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Home My WebLink About1444 MAIN ST BU1LUlNU Vh MIT STATE OF CONNECTICUT WORKERS' COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn.Gen.Stat. §31-286b) Property located at 1 L-k+k a 16' ram%c\ st- In the town of S k,.S,,c Sd c' Name of building permit applicant' r-\ %chat Tom-t h Please check one: 1._I am the owner of the above property. 2.�4 I am the sole proprietor of a business. 2A.Name of business To--c n 6`S (-(o r1� =,gyp r e w�e ►� S , 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._2:�I do not intend to act as a general contractor or principal employer. [Sign and stop re 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 cov ra . Signature o applicant *h Subscribed and sworn to before me this Z�j day of r',,\o,y ,200 G. (Notary Public/Commissioner of the Superior Court) Electric # APPLICATION FOR BUILDING PERMIT Plumbing# 1444 Old Main Street Date: ^2-5 —0 HVAC # Sprinkler# 3 2 610 Q FINAL RO ___- ___--_— Estimated Cost r -- - ----� ' Permit Fee $ o � Building f y= COMPLETE RED BOXED AREAS En neen Occupancy Fee $ g TYPE OR PRINT ONLY Eng. Insp. Fee $ Affidavitppr. for CO. ► SIGN ON REVERSE SIDE Total Fee $ y TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) The undersigned hereby applies to do work according to the following: Applicant TvN-\e\o Location of Work ^ 1--v,\n e,� Lot No. o Applicant's Address l --��.hn�� si- Tel.# SO --11 c,--Tsa 1 Town---N.o. Zip ix00 4 O Lic.# y(o 4`{—1 Owner JL,,� r-\,>,'WNe v 5 Architect Owner's Address UALALk o iS c-:�,ok to Architect's Address Zip �� Zip Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area Purpose of this permit re,roo co✓e-r eA,, 5 h r\ r City ater❑ Well❑ Septic System❑ Sewer❑ Ins: HO SP Cert. Area Basement Garage Approved by x/-- Date Use Grou Construction Type Revised 6102 I hereby agree a ee 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 buil ng nd its use is allowed Signed 1 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 Inspection / Approval Date By Appl Code Description Due Whom Code Comment ------------------------------------------------------------------------------- **-32610-B 3,850 B10 FINAL 04/19/07 JFF A • F Amifth immm qw APPLICATION FOR HVAC PERMIT TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 (PHONE)860-644-2511 EXT.230 DEPARTMENT DECLSION PERMIT NUMBERN� APPLICATI BY: �OOO�S3 O BLDG.PERMIT NUMBER- DATE IVECTOR LOCATION OF WORK: APPLICANT: OWNER: TYPE OF STRUCTURE: / ❑NEW BUILDING NAME:V d A k i /y/J'f``'��k p I/�J� , NAME: ��l/ �-- O ADDITION PHONE NUMBER: �Q� PHONE NUMBER,�U��' 9 q_�f g y MSG BUILDING ADDRESS:/- �. U6 k //6-3 ADDRESS:1, 1 _L►Lf /�/�!/V ��- ��Q�i757 TYPE OF USE: RESIDENTIAL O COMMERCIAL / HVAC INFORMATION: ` FURTHER DESCRIPTION OF WORK: TYPE OF SYSTEM: V0 HEATING ❑MC HEATING: TOTAL HEAT LOSS(BTUH) T (HEAT LOSS SHEET REQUIRED) DESCRIBE ALL HEATING EQUIPMENT(INCLUDE MAKE AND MODEL NO.): ESTIMATED COST:S AIR CONDITIONING: / ,C DESIGN TEMP:OUTSIDE °F INSIDE 'F DIFFERENCE FEE ENCLOSED:S TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET REQUIRED) DESCRIBE ALL COOLING EQUPMENT(INCLUDE MAKE AND MODEL NO.): FEE SCHEDULE:$18 PER$1,000 OF THE ESTEKATED COST. ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS S1.00 OVER (16 CENT EDUCATIONAL FEE INCLUDED AS PART OF THE PERMIT FEE) 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 PERFOMANCE OF SUCH WORK. CONTRACTORS LICENSE NO.: OVa 1G o2 TYPE: �'' ) STATE: (f 7 SIGNATURE OF APPLICANT: , DATE: �on I _ 2000053 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER HVAC PERMIT DATE: 02/18/2020 G1S ID: 54901444 FEE: 162.00 MUNIS APPLICATION# 202000207 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: MITCHELL FUEL CO. INC. ADDRESS: 1444 MAIN STREET ADDRESS: P.O.BOX 1163 OWNER: MATHERS ROD B 1444 MAIN ST SOUTH WINDSOR,CT 06074 t ' DESCRIPTION OF WORK: OIL TO GAS CONVERSION SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITII THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 2/18/2020 10:28 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE