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Electric# APPLICATION FOR BUILDING PERMIT
Plumbing# Date:
HVAC # 124 Natsisky Farm Road
Sprinkler# 30143
FINAL P O ----- - _-- - _ - - Estimated Cost $
Building/b oSr COMPLETE RED BOXED AREAS Permit Fee $
Occupancy Fee $
Engineeri TYPE OR PRINT ONLY Eng. Insp. Fee $
Affidavit SIGN ON REVERSE SIDE
Appr. for CO. _ _ _ Total Fee $ ' S- r
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant [)Zen Location of Work lay -Vtfs,sk V 1t.9- Lot No.
Applicant's Address ion Tel.# &Y X- P-7-A 3
Town Zip 0(-0-2 Y Lic.# C.flan
Owner g",.� } '�o«.,�� L�r„:,r}�.� ... Architect
Owner's Address /2 ti n c,&.4 LV F... Q9 Architect's Address
cr Zip c(Qo-)ti Zip—
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit-ee_rnoie a-,- , ?14, -rcc- is 16 o"O,C-
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO ft=�Cert. Area Basement Garage
Approved by Date 11- 4 . Z>L Use Group 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 this 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 _
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
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Inspection / Approval Date By Appl
Code Description Due Whom Code Comment f
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**-30143-B 6,570
B10 FINAL 10/23/08 JFF A