HomeMy WebLinkAbout110 PINE TREE LN Electric # APPLICATION FOR BUILDING PERMIT
Plumbing# . 110 Pi ne TrPP Tana Date: _ �Z&kf9
HVAC #
Sprinkler# 32648
FINAL APPROVALS --- --- - - - Estimated Cost $ 4 c� �
- -- - Permit Fee $
g COMPLETE RED BOXED AREAS
Buildin Occupancy Fee
Engineering TYPE OR PRINT ONLY Eng. Insp. Fee $
Affidavit SIGN ON REVERSE SIDE 1
Appr. for CO. Total Fee $
i
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) �155 �f5'
The undersigned hereby applies to do work according to the following:
Applicant , I� C-k� f: !_A 0�NF P,S� Location of Work Lot No.
Applicant's Address_A ko Tel.# Skc r
Town Sr,u �-\A, U. >► joSo 6�, Zips,o-7 y Lic.#
Owner U, �-- LA+J'+J�L R Architect
Owner's Address It(3 P, N e- 1f;k c t A Architect's Address
�I"-O so R Zlp 0&,6-1``� Zip
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit F 1,)c. L,osE R E e z vo A
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO SP Cert. Atea Basemenh , Garage
Approved by Date - Use Group Construction Type
Revised 6/02
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 io use is allowed
� I
Signed
I hereby apply for a Certificate of Occupancy for the work escribed in this application for the permit.
Signed —e DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
Y9
IIome Occupation Information and Application Form
Minor Approved b Date Q
ASSESSOR'S USE ONLY
❑ Major I o Home Occupation Type
\ Code
Name L I
DBA
Address of Proposed Occupation: - - L N-P-soR CT 060711
Telephone S(a y y-S a7 S Zone (Note:in DRZ,MF zones only minor home occupations are
allowed;approval letter from homeowners assn required
Description of Home Occupation:
CS�zr�ame t� �-
o CS'tt,R —r,O CL 't
L � e NJQ �►.� t � k
trJ ��e ANC l'RIN4 -�� rnu I�nrnE' �oR L71csXt^�r, "Sta RIC+.
Please use the boxes below or an attached sheet to provide the following:
A.Proposed Sign
1. Attach copy of plot plan if available.
2. Use Box A(or attach sketch)to draw proposed signage.
3. Use Box B(or attach sketch)to draw the floor plan of the Home
Occupation area.
4. Architectural elevations for any proposed additions or modifications
must be provided.
FLOOR PLAN (O Basement ❑ 1u floor ❑2°d floor)
Floor area of dwelling tJ S
Floor area of home occupation ` t2 r \
%of floor area devoted to home occupation �- 5 67 a
I have read the regulations regarding
� g g g home occupations and will comply with said regulations.I understand tha
D � t I must notify
the Planning Department in writing upon termination of this occupation
p Uon at this address.This permit is not transferable or
assignable to another person.In the event of relocation,the permit holder must notify the Planning Department in writing to
transfer the permit to the new location.
C
Signature of Applicant Date 8 —
1 �vos
Signature of Owner Date d Q
2 I
4 t'
44
( ♦ .�.,� , y ..�.. �+F :x't' •;r ',.Y:. iu.,. 4�+•:�,t �`'s:'q�,�.�,r' '{1, Y„��.. #' �'�' � , .i' ,
F.' ♦\ 'i - ..>�i.,.is F � v :;u�, r,s,�'A�°t�•�. ad,' y �f�:�' i Y. t ;•ro'i'lr
\F1
,Y �,^' .k s;.., f �� \J •.ems :I ♦4,� l�
IN
' \��� vY�/� �ti,_ N` fi 3 ���a`��•"dfrea`,,� (C• 1}�,} ���1. '�� iY• �l � -�1 ,/ }•v�s 1 ( '•e�.t.• (
MHO ill
,�,r�•. nS,y. I (�,. \�•f. 1_ , � ''�,.�L7 /-/,�'-� -t 6 "�f'+ _;tt�� i', d rt � `T�Y'�� j� ;'` r/�•i ate � ���. .w���.•. � , /�,�
n r"� s /� .Vt '•f :! A, ,y f: ` 'c'N £ G': Y• I 7� .2J_V�1 �` • ♦ •..- -�.�.�
s 4 �;:9j �:: �'� .0 � t o � '��.' N i. I n r •� i r V V C I �L. / _ - �I``
/ .. (.j 1.::ti „- t1 ' ,r. ° vp� Y( „y .•,st R�„•'. x: I, vw.• .. ; OC.
V S.i .�y, ��PP \ .•7 t
� 3
,e
44
7 ,. '! :�-a;n :yx �,r.'• �,,. �"�. f�J)� -./y��>�
RA
i,
11�•--•-"'�---�'" } �,c, r` � � >.a � y :'�. -.� ,� �" ,�,�'"
- ;-t �1 ^p„v •Yi '�y I*� v _ -.f. S:: s�' •.- : "':.,,�a.�,1;" For
. r.� r _ —
`� !' ;'rr� 8 � G a r. -,gip% �`x j ,�>t hive �.,�•
Y ..
!r
''.�': - ' t ,� .. �. � :,-, N�,. ,"•:". ..:: a� s.:. �,{�s.:q� "ek. ;.•R:.' :)' j .ry Cr.� �..,� i � .,ire.,• !.
ell ���c�.�sC'•..��l�F'•. �L/�..
a•
'>.. •�° '"ice+y� •L� 'a. J v.. _ #� 't, , :i-r. ::i-x
.. 2
-.; -:sx:. •.:1 � .jar.*� : � ..:": � . :, :S' '/ ���: � _ L �•G. `
*. �,
. . -.. ., ,fix Sf-•r< n
i
Vi
k r.7 rJ �! J �
04
?4 S
'SG .jY I',h 5:: `yA�;`}' �' -z �. ,,y +;' ! V r "'�ib'E f"� �•�..7 .
a
414
77
•
! r .
s
A x;:' Z•. 'rF-_ .). yM - s•G -e=:• � -.. s -� �?�� 1 - �;� " �..;' -,�;�y,.,>..,�♦e:» y�� - s .. � , .,�y. .s
F.
v
1
J - �' - 4 � � r Y •'f� •tom l
s,
i
�� � ��
��
n
posed
2.o
a
1�wEx.t..r 6
6S,
o.
All
tot
bulLulvu YLKMl'1'
STATE OF CONNECTICUT
WORKERS'COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn.Gen.Stat. §31-286b)
x Property located at
,
In the town of_154'14 j 7& L�l sN _ �� A, T /
Name of building permit applicant: O GK/ a,4 i 2444Zl�
Please check one:
1.;x-I am the owner of the above property.
2._I am the sole proprietor of a business.
2A.Name of business
213.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).
I 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.
Signature of applicant
Subscribed and sworn to before me this day of ,200 .
(Notary Public/Commissioner of the Superior Court)