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HomeMy WebLinkAbout11 LAKEWOOD Electric # APPLICATION FOR BUILDING PERMIT Plumbing# 11 Lakewood Drive 4H-c�in NSF Date: l 28 _Ott HVAC # Sprinkler# -- - - 730931_-_ FINAL APPROVALS Estimated Cost $ Building ESSIGN TE RED BOXED AREAS Permit Fee $ U Engineering E OR PRINT ONLY Occupancy Fee $ Affidavit Eng. Insp. Fee $ Appr. for CO. 1� ON REVERSE SIDE Total Fee $ 6 v TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant 6 P-T 5-T e Kk!+J 4 Location of ork L_A1Cr_ tVv-v1 Lot No. Applicant's Address t1 =-G-(7�1 ��S' w� Tel.#�,,cU —L-t 36, 9��a Town 5 v;.), ki W la hSo 2. Zip 06 v'A 4} Lic.# Owner U yT S"iEkALyt1C-21 Architect Owner's Address 11 a_DtJ N Architect's Address SovTv� ZipO(9 U'1y Zip- -Sq. Ft. New Area: 1st A. 2nd FI. 3rd FI. Total New Area Q� Purpose of this permit U S i= U (Jv A it E= S OP GAF ri ,R L l N4_ P hF i'9(Uj,lat A7e.( t4 A TEC.�YC.W- L- -- erI? � l NT a Aa- �Z.7' i S .41v s. City Water Well❑ Septic System❑ Sewer❑ Ins: HO Cert. Area Baseme t Garage Approved by_ — Dat o Use Group V-L4 Construction Type Revised 6102 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 th s boil an 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 e BUILDING PERMIT STATE OF CONNECTICUT WORKERS'COMPENSATION CONMIISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn.Gen.Stat. §31-286b) Property located at NEST —AK�wov� In the town of `30U7 N W t rJ QS6& CC Name of building permit applicant: Kj titt' <3�(t Ll NCB, Please check one: 1. ✓raam the owner of the above property. 2._I am the sole proprietor of a business. 2A.Name of business 2B.Federal Employer Identification Number(FEIN) .................................................................................................................... Pursuant to§31-286b,"a property owner or sole proprietor[who]intends to act as a general contractor or principal employer"may provide either a certificate of workers'compensation insurance or a"sworn notarized affidavit... stating that he will require proof of workers' compensation insurance for all those employed on the job site in accordance with this chapter." Please check one: 1._I do not intend to act as a general contractor or principal employer. [Sign and stop here] Signature of applicant 2._I intend to act as a general contractor or principal employer.Applicant must either provide a certificate of workers'compensation insurance or sign the affidavit below. .................................................................................................................... Affidavit I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers'Compensation Act(Chapter 568). 1 understand that pursuant to§31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. a re of a pl11cant Subscribed and sworn to before me this day of I UI y� ,200�. (Notary Public/Commissioner of the Superior Court) INSPECTION FIELD SHEET 08/31/11 Printed by Peart, Dayshell 11 56 35 INSPECTION: 5292 FINAL PERMIT: STATUS: APPLICATION: 200700983 LOCATION: 11 LAKEWOOD SOUTH WINDSOR PROPERTY ID: 51900011 OWNER: STEHLING KURT L & KELLY E CONTRACTOR: REQUEST BY: DESCRIPTION: RESURFACE ROOF OF EXISTING HOUSE 20 SQ. REPLACEMENT OF ROOF WORK ORDER: INSPECTOR: ROSE RESULT: PASS REQUESTED: 08/05/11 PRIORITY: SCHEDULED: 08/05/11 PM COMPLETED: 08/05/11 UNPAID FEES 00 Date Time TIME: TRAVEL ONSITE COMMENTS: � IV � AV / MAP00 12f'i�PilzYINLF� ��°^I�_ -�'•�•�� - "LA�r✓WVOD �Url,S�rN� >Jh1V�LOP� .4Nd bUILDt1Jc� I � � ►' N Pf'Jfr'MfT ,QPPLIL.ATIOt�! pLdtl" �(..dL.C'i � I"=4D` �Y P�� e.f7h • �.,,, � /} ' p1, r � •� - . .oj-Pjqf'-p' r ^� i2A, ��' \ �u I LD I N(�� O 10 t I I �2 13 14 ly 51�DW N A� STAY-bD 4/ )2JSlo s 44 1-71e%q ur N r L 3►' °' Q (� � M Ai ( 1 WO I �A,ZA!sP, Q , j 40 o .vJ°l1L Diu w y to ,�°/ '� r l\ °_0►'O ,�% .fl its _�-r--, `�� ^ � loe-t3'-40„ ,� r 3 �" � L9 64) D m S US/ e.k�-7' lz 1 oY� ,,� ► W } -V Q � -p' ' -9 DPf."� T7 to S� .p 0 � ' F tS P �c �O pN �V 1 yf} ' esSStLC7 '9 lz Hem ZS 9 op 410' Ne�v - i , E >o.o -zLO � i+> O D >� COIVly FUSS&O'NEILL I Nbebely LbeTWY TgA.T TN I� MAP i� ;`°;,�'w��``R. sf'ssl �: � consulting engineers TAI�ITIALLY L021Z�LT { LL-A55 A-2 ��'i3 MANCHESTER , CONNECTICUT • Z5 ; � $ ALLUfZALY � AND 7"NAT 1J0 ZONIAJI� t`�' �►* 1zULoBL.A.TiO1Je) AZb VIOLATt P WITH •"•.<<cENsE10A �,A �woo D k PELT TD T'pb qOU`Db LCLATION.1 . 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