ITLE o wne r authorizedO Penalties:any ownerwho knowingly fails to notify shall be subject to a twit penalty not to represenfatrve) w 0 exceed$10 000 for each tank for which notification is not given or for which false Information is submitted. COPY 2. SEND TO LOCAL FIRE MARSHAL UNDERGROUND STORAGE PG of I STATE OF CONNECTICUT Department of Environmental Protection EPHM 6 NEW 10/85 2 A.SITE I.D. a FACILITY NOTIFICATION UNDERGROUND STORAGE FACILITIES PROGRAM 3. FOR STATE HAZARDOUS MATERIALS MANAGEMENT UNIT AGENCY USE ONLY z 165 Capitol Avenue,Hartford,CT 06106 O ® FIRST _ - ____ B.DATE RCVD BY D.E.P C.DATE ENTERED F la. NOTIFICATION — TEL, 556-4630 U SITE LD. Lu OR SUBSEQUENT (if checked, PLEASE TYPE.ALL THREE COPIES MUST BE LEGIBLE! •y`•rY'r D.GRID COORDINATES E.DOES FACILITY MEET NEW REQUIREMENTS? b. ❑ NOTIFICATION enter No.) Refer to INSTRUCTIONS FOR FILING NOTIFICATION before completing form. Ix Y 1 ❑YES ❑NO SITE NAME NO.AND STREET NEAREST INTERSECTING STREET CITY OR TOWN STATE S.LATITUDE t LONGITUDE LOCATION p I Q 4. OF FACILITYCAJI(AJE—�CF— hl /� •} _ y9-3o FI 72'-11, BUSINESS NAME AND NAME _ NO AND STREET CITY OR TOWN STATE ZIP CODE TELEPHONE 6. MAILING ADDRESS JA lq r S�ro G co NAME�•e NO AND STREET ` CITY OR TOWN STATE ZIP CODE TELEPHONE y 0 7. FACILITY OWNER J ? /L 60 �IFwpF/I(/� • � /"� 6 60 f�03 1 �.( �Q-F N 8. TYPE OF OWNER 12 PRIVATE ❑ STATE ❑ MUNICIPAL ❑ FEDERAL(G.S.A.No. OPERATOR]CONTAC NAME NO AND STREET TY OR TOWN ST TE ZIP CODE TELEPHONE 9. PERSON A Il pt �D/0 AM/� ( I � -77 71 10. 110. 11b. 12a. 12 b. STATUS 13. TYPE OF 14. CONTENTS- 15.CONSTRUCTION 16-PROTECTION 17. INTEGRAL >- DATE CONTENTS MATERIALS N RNAL b. EXTERNAL PIPING SYSTEM 16. 19. FAILURE DATE OF z_ TOTAL O ( EST.QUANTITY CHEMICAL NAME OF PRINCIPAL a. b. DATE OF MONITORING DETERMINATION TANK ID. F w TANK u _ ti a v—z z INSTALLATION V d CAPACITY Z V I LEFT STORED O SUBSTANCE v w Q O �O U z _ INSTALLATION O p v O— O w O m 0j SYSTEM CONDUCTED. w O Q w LAST o: Q not trade name. w ~ w a = '° OR o.� (Gals.) O > �.C1 U O O u-`; w O V t-o_ O V w _ o v < (if"YES",enter DATE' (Mo./Yr.) x o w o_ ( (il any). O w o: O ss:LL Q = d O z =t+s Q Q = m— UD Z W wg w Z USED o_o_ — (Enter C.A.S. No. If known) w z �- a E w <0 o: �� a E < = REPLACEMENT w�- Q z I (Gals.) � w O r w m—a O�o Q O G O rn o f O (Specify type and attach results). Z Q 1 (Mo./Yr.) O W V N •� ? V a V 3 U w = o _ (Mo./Yr.) from list 8) If"NO",enter"NO") p 5/75 30 5000 X X Heating fuel#2 X I X H 5 5/75 U N0 Example y fl Example 7/60 - 8000 X 8/78 X ICl/lr"CrASI#790 6ne X X E 7 7/60 U — 7 000 X I X NE41'1I0c F tk X X 7 7/67 0 IV O W N 20. HAVE YOU ATTACHED SKETCH OF TANKS AND LOCATION? ® YES, ( 22.CERTIFICATION: I certify under penalty of law that I have personally a SIGNATURE 22b DATE SIGNED y / ,'t�i��uf t6" r �` examined and am familiar with the information submitted in this and all attached e( z 21. COMMENTS: `w documents and that based on my inquiry of those individuals immediately responsible X O "/ A 111 / ' 'ma`s► for obtaining the information,1 believe that the submitted my fails ion o true, a4flz- 2-4.�;4' H -��i^�y—r• " / accurate and complete.Penalties:any owner who knowingly fails to notify shot!be V 22d.OFFICIAL TITLE of owner or authorized W to is ta o civil penalty not to exceed$10,000 for each tank for which notification 22c.NAME(Type or Pony /I S representative). is not given or for which false information is submitted. �/ `� �JJ �• COPY 2 . SEND TO LOCAL FIRE MARSHAL [ f /' }� f�>L D W,4 V.x r�G O L C ?%-L 70vc:' 13 ./ cG✓>L./Nr SF - `1 1✓�zc.�1 Z 5r',��o Zicv c_�� ? Sur'rLy F"r'ar�'� :Lf 7:7 >'4 64>--2 i2,17j f.t Er I is I � 1I I � Ll 1 i i i I II li I I t I t i t I I I I j _ I ,j Oo Mz 4 i I Er' r•/ j �I I f 4! _ I y��}��X//v►:!il�� J '✓ ' I lV i ?•+�i! L.7`—J �J 1 !•1 Y 'J I "J ! ' i,'' H V{vl 1.� --------- I �lrcc�seii�aM F. r♦ �'•1 l NOTES: FILL BOX 1.) OXYGEN STORAGE REQUIREMENTS TO MEET SEE DP-1 OVER C NCRETE PAD REQUIREMENTS OF NFPA 99, 1999 EDITION PER CT STATE BUILDING CODE MODIFICATION. SEE DP-1 2.) SEE DRAWING D-1 FOR ADDITIONAL SPECIFICATIONS. EXISTING STORAGE T� 3.) EXISTING WALL CONSTRUCTION: VAPORPROOFLIGHT DEDICATED EXHAUST FAN 7� BRICK CLAD WITH GYPS STORE O ® 24 HOUR CONTINUOUS SPRINKLER STEEL FRAMING,3 1/2"WITH ONE LAYER 5/8"GYPSUM BOTH SIDES POURED CONCRETE FLOOR FIRE DOOR SELF CLOSING I HOUR RATING OFFICE SERVICE ACCESS AREA STORE TECHNICAL GAS PRODUCTS STRATFORD CT 203-380-8270 REVISED BY OXYGEN STORAGE ROOM DATE: SCALE: FILE NAME FP-1 I REQUIREMENTS OF AN OXYGEN STORAGE AND TRANSFILL ROOM TANK INTERCONNECT PIPING SPECIFICATIONS TGP and NFPA 99 STANDARDS for HEALTHCARE FACILITIES, 1999 Edition FILL,VENT AND SAFETY RELIEF LINES: ITEM NFPA Ref. DESCRIPTION Cylinders shall meet DOT specifications and be yroperly labeled 1.)PIPING TO BE STAINLESS STEEL 304,0.625" O.D., 0.045" WALL 1 4-3.1.1.1 a to c Sources ofheat shall not cause the room temperature to azceed 130F 2.)WORKING PRESSURE; 90 PSI 2 4-3.1.1.2 a(1) Enclosure shall be eanstroc,edwith materials with a minimum fire raring ofone hour. 3.)MAXIMUN ALLOWABLE PRESSURE; 1500 PSI 3 4-3.1.1.2 a(2) Flammable gases shall not be stored in room.Single purpose enclosure, 4 F4-3.1.1.2 a(3) Cylinders shah be protected from damage with appropriate mcks w fastemws. 4.}TEST PRESSURE;200 PSI. Electrical in storage location shall conform to MA 70,Natl Else Code far ordinary location. 5.)MECHANICAL OR WELDED JOINTS ONLY,NO BRAZED JOINTS. 5 .2 a(4) Electrical fixtures,switches,outlets&hall be at a min.of 5 fr shove floor. 6.)NO PERMANENTLY CONCEALED JOINTS 6 4-3.1.1.2 a(5) Storage area shell be kept free of flammable materials. gtoraget�,,d&hanbeyromctedfrom&oumssofdhesthsat. 7.)DIRECTION CHANGES TO BE BY 3" RADIUS BENDER WHENEVER POSSIBLE 7 4-3.1.1.2 a(6) Combustible materials shall not be&tomdinroom, 8.}TUBING TO BE CLEANED FOR OXYGEN SERVICE 8 4-3.1.1.2 a(7) 9.) SUPPORT EVERY 6'MINIMUM 9 4-3.1.1.2 a(8) Cylinder caps shall be secured tightly in place when cylinders we not in service. Containers"I raw be a,oredinatighly ealeesed space. 10.)TOTAL PIPING RUN NOT TO EXCEED 30' FROM TANK TO FILL BOX 10 4-3.1.1.2 a(9) Storage shall be used only for the emerge ofnon-flammable gasea. 11 4-3.1.1.2 a(10 e Adequate ventilation shall be provided. Walls,noon,ceilings,roofs,doors,int.finish,shelves,racks 12 4-3.1.1.2 a(I l a) wad supports shall be contracted ofnon comhusfible or limited combustible materials. 13 4-3.1.1.2 a(11 b) Location shall sot communicate with anesthetizing location or stomge locations for flammable anesthetizing agents. 14 4-3.1.1.2 a(1 1 C) Enclosures span be provided with doors or gates that can be locked. Ordinary electrical wall fixtures in mom shall be installed 15 4-3.1.1.2 a(11 d) s fr above floor. Enclosures located near sources ofhew shall be protected from temparawes exceeding 130 F.Open e1w.conductors 16 4-3.1.1.2 a(11 e) wad tranfomters shall not be located in close proximity.Flammable liquids shall not located adjacent to storage. 17 4-3.1.1.2 a(1 1 f) Smoking shall be prohibited in storage room. 18 4-3.1.1.2 a(1 1 g) Heating shall be by steam,hot water,or other indirect means. 19 4-3.1.1.2 b (1) Oxygen storage exceeding 20,000 cf(174 gallon)shall be located outside and comply with NFPA 50. Walls,flown,ceilings of storage rooms with total capacity above 3000 of 20 4-3.1.1.2 b (3) shall be cwntructed of materiels with a fro rating of one hour minimum. Location for supply systems of move than 3000 cf shall be vented to the outside by a dedicated 21 4-3.1.1.2 b(4) mechanical ventilation system or navel venting with a min.of 72 sq in free area. 7mnfilling shall be separate frwo patient area and be 22 88-6.2.5.2 a constructed of s fire resistance barrier of one how. ti The tranaftll area shall be mechanically vented,is sprinklemd,and has 23 8-6.2.5.2 b ceramic or concrete flooring. The mmaftll was shall be posted with sign Indicating the transfdling 24 8-6.2.5.2 c ofoxygen and ihatsmoking is sot permitted. Main storage vessel safety relief valves and venting devices shall be piped 25 TGP spec to the exterior of the building to prevent discharge into the storage room. Main storage vessel shall be properly labeled with DOT,OHSA,Company info, 26 TGP spec No smoking sign and valves and gages shall be labeled. Main storage vessel sball be seared to floor to prevent tipping,piping shall 27 TGP spec be supported. TECHNICAL GAS PRODUCTS abbe— STRATFORD CT 203-380-8270 REVISED BY EXISTING OXYGEN STORAGE ROOM PLAN VIEW DATE: s-,s-oz SCALE: ix-i-o,, FILENAME MONTOWESE HEALTH CARE D-1 I TO OXYSAF TO BUILNG EX STORAGE VESSEL REINIO EFILLBOXRIOR I i TL1 I -------------------------------1 --—————— —————— I IC PIPING CONNECTION PONT I T P-1 I SUPPLIED BY TGP,SWAGELOCK I I TYPE FITTING OR EQUtV. 1 L-2 P-2 1 PCV-i ——— — I V4 L V-6 I I 1 I i 1 1 CV-3 V-3 I 1 RV-1 i 1 -- - '\ I 1 V-8 V-7 PCV-7 SPV-1FIELD 1 RD-2 TECIINION NE CIAN IIC� BY 1 I I I 01010 C 3 C-g I I I I I I I I I I I I --------------------------------1 I REMOTE FILL STATION I OXYSAFE RV-3 I CRYOGENIC ' V-1 I I STORAGE VESSEL I I 600 LITER I I I I I I I I I I C2 SP-1 --- ---I I I I I i I I I I � I I I I I SP-2 ——— __ I i LIQUID OXYGEN RESERVOIR I I V-1 LIQUID WITHDRAW VALVE IPHERE V-3 PRESSURE BUILD ISOLATION VALVE �� XCIERNATMOBUILDI VS GAGE HP ISOLATION AL PCV5 PRESS SURE HU�IL PRESSURB OCIU.LOVLAIVVEE (FXT�NAL TO BUILDING V-S GE IS T[ON VALVB Ve'.P-1 ' Technical Gas Products V-7 VENTIFULL TRYCOCK VALVE PCV-7 AUTOVENTPRESSURECONTROL VALVE V-8 RPMOIE TOP FIIL VALVE RV-1 STORAGE VESSEL SAFETY RIISEF VALVE RV-3 LIQUID WITHDRAW MANIFOLD SAFETY REI.IFF VALVE Stratford CT 203-380-8270 C-2 LIQUID WITHDRAW CONNECTION CV-3 PRESSURE BUILD CHECKVALVE C-I REMOTE TOPPBYCONNECTION VIE BY OXYSAFE(E)MEDICAL LIQUID OXYGEN STORAGE AND DISPENSING SYSTEM C-5 RE MOTE SAMPLE CONNECTION SPV-1 SAMPLEPORTVALVE RD•I STORAGEVESSELINNERRUPITRtEDISC The materials and information,including the principals of design presented by this print P-I STGRAGEVEssE,PRPssvREumlcATnR RD-2 STORAGE VESSELOU.MUPIV -I&C is the exclusive roe of Technical as Products,LLC.,and is confidential information P-2 sTORAGEVESSEIRE�IGTEPRESS.�DIGATGR L-I STGRA VE ELLE1.>NDIGATGR property g DATE: 9/1Q/98 SCALE: NONE DRWG # L-2 STGRAVE ELREMOTELEVELQrDICAPOR accordingly. This information is submitted to you with agreement that it is not to be reproduced,copied,or loaned,in any part or in whole,nor is the information to be relayed DPI VAP-i INTERNAL VAPORISER to any company. Acceptance of this drawing will be constued as an agreement to the above. SYSTEM SCHEMATIC Electric # A P LICATION FOR BUILDING PERMIT Plumbing# 1060 Main Str HVAC# iil@100236 Date: (-P Sprinkler# Estimated Cost $ FINAL APPROVALS Permit Fee $ Building COMPLETE RED BOXED AREAS Occupancy Fee $ Engineering TYPE OF PRINT ONLY Eng. Insp. Fee $ Affidavit ► SIGN ON REVERSE SIDE Appr.forCO. Total Fee $ �s TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant _ of Work LotNo. Applicant's Address Tel # -7-71 Town Zip ()DG�y Lic.# Owner Architect Owner's Address Architect's Address Zip _ Zip Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area Pur ose of thi mit w C rNA -6 C- . City Water❑ Well D Septic System 0 Sewer❑ Ins: HO SP Area Basement Garage Approved by w Date I Use Group Construction Type 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 pla s r specifications of the Building for which this ` permit is asked,and agree that this building is to b ated the proper dista ce from all street lines,side yard lines,and required distances from all other zones and is located in w ch this building and its us i allowed. Signed I hereby apply for a Certificate of Occupancy for the work escribed in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS Electric # .1000 is3 APPLICATION FOR BUILDING PERMIT Plumbing# 1060 Main Street HVAC# 1000303 Date: G ' O Sprinkler# FINAL APPROVALS Estimated Cost $ Jo da•D o Permit Fee $ 30 Building COMPLETE RED BOXED AREAS Occupancy Fee $ Engineering TYPE OF PRINT ONLY Eng. Insp. Fee $ Affidavit ► SIGN ON REVERSE SIDE Appr.forCO. Total Fee $ TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant .. Y''LocationofWork M Lot No. Applicant's Address 1 `I bC h n m-0 R d Tel M a?0.3'qkf-263 6 Town g0.St Nay r-n C.711. Zip O Lic.# 4C C2 670 1696 ur•'� c Owner So with w d�c- 2 ctnats: M Architect Owner's Address 0J00 M4%0 S*• Architect's Address Soh .a•..d.coc a�,„ Zip QLD Zip Sq.Ft.New Area: st F 17- 4/ / 2nd FI. 3rd FI. �Totai w a Purpose of this permit +Z •Y.0-4 e d: ed vwn 1 Y -Two City Water 0 Well ❑ Septic System ❑ Sewer❑ Ins: HO SP Cert. Area Basem t Garage Approved by Date Use Group' TjFC Construction TYP 024/oo6,jf X 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 Occupancy for the work described in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS 11000236 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER TEMPORIARY STRUCTURE PERMIT DATE: 06/08/11 GIS ID:54901060 FEE: 15.00 MUNIS APPLICATION# 201100543 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: CONTINUING CARE OF SOUTH WINDSOR ADDRESS: 1060 MAIN STREET ADDRESS: 1060 MAIN STREET OWNER: CONTINUING CARE OF S WINDSOR INC SOUTH WINDSOR,CT 06074 1060 MAIN ST SOUTH WINDSOR,CT 06074 DESCRIPTION OF WORK: TEMP TENT FOR SOUTH WINDSOR ANTIQUE APPRAISAL DAY. TENT SIZE 30 X 30. SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE-WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 6/8/201 111:06 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE 1400018 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER ELECTRICAL PERMIT DATE: 01/14/2014 GIS ID: 54901060 FEE: 75.00 MUNIS APPLICATION # 201301853 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: THE MAIN CONNECTION OF CT LLC ADDRESS: 1060 MAIN STREET ADDRESS: PO BOX 501 OWNER: CONTINUING CARE OF S WINDSOR INC SOUTH WINDSOR,CT 06074 99 EAST RIVER DR 8TH FL EAST HARTFORD, CT 06108 DESCRIPTION OF WORK: INSTALLING NIGHTLIGHTS TO EACH BEDROOM. 65 TOTAL NIGHTLIGHTS. SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH TI It APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL If 14/2014 2:50 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE 12000242 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER BUILDING PERMIT DATE: 05/14/12 GIS ID: 54901060 FEE: 800.00 MUNIS APPLICATION# 201200539 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: CONNECTICUT RENOVATIONS& ADDRESS: 1060 MAIN STREET ADDRESS: 94 WINDSOR STREET OWNER: CONTINUING CARE OF S WINDSOR INC ENFIELD,CT 06082 :1060 MAIN ST SOUTH WINDSOR,CT 06074 DESCRIPTION OF WORK: 133 REPLACEMENT WINDOWS. SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 5/14/2012 1 1:14 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE 1000303 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER BUILDING PERMIT DATE: 06/29/10 GIS ID:54901060 FEE: 30.00 MUNIS APPLICATION# 201000756 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: MONACO CONSTRUCTION&PAINTING ADDRESS: 1060 MAIN STREET ADDRESS: 124 BENNETT ROAD OWNER: CONTINUING CARE OF S WINDSOR INC NEW HAVEN,CT 06513 245 LONG HILL RD MIDDLETOWN,CT 06457 DESCRIPTION OF WORK: REMOVE DIVIDED WALL AND TWO BATHROOM,WALLS. SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 6/29/2010 10:55 AM THE FEE ABOVE INCLUDES A$0.22 PER THOUSAND CT STATE EDUCATION SURCHARGE 1 14000042 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER BUILDING PERMIT DATE: 02/07/2014 GIS ID:54901060 FEE: 1021.00 MUNIS APPLICATION# 201400010 BUILDING DESCRIPTION: APPLICANT ` LOCATION NAME: CONNECTICUT RENOVATIONS& ADDRESS: 1060 MAIN STREET ADDRESS: 92 STOUGHTON ROAD. OWNER: CONTINUING CARE OF S WINDSOR INC EAST WINDSOR,CT 06088 99 EAST RIVER DR 8TH FL EAST HARTFORD,CT 06108 DESCRIPTION OF WORK: 380 SQUARE ROOF REPLACEMENT. SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS'APPROVED BY THE BUILDING DEPARTMENT. y CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 2/7/2014 11:37 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE 1200099 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER HVAC PERMIT DATE: 03/07/12 GIS ID: 54901060 FEE: 195.00 MUNIS APPLICATION# 201200203 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: MITCHELL FUEL CO INC - ADDRESS: 1060 MAIN STREET ADDRESS: 1209 SULLIVAN AVENUE,, OWNER: CONTINUING CARE OF S WINDSOR INC SOUTH WINDSOR,CT 06074' 1060 MAIN ST .- SOUTH WINDSOR,CT 06074 DESCRIPTION OF WORK: INSTALL ABOVE GROUND TANK FOR GENERATOR. ;4 L ry h SPECIAL CONDITIONS: a, w ALL WORK TO BE DONE IN ACCORDANCE WITII THE APPLICATION AND PLANS"APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 3/7/2012 3:09 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE 1400241 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER ELECTRICAL PERMIT DATE: 06/30/2014 •` GIS ID: 54901060 FEE: 60.00 MUNIS APPLICATION# 201400864 " BUILDING DESCRIPTION: APPLICANT LOCATION NAME: THE MAIN CONNE ION OF CT_I,LC ADDRESS: 1060 MAIN STREET ADDRESS: PO BOX 501 OWNER: CONTINUING CARE OF S WINDSOR INC SOUTH WINDSOR,CT'06074 = 99 EAST RIVER DR 8TH FLR N ` EAST HARTFORD, CT 06108 DESCRIPTION OF WORK: WIE 1 EXTRA OUTLET IN EACH ROOM IN MC TO NEW OUTLET. REPLACING EXISTING. SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 6/30/2014 4:19 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE 1000144 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER ELECTRICAL PERMIT DATE: 06/18/10 GIS ID:54901060 FEE: 15.00 MUNIS APPLICATION# 201000733 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: P.J.LODOLA&SONS INC. ADDRESS: 1060 MAIN STREET ADDRESS: 373 SOUTH MAIN STREET OWNER: CONTINUING CARE OF S WINDSOR INC WINDSOR LOCKS,CT 06096 245 LONG HILL RD MIDDLETOWN,CT 06457 DESCRIPTION OF WORK: REPLACE AND REWIRE GENERATOR SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 6/1 S/2010 9:17 AM THE FEE ABOVE INCLUDES A$0.22 PER THOUSAND CT STATE EDUCATION SURCHARGE 1000153 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER ELECTRICAL PERMIT DATE: 06/29/10 GIS ID:54901060 FEE: 15.00 MUNIS APPLICATION# 201000756 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: DFG ELECTRIC CO INC. ADDRESS: 1060 MAIN STREET ADDRESS: 218 FOXON ROAD OWNER: CONTINUING CARE OF S WINDSOR INC NEW HAVEN,CT 06513 245 LONG HILL RD MIDDLETOWN,CT 06457 DESCRIPTION OF WORK: REMOVE DIVIDED WALL AND TWO BATHROOM WALLS. SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 6/29/2010 10:56 AM THE FEE ABOVE INCLUDES A$0.22 PER THOUSAND CT STATE EDUCATION SURCHARGE 1000343 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER ELECTRICAL PERMIT DATE: 11/29/10 GIS ID:54901060 FEE: 45.00 MUNIS APPLICATION# 201001548 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: PJ LODOLA&SONS ADDRESS: 1060 MAIN STREET ADDRESS: 373 SOUTH MAIN STREET OWNER: CONTINUING CARE OF S WINDSOR INC WINDSOR,CT 06096, f '1060 MAIN ST w SOUTH WINDSOR,CT 06074 A DESCRIPTION OF WORK: WIRE FIRE DAMPERS FOR A/C UNITS. 4 , °1 5 SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH THE'APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 11/29/2010 2:26 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE