HomeMy WebLinkAbout115 OLD FARM RD APPLICATION FOR ELECTRICAL PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT 1'3t��7
APPRO D 1540 SULLIVAN AVENUE Bldg. Permit
644-2511 ext. 230
Date Building Ins �-
Application must be printed or typed
FEE SCHEDULE l _ Location J
$0-$1,000=$15.00 r �4
Over$1,000= I Street No. Street Lot No.
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 1
APPLICANT ADDRESS
APPLICANT'S PHONE # B
OWNER i
�0MI N Sf q< OWNER ADDRESS
OWNER PHONE
ESTIMATED COST$
C �
IS THIS A CONTRACT COSH _L--Ye-s No
FEE ENCLOSED$
�1 �G TYPE OF JOB: f "�
C0 New Installation
Alteration/Addition/Repair
c>lQl 300-7 p
Revised 03/05/10
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITXf_N0
BUILDING PERMIT APPLICATION? ❑ YES
b'g-SIDENTIAL CURRENT USE AND OCCUPANCY
❑ BUSINESS
0 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
SIZE OF SERVICE O 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
r _Pi�C�e— fJ - 9
C R sit 1g67,s`�
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
- I ''E 1 P190 c?
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DAT hp / 3
BUIM1'FG PERMIT. ]f Z7
STATE OF CONNECACUT
WORKERS'CON E NSAZI(iN COWSSION
ATUMOZ permit Affidavit for Property Owners or Sole Proprietors
(Conn.Gem SUL¢31286b)
PiWerty b*od at
1n the town of t? G
Name of building permit Applicant:_ f a"lC
Please check one: .
I am the owner of the above property,
z m the solepr oprietorofa business.
2A.Name of budness
. 2B..Federal Employer.kkaffication Number qMQ
...........................................................N.........i.....................
"&
pucsuaat to§31-?.86b, .property owns oc sole proprietor[who]intends toad as i general
0°°fiacf°rapriaapal C=PIDYU niayprew&eitherace tiowde ofworkers;'compensation
iawranoe or.a- R a%Iiirit,..stating that he will rvquira pc�oof of worim
CWV=IIkW kwmw for all dioko employed ou de3ob site m s000rdaaoe with this chapter."
- Please ckcdC od— .
1._I do not intend to ac#as a general ooa6W W orFrncipal anpioyer. -
[
S o ticant
2._I intend to ad as-a gene al contractor or prndpal employer.Applicant must either
*ovida a certificate of workers'compensation insurance or sign the affidavit
Wow.
:.................................
...............................................
AWA&vit
I hereby swear and attest that I will r*jre,proof of workers'wmpcasation inane for every
contractor,subcontractor,or other worker.before he/s he eagsges is work on the abovi property iA
accordance with the Yorkers'Compensation Ad(Chaptcf568).
I understand the Pit 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 ofapplicant
Sub-SM'bed and sworn to before me this day of ,200 .
(Notary Public!Commissioner of the Superior Court)
a °'"oe S't
,
ZONING COMPLIANCE FOR SMALL STRUCTURES
(Sheds and detached decks 200 sq. ft. and smaller)
Address of Proposed Structure: 1/J' 01J A r,h Roar l Zone: Z 0s
Name of Owner: A,,l e F.ei-N4h �� a GIS PIN: 1,6300 11 S
Phone Number: �lG — 3—y.�' �.��� Application #:
1. Name of Applicant: X J"C/+'e / �r/14Jf d00,
d Z-
Address: 11.r" Ply /c r.y 144r,/
Phone Number: yd2�'
2. Structure cannot exceed 200 square feet.
TYPE OF STRUCTURE: V SHED DECK (not to exceed 30"from grade)
DIMENSIONS OF PROPOSED STRUCTURE: 9 k t Z
3. A Class D survey must be submitted with the application showing the property lines, all other
buildings and the location of the proposed structure.
4. Is the property served by a septic system? Yes /No If yes, the applicant must
complete and submit a B100a Application to the Health Department for review and approval.
The undersigned hereby permits Town staff to enter onto and inspect this property during
reasonable hours for the purpose of reviewing this application and to determine final compliance
once construction is completed.
I, the undersigned, acknowledge that the above information is true to the best of my knowledge
and that the above requirements are understood.
Applicant Signature: Date:
Owner Signature: Date:
*****************************************************************
1� V 7/a�Jr i
Reviewed and approved by: �'��+ ,u�. �� � C, ��U�- Date:
Zoning Enforcement Officer
Reviewed and approved by: Date:
Environmental Health Officer
cc: Assessor
Building File
04/15/14
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NO. REVISIONS DATE SCALE 1"s 40' DATE 2 -23-83
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ASSOCIATES 5 OAKLAND ROAD SOUTH WINDSOR, CONN.
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490 SUCKLAND ROAD DRAWN A.V.H. CHECKED E.W.L.
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490 SUCKLAND ROAD DRAWN A.V.H. CHECKED E.W. L.
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I HEREBY CERTIFY THAT THIS MAP AND SURVEY WERE PREPARED IN ACCORDA WITH THE
STANDARDS OF A CLASS A-Z SURVEY AS DEFINED THE EXISTING "CO PR ICE
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NO. REVISIONS DATE SCALE I": a0' DATE 2 -23-83
CONSULTING ENGINEERS
490 SUCKLAND ROAD DRAWN A.V.H. CHECKED E.W.L.
SOUTH WINDSOR. CONN.
203-644.2474 PROJECT 78'68 SHEET
1 HEREBY CERTIFY THAT THIS MAP AND SURVEY WERE PREPARED IN ACCORDA WITH THE
STANDARDS OF A CLASS ..$-7-_ SURVEY AS DEFINED THE EXISTING "CO PR ICE
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10-21-80, 4'8-81, 12-2'82 DRAWN: A.V.H. CHECKED' E.W.L. PRGJECT: 78'88 SHEET 2 OF T EMIL W. LUCEK
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NO. REVISIONS DATE SCALE I"a 40' DATE 2 -23-83
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CONSULTING ENGINEERS
490 9UCKLAND ROAD DRAWN A.V.H. CHECKED E.W. L.
SOUTH WINDSOR. CONN.
203-6"2474 PROJECT 78-68 1 SHEET
I HEREBY CERTIFY THAT THIS MAP AND SURVEY WERE PREPARED IN ACCORDAPCIPWITH THE
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LUCEK ENGINEERING ' A'5OC. INC.
NO. REVISIONS DATE SCALE 1 "s 40' DATE 2 -23-83
CONSULTING ENGINEERS
490 BUCKLAND ROAD DRAWN A.V.H. CHECKED E.W. L.
SOUTH WINDSOR. CONN.
2OS644-2474 PROJECT 78'68 SHEET
1 HEREBY CERTIFY THAT THIS MAP AND SURVEY WERE PREPARED IN ACCORDA WITH THE
STANDARDS OF A CLASS _A-Z-_ SURVEY AS DEFINED THE EXISTING "COAt OF PR ICE
FOR STANDARDS OF ACCURACY OF SURVEYS AND A . A" CONN ICUT
ASSOCIATION OF LAND SURVEYORS INC. '
ZONING COMPLIANCE FOR SMALL STRUCTURES Y _'
(Sheds and detached decks 200 sq. ft. and smaller) y~
Address of Proposed Structure: rawRoca Zone: R R yS
-�7
Name of Owner: Andrx F,Pra4•, Qr GIS PIN: 6&3001'S'
Phone Number: Application #: a of you 7y4,
1. Name of Applicant: 140WIrle 1�;r0ONVeoe
e -
Address: A eov '40"t/
Phone Number:
�,d� - APR 2 3 2019
WM WWDWR"NING DEPT.
2. Structure cannot exceed 200 square feet.
TYPE OF STRUCTURE: SHED DECK (not to exceed 30"from grade)
DIMENSIONS OF PROPOSED STRUCTURE: ? k 12
3. A Class D survey must be submitted with the application showing the property lines, all other
buildings and the location of the proposed structure.
4. Is the property served by a septic system? Yes /No If yes, the applicant must
complete and submit a B100a Application to the Health Department for review and approval.
The undersigned hereby permits Town staff to enter onto and inspect this property during
reasonable hours for the purpose of reviewing this application and to determine final compliance
once construction is completed.
I, the undersigned, acknowledge that the above information is true to the best of my knowledge
and that the above requirements are understood.
Applicant Signature: Date: 1-� �a/9
Owner Signature: Date: �1 ' 1G/y
*****************************************************************
Reviewed and approved by: Date: Y o2
—Z f
Zoning Enforcement Officer
Reviewed and approved by: Date:
Environmental Health Officer
cc: Assessor
Building File
A .) ANNED04/15/14
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Electric # - J�� i APPLICATION FOR BUILDING PERMIT
Plumbing# 115 Old Farm Road
HVAC �l# 9 0 0-1 0 2 Date: �9/0`i'
Sprinkle SED
FIN - - - Estimated Cost $ Zt{3 Building "-
76
-- --- ---- -- - - --- - - Permit Fee $
Engineering COMPLETE RED BOXED AREAS l i Occupancy Fee $
Affidavit g- AND — TYPE OR PRINT ONLY Eng. Insp. Fee $
Appr. for CO. CGS M93 SIGN ON REVERSE SIDE / Total Fe ,O\5 $ qQ,
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional ost) $
The undersigned hereby applies to do work according to the following:
Olc! Farry) Rd
Applicant -T -iL2 A+- FV>fne 3eA\AGEZ5 Location of Work - Lot No.
Applicant's Address k6A OCeerlu)CZ�3 t Tel.# 401- -?1-22
Town WO C04er MA Zip O 1607 Lic.# 565E22
Owner L'na%Qa MnCffl750n Architect
Owner's Address 11 L15 Id Farm M Architect's Address
SOLAh LQy)d5Or,GT Zip o6p7+{ Zip
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit 31-IS1 U11 W 1;e0�aC0Y1G(* W if-)d0U-S
NO s-t uc4t;r-a) C 2 e i
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO SP Cert. Area Basement Garage
Approved by Date j Use Grou� Construction Typ
Revised 6/02
aooQOo313
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 h this buildmaQ a d its use is allowed.
Signed
I hereby apply for a Certificate of u ancy for the work described in this application for the permit.
Sign
OT WRI BELOW THIS LINE
INSPECTION COMMENTS
TOWN OF SOUTH WINDSOR
AFFIDAVIT OF ACTUAL COSTS
PERMIT NO: �e,-o/aoZ DATE !i b b q
The undersigned,being a duly authorized representative of, -TH D A+ - 1-(nI'Yle. �' t (cC->S
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 II, 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:
15243
Signature of Permit Holder.
Name(Please Print) �(phn ?t ha
Date:, i Let lei
T
■■a■tttttttattttttttttttttttutttttttttttttttttttttttttttttttttttttttttttttuttt• �
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
1300271 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER ELECTRICAL PERMIT
DATE: 06/13/2013 e s' �.{ ?r.?, g =� .x• «°
GIS ID: 66300115 FEE: 15.00
MUNIS APPLICATION# 201300790 or - ` "•. BUILDING DESCRIPTION:
APPLICANTS ( w, „ "w LOCATION
NAME: RUSSELL E. WILSONv q�r1'( e,ADDRESS; 115.OLD FARM ROAD
ADDRESS: 443 LYDALL STREET' C y�j� 'i '-,OWNER: THOMPSON CRAIG G
9 M Ly - p
MANCHESTER,CT 0G042 R", 3 �115 OL D FARM ROAD
WINDSOR,CT 06074
DESCRIPTION OF WORK: REP ACE METER SOCKET. UNDERGROUND FED.J
CRS N0r.2146753.
SPECIAL CONDITIONS: 1 S
ALL WORK TO BE DONE IN ACCORD NCE�WITH„THE APPLICATION'ANIA'PLANS-,APPROVED BY THE BUILDING DEPARTMENT.
CONSTRUCTION TYPE:
OCCUPANCY GROUP: BUILDING OFFICIAL
6/13/2013 3:30 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE