HomeMy WebLinkAbout15 DEVONSHIRE DR APPLICATION FOR HVAC PERMIT
TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT
1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 (PHONE) 860-644-2511 EXT. 230
DEPARTMENT DECISION
PERMIT NUMBER:
APPLICATION IS HEREBY:
APPROVED: BLDG.PERMIT NUMBER:
DATE INSPECTOR
LOCATION OF WORK:
APPLICANT: OWNER: TYPE OF STRUCTURE:
❑NEW BUILDING
NAME: c1mC JUU NAME: �G��2� � ❑ADDITION
PHONE NUMBER--c I� tl E/� 1y��-:>_I C-'J���/ PHONE NUMBER: �O� E ,O�' �S EXISTING BUILDING
ADD (!TRESS: , C)C� I�`(�1 ADDRESS: I 11C�1�i1��C' [wp
E 11�Q�ck-) , c� c�aG TYPE OF USE:
R RESIDENTIAL ❑COMMERCIAL
HVAC INFORMATION: FURTHER DESCRIPTION OF WORK:
TYPE OF SYSTEM: pi HEATING o A/C
HEATING:
TOTAL HEAT LOSS(BTUH) 'F (HEAT LASS SHEET REQUIRED)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDE MAKE AND MODEL NO.):
[c& Ll�cw,� MOT"\ ESTIMATED COST:S
AIR CONDITIONING:
DESIGN TEMP:OUTSIDE °F INSIDE 'F DIFFERENCE F' FEE ENCLOSED:S y
TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET REQUIRED)
DESCRIBE ALL COOLING EQUPWNT(INCLUDE MAKE AND MODEL NO.):
FEE SCHEDULE:SI8 PER$1,000 OF THE ESTIMATED COST.
ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS
$1.00 OVER. (.26 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.: TYPE: STATE:
SIGNATURE OF APPLICANT: A DATE: I-Q - X lQ
APPLICATION FOR BUILDING PERMIT
Electric #
Plumbing# Date: :/�� `-7
HVAC # 15 Devonshire Drive
Sprinkler# 730863
-_- " -- ----- _ _- - Estimated Cost $ %.OP/_ 'DOFINAL O
BuildinjoI COMPLETE RED BOXED AREAS Permit Fee $ ',�
Engineeri TYPE OR PRINT ONLY Occupancy Fee $
Affidavit Eng. Insp. Fee $
A r. for CO. SIGN ON REVERSE SIDE
pp -- Total Fee $ _
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant ecJ ^�'I D '� cl r Location of Work / S t- Lot No.
Applicant's Address /5-0V1�S�i�. Tel.#
Town Zip a'�/ Lic.#
Owner Sa. G 0 s t� u�e Architect
Owner's Address Architect's Address
Zip Zip-
.-Sq. Ft. New Area: 1 st Ff. G O ' 2nd FI. 3rd Ff. Total New Area
Purpose of this permit
City Watero Wello Septic System❑ Sewero
Ins: HO SP Cert. Area Basement Garage
Approved by Dat4fflel� _ Use Grou Construction Typa-��
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 whi !?wilding an use allowed.
S i g n L.'a, r
I hereby apply for a Certificate of Occupancy f he wor descn in pplication for the permit.
Signed - =
DO NOT WRITE BELOW THIS E
INSPECTION COMMENTS
BUILDING PERMIT
STATE OF CONNECTICUT
WORKERS'COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn.Gen.Stat.§31-286b)
Property located at_ 1 � ar `'/-rr J ,
In the town of f L(
Name of building permit applicant: ' Nth•`� i
Please check one:
1.L/I am the owner of the above property.
2._I am the sole proprietor of a business.
2A.Name of business
2B.Federal Employer Identification Number(FEIN)
......................................................................................... .. .......................
Pursuant to§3l-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.-- -1 do not intend to act as a general contractor or principal employer.
[Sign nd top her cJ
c�
rgnature of appli
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 coverage.
Signature of applicant
Subscribed and sworn to before me this day of ,2p0 .
(Notary Public/Commissioner of the Superior Court)
f
09
Printed ,by Peart, Dayshell INSPECTION FIELD SHEET 13/18/12 •
INSPECTION: 4571 FINAL PERMIT:
STATUS
APPLICATION: 200700840
LOCATION: 15 DEVONSHIRE DRIVE
SOUTH WINDSOR
j PROPERTY ID: 27900015
OWNER: RODRIGUEZ EDWIN M & DIANE C
CONTRACTOR:
DESCRIPTION: REROOFING/ ADD LAYER 16 SQUARE
WORK ORDER:
INSPECTOR: FLAN RESULT: PASS
REQUESTED:
SCHEDULED: COMPLETED: 03/05/09
UNPAID FEES 00 Date Time
TIME: TRAVEL ONSITE
COMMENTS
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APR U 5 1989
South Windsor
BUILDING DEPARTMENT
19 INI &VIto" DIPT' iowu Of sours WINDSOP
Thlg seftifled that this Plan and sptsiflaatlans or#tme
Ieples Of the PfOPused building of alterations to be
areetad at
together with amendments �teeet
filed with plan and I a ree - " acalic2tG�n on,
Building and state laws and0Such ptY,r+-rsnasl lsha ling
Issued by the Building Department bn
Of this application an au gyring Pendency
d final issuance of s building
Permit. /
Signed
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�'cIVCINEERING 1750 ELLINGTON ROAD
ANC.�-. SOUTH WINDSOR CT 06074
203'644-4691
sIG.-
1900042 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER HVAC PERMIT
DATE: 01/23/2019
GIS ID:27900015 FEE: 144.00
MUNIS APPLICATION# 201900032 BUILDING DESCRIPTION:
APPLICANT LOCATION
NAME: HOMESTEAD FUEL INC ADDRESS: 15 DEVONSHIRE DRIVE
ADDRESS: PO BOX 749 OWNER: AMBROSE JAMES J III& SHARON H
15 DEVONSHIRE DRIVE
ELLINGTON,CT 06029
DESCRIPTION OF WORK: REPLACE GAS FIRED HOT WATER HEATER
SPECIAL CONDITIONS:
ALL WORK TO BE DONE IN ACCORDANCE WITII TIIE APPLICATION AND PLANS APPROVED BY TILE BUILDING DEPARTMENT.
d4-
CONSTRUCTION TYPE: &-
OCCUPANCY GROUP: BUILDNP O FICIAL
1/23/2019 12:57 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE