HomeMy WebLinkAbout1104 ELLINGTON RD Electric # APPLICATION FOR BUILDING PERMIT
Plumbing# 1104 Ellington Road Date: 225
.HVALC� #
Sprinkler# 800104 - Estimated Cost 'fect
FINAL OV - - - -
Building3 1 v� COMPLETE RED BOXED AREAS Permit Fee $
En nee ' Occupancy Fee $
Affidavit g TYPE OR PRINT ONLY Eng. Insp. Fee $
Appr. for CO. ► SIGN ON REVERSE SIDE
- - Total Fee�msG", $ �
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant Location of Work I ir4 El I i N Lot No.
Applicant's Add ess
Town Zip (AO 10 k Lic.# '`' j q q:7
Owner Architect
Owner's Address Architect's Address
Zip Zip
Sq. Ft. New Area: 1st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit
Q
City Water❑ Wello Septic System❑ Sewer❑
Ins: HO ' Area Basement Garage
Approved by ate Use Group Construction Type
Rsvlssd GM2
07�6�
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 bcated in which this building and its use is all
SI i 1
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
1
INSPECTION FIELD SHEET 03/18/09
Prirlted by Peart, Dayshell 13:47 14 r
INSPECTION: 12843 FINAL PERMIT:
STATUS:
APPLICATION: 200800355
LOCATION: 1104 ELLINGTON ROAD
SOUTH WINDSOR
PROPERTY ID: 30301104
OWNER: GORBORINO JAMES E & SUSAN T
CONTRACTOR:
DESCRIPTION: REMOVE 2 LAYERS OF ASPHALT SHINGLES REPLACE W/ ICE AND WATER
WORK ORDER:
INSPECTOR: FLAN RESULT: PASS
REQUESTED:
SCHEDULED: COMPLETED: 03/12/09
UNPAID FEES 00 Date Time
TIME: TRAVEL ONSITE
COMMENTS
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TAL LOSS 8 SALVAGE REPORT �r
CLAIM NO. INSURED: YEAR 8 MAKE OF VEHICLE D/L:
TYPE OF DAMAGE: COLLISION FIRE THEFT FLOOD VANDALISM OTHER
EQUIPMENT (SHOW ADD OR DEDUCT AS LISTED IN GUIDE BOOK)
ADD DEDUCT ADD DEDUCT ADD DEDUCT
1) AIR CONDITION 8) POWER BRAKES 15) SPECIAL: TRIM _
2) AM-FM RADIO 9) LOCKS 16) WHEEL
3) W/TAPE 10) SEATS 17) OTHER
4) ALARM SYSTEM 11) STEERING 18) TILT WHEEL
5) CUSTOM PACKAGE 12) WINDOWS 19) WINDOW DEFROST
6) CRUISE CONTROL 13) ROOF: SUN 20) OTHER
1) ENGINE 14) VINYL 21)
ADDITIONS DEDUCTIONS TOTAL
TOTAL LOSS EVALUATION
1) NADA (DATE) VALUE f 1) RED BOOK (DATE) 'VALUE $
2) ADD/DEDUCT EQUIPMENT (BY #) 2) ADD/DEDUCT EQUIPMENT (BY #)
A S A f
B S B $
C $ C f
D f D $
E f E
TOTAL S $ TOTAL y $ _
3) SUBTOTAL f 3) SUBTOTAL f
4) MILEAGE ( > ODOMETER 4) MILEAGE ( ) ODOMETER
A) HIGH MILEAGE (DEDUCT) f A) HIGH MILEAGE (DEDUCT) f
B) LOIN MILEAGE (ADD) f B) LOW MILEAGE (ADD) $ _
5) SUBTOTAL f 5) SUBTOTAL f
6) SUI- IARY NADA f (+) RED BOOK f = $ = 2 = $
7) OTHER DEDUCTIONS
A) OLD DAMAGE
B) DEALER PREPARATION f MECHANICAL f INTERIOR/EXTERIOR S TIRES $ = $
8) SUBTOTAL (SUBTRACT #7 FROA #6 MARKET VALUE S
9) SALES TAX (—I X NARKET VALUE #8) $ = $ E
10) TOTAL EVALUATION �
11) LESS: SALVAGE (IF APPLICABLE) f
. DEDUCTIBLE (IF APPLICABLE) $
12) TOTAL LOSS EVALUATION s
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