HomeMy WebLinkAbout122 DEBBIE DR DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT 9a O
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.Permit#
Dat Buildi g Inspector
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$1,000
or any fraction thereof gnation Apt.No.
APPLICANT Sfa 1;r,,.l , .y
APPLICANT ADDRESS 7/ G✓a, S���f�
� f' "--!S GT Oho?�
APPLICANT PHONE# Dlri-
S OW N Se-
OWNER
OWNER ADDRESS /2 Z-
Ste + � T
b OWNER PHONE /7k7
C ESTIMATED COST$ �/�17U,OG
xk
� IS THIS A CONTRACT COST? tffYes _No
FEE ENCLOSED$ 45
TYPE OF JOB: m5So
l)SOR•COS New Installation
.Z Alteration/Addition/Repair '30410025 g
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
HEATING ,RESIDENTIAL
I]ABC ❑COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC ❑WARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION/cat • 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=ING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH) L
TYPE OF FUEL
❑OIL—GPM OIL TANK LOCATION :❑INSIDEO OUTSIDE CAPACITY
GAS—INPUT (/y A 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)
FURTHER 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.
3Q3U,,�-3 S"1 C 7—
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT '�%% DATE
P1 TO THE BUILDING INSPECTOR '
�v of the APPLICATION FOR
PLAN EXAMINATION AND
TOWN OF SOUTH WINDSOR, CONK. BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, ll, 111, IV, and IX. 0
ZONING
• AT (LOCATION) DISTRICT _3cJ
LOCATION �Z7(NO') (STREET)
OF BETWEEN t`Z�• AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION ' J'^ � LOT_L�BLOCK SIZE IJn ' X a00
N
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
�v
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For—Wrecking" most recent use m
m
—I
1 []?New building Reside tial Nonresidential
2 ❑ Addition(►/ residential, enter number 12 One family 18 ❑ Amusement, recreational
o/ new housing units added, if any, 13 ❑ Two or more family — Enter 19 Church, other religious
i Part D, number of units— — — — -
3 ❑ Alteration (See 2 above) i 20 ❑ Industrial
14 ❑ Transient hotel, motel, 21 ❑ Parking garage
4 ❑ Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (f/ multifamily residential, of units ——————— — --i 22 ❑ Service station, repair garage
enter number of units in building in 15 Garage 23❑ Hospital, institutional
Part D, 13) ❑
6 ❑ Moving (relocation) 16 Carport 24❑ Office, bank, professional
7 ❑ Foundation only 17 ❑ Other — Specify 25❑ Public utility
26 ❑ School, library, other educational
B. OWNERSHIP 27❑ Stores, mercantile
8 [Z Private (individual, corporation, 28 ❑ Tanks, towers
nonprofit institution, etc.) 29 ❑ Other — Specify
9 ❑ Public (Federal, State, or
local government)
C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food
7 processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement•,,,•,,,•••,,,,, -7 / OO� school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost a. Electrical..................... 7�
b. Plumbing .....................
c. Heating, air conditioning........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT s 7 7CCC'
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS ,
30[]],Masonry (wall bearing) 40 Public or private company 48. Number of stories...............
31 Wood frame 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area,
all floors, based on exterior
32 ❑ Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE9F WATER SUPPLY
42 Public or private company
50. Total land area, sq. ft. ........... 6/000
34❑ Other — Specify
43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed .......................
F. PRINC)PAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
35 rV J�Gas Will there be central air 52. Outdoors........................
36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY
37 ❑ Electricity 44❑ Yes 45�No 53. Number of bedrooms..............
38 ❑ Coal
39❑ Other— Specify Will there be on elevator? w
{� 54. Number of ,V
46❑ Yes 47❑" No bathrooms tN I
IV. IDENTIFICATION — To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No,
Owner or /-�
Lessee L
2.
Contractor
3.
Architect or
Engineer
The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction.
Signature of applicant Address Application date
A"-'e-4 1 -24 86
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans Review Required Check Pion Review Date Plans By Date Plans By Notes
q Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
ate
Permit or Approval Check obtained Number By Permit or Approval Check ObDto ed Number By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING _
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building ,y
Permit number �4/
Building p/
Permit issued //` 19111�
Building
Permit Fee $
cr(�
eA
�� rove b
T
Iqj
REINO E. HYYPPA 6 ASSOCIATES
CIVIL ENGINEERS S LAND SURVEYORS
GLASTONBURY, CON Pi
f.
s�� a
DEBBIE DRIVE
At
�( T4
`Jv
T
06
Mo
Ll
� 5 ;t�0!` «lam • SV' a �•" - s
c y 'ar i3 19.5 :oz zL `« q
44,
T° sue.'�� �'k°�.`�,�4t'� f='". n !'�ee:+ $' A�a'r�`Y� �y nEP� i�d�� $,I'n �M,r •(�� �� .
F w �d 16
{A .7[ �'^�� a -. r��,.._ �8 "�i p � �T -t G �•ye?ter' �y� � r�Y � � �
(,j �s
04,
*41
#'t
�` �yj,,aP. Y •a f�i?� �w rt ,�* yr" � �' y}'
"r'�.' q-. J� +sS' �•e �',FY a ;�"'�'yd`. ?a#xit- �,r a�s44..(. >J�vrw� �,�,y�- ii'i -r �AV�,`tir -
,r �� i ( 7 �, �A`� xc'`� °�'`�c�'�,t k,°� ;' �.�'• �.�',•� i
: wR r�ir ¢� AREA:
.
20,000 ' SE
kv,
1 «
4V 30' 04 rJ ;_
_ r t
t pT UME-5 FROM MAP ow FILE M-EO, C,I,
'Opf-»Sptz-E svWvisOw A-30 10 ,: ., OFEN �. SPAC
- �N 5ECTIC J I MOjNT1aNwErV� PLAN _ r _
p ES�TATES SpU1 H W i w c-`50R;�►J►J'BY «' L
Retoo E. P"Pm 4 5aq-.fE a r
I`:40' DATE 3-14-PS N/W NO•183-BZZ-fG:
e'
-`N4EIET 3 0Fyq S► f_e-s REV (o-30-85 E
- . � PARED FOR
DA,
Ido 7-0W;►dG RT HILL REALTY !N C
v►r�,1,-�tJ
CI KTIFIED SJ55TA►JTIAL0 CORRECT S0JTH WIMDSOR, CONN.
SCALE -, 1"-40*
R8- S5- 17
REINO E. HYYPPA 8 ASSOCIATES
CIVIL ENGINEERS 9 LAND SURVEYORS
GLASTONBJRY, CON►
qoZ
—T — 8' SAN _
DEBBIE '"'F{ DRIVE
- - - - N C4�° �G 00 _
L9R 30
O V1
5
29$
i
Li
19'
s PROP: 4bv'+E 7
c \
29 00 p - 9 tom.
.o 0
° '00 ° ° 16
O
.294
o� n '
L94 - - -
AREA : 20,000 S.F.
292.
LoT Fr,DW ►Mp rJN F�,-E TTr�EO,
*0-«5 � E A-30� OPEN SPACE
F--OT PLAN Wy.)NTA WPEW
ELATES SaJTH W NL'KK.w,CosWby
'two E. Ass--cfATE,-r Scrc�
oF,9 �.,.�EETS u�.� rr-3o-8s PREPARED FOR
N� zoN;Nc-, DART HILL REALTY INS
CERTIFIED 'Ek BSTA.NTtAWI =RREC-T SOUTH WIN'JSOR, CONN.
SCALE : t"•40' DACE - -ate
REINO E. HYYPPA 8 ASSOCIATES
CIVIL- ENGINEERS G LAND SURVEYORS
GLASTONBURY. CONK
5AN_
DEBBIE 'MFi�T DRIVE
Iv �° 30' 00' E
298
C Vt
S 29$
i
so bLp /
_ I.INiE •� _
s PaOP, �.1ovSE ,
29Z,3 —296
o O
0
° 00 o ° 16
294
�
-- -
294 - - -'
AREA-- 20,000
292
LOT LIMES FRDW wiAc dJ F•,.-E TIT-EG,
•COEN SSE 4-30 24>& OPEN SPACE
F-or PLAN, 5ECT,o" 1 Nl--,-f►JTAjwoE-W
F----TATE5 5ouTH Wiwc--cw,Colw*BY V
RzIwo E. F"PPP 4 As✓x+ATE: 5c4i-f
t"=40' GA.TE 3 14-R5 WAr- No 1i;7�-6- 1,
PREPARED FOR
No DART HILL REALTY IN'
CERTIFIED SUBSIANTIALL`f CORRECT SOUTH WIN'JSOR, CONN,
!SCALE 1"-40' :)GCE
.a- C-E- 17
i ✓Z `,.o.
pATL:�---`
11
f - f
p v �t
L� k43 fKv ,kT
AREA : 20,000 SF
.� r' ,d'"` ��.'t vd" � z.A'; � rs�•., ems}
t w v� �r • ; "x� �'l
"4
.L� :.yi' fir �! 9, 7 � '.' � y� Ir. ��, ° .p4•rd� ..1e�q .tip y,t T �ry
• � Ar „tom Y�`1 x: �`'�r�`a<t+x f '' ���� �� '• r
• • r�r•,. +�{ .��` ' . + q ar�"i'a k�a,'t" ' '•-e++in J ,.. .-Yx�1 -$�, #
�SOR
D:Z'PA
D%T
SIG..
REINO E- HYYPPA 6 .ASSOCIATES -
CIVIL ENGINEERS 6 LAND SURVEYO tS
GLASTONBU Y, CONK
298 1 +
/ SAN 8" SAN
DEBBIE sMN DRIVE
N C° 30 00 E _
tOC7.U0'
� 1
a 5 29g
LINE
5tt• a
a� i�oUS�
' � � u.i '' `•29Cv
'C9 Q pt TfoE" i �bvc%'
00
I f7
OR! � ��1 ��.294)�T.� 1���5•_
1;!�
"In -oq3jq
C. y
-292
qqG
AREA= 20,0,O0—S,F.7,'
4Cv` -3 oo" �,�
�`--,
2?2
LOT LIMES FRDO►-AC pN F-11..E TVT�.ED,
OPEK SALE &JWVlSi0w 4-30 Zo►,& OPEN SPACE
R-M PLAN cTsa~t ► Maj+4TAwNwEw
ESTATES SovTH YJ.NvsoR,cDw-*6Y
F nwo E.14"PP./A550Cl4TE .5c'4
1%40' OaTE:3-14-65r
5+ECr t 0Fw 5N EErS .REv (o-3o-ss PREPARED FORDART HILL REALTY INC-:..
No Zo+J;NU Vlc�tr�h15
CERTIFIM 5Ua5TANTIALU7 MiMECT SOUTH WINDSOR$ CONN.
SCALE . 1"=40'
JUN ,;3 2009
• a - .- VUV111 VYIIIV��
BUILDING DEPARTMENT
din�.
t
G GOMpLI ANCE
OF ZONIN t��cture�gl
GERTIFICN?ION ors) use(sl ar �e in
proposed 0� llie`n' ,j -,�sor
as shown ram' r , .u,
conformance
regulations
maY
b �
Date O{licer
nforcement
Zon'n9
� add
Electric # APPLICATION FOR BUILDING PERMIT
Plumbing# 122 Debbie Drive Date: _y
HVAC# -F
Sprinkler# 900216
Estimated Cost $ 494
FINAL APPROVALS
Permit Fee $
Building COMPLETE RED BOXED AREAS
Occupancy Fee $ (D
Engineering TYPE OF PRINT ONLY Eng. Insp. Fee $ aT15
Affidavit ► SIGN ON REVERSE SIDE
Appr.for Co. Total Fe $ 0
N DEPARTMENT, T F SOUTH WINDSOR (Additional Cost) $
TO THE BUILDING D E OWN O OU , CT
The undersigned hereby applies to do work according to the following:
Applicant ► Location of Work Lot No.
Applicant's Address 142l ;;V, -1Z k2t Tel # 8'60 �F2 YOOK
Town/ �eri Zip U6p3 Lic.# g/C DS�78'y0a
Owner �' 1 i / �� Architect
Owner's Address A � Architect's Address
Zip Zip
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit 1?01 ors"e
City Wate Well J Septic System ❑ Sewer
Ins: HO SP ert. Area Basement Garage
Approved by to b Use Group Construction Type
Wi Colo 3) ", „08
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 i I ich th 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 Q-
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
BUILDIVG PERMIT. .21
STATE OF CONNECTICUT
WORKERS'COMPENSATION CONMUSSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn.Gen.Stat.§31-286b)
Property located at 12 2 pe 6�,
In the town ofCJ��
Name of building permit applicant. Nd G
' ��" r -
Please check one:
1._I am the owner of the above property.
2.A I am the sole proprietor of a business.
2A.Name of business e 7' i e Z—L C
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
2.261 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)
TOWN OF SOUTH WINDSOR ,UN D
N 8 2009
South Windsor
AFFIDAVIT OF ACTUAL COSTS BUILDING DEPARTMENT
PERMIT NO: Q( Ito DATE
Vie undersigned,being a duty authorized relxesentauve of,_ �,p T� S
C
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).
1 understand that verification for accuracy of actual casts 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 tho*actual cost of the work performed under this permit is:
s I 1 ODD
Signature of Permit Holder.
Name(Please Print)
-Date:
■rrrarararraaraasaaarrrarrrrrrrrarararaaaaraaarraaarrararaaaraarrrrra■aaara�aaaaa
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
1200122 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER HVAC PERMIT
DATE: 03/22/12
GIS ID:26700122 FEE: 75.00
MUNIS APPLICATION# 201200258 BUILDING DESCRIPTION:
APPLICANT LOCATION
NAME: STAFFORD MECHANICAL SERVICES,INC. ADDRESS: 122 DEBBIE DRIVE
ADDRESS: 71 C WEST STAFFORD ROAD OWNER: LEPAGE JOHN R IV&PAIGE A
STAFFORD SPRINGS,CT 06076 122 DEBBIE DRIVE
SOUTH WINDSOR,CT 06074
DESCRIPTION OF WORK: REPLACEMENT OF ORIGINAL GAS FIRED BOILER.
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
3/22/2012 12:45 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE