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Home My WebLink About154 KELLY RD Electric# APPLICATION FOR BUILDING PERMIT Plumbing# Date: - z -v HVAC # 154 Kelly Road Sprinkler# 9 0 012 8 _ ,__ Estimated Cost $ •2�- r FINAL APPROVALS ' -- _ — _ - _ - - -- ---- Permit Fee $ Building j COMPLETE RED BOXED AREAS Engineering TYPE OR PRINT ONLY Occupancy Fee $ - - Eng. Insp. Fee $ Affidavit � Appr. for CO. SIGN ON REVERSE SIDE / 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 U-o tf� S; •7 -N Location of Work ZS- Lot No. Applicant's Address 107 60,17 Rp . Tel.# a25- -75 Ts'� Town werRe-/1SF'iCL D c i Zip 0610 5 Lic.#S1!� 19 c/ Owner A RT- M flTFI,6�-W S' Architect Owner's Address Architect's Address Zip Zip- -Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area Purpose of this permit CM41/,� a2 /_A./FA-s - 1.j4' -TeVA. YMCN. Sd,,t,CC4-s 6u 47-r-/L <;4( 1—Az, o e-17 Vr City Water❑ Well❑ Septic System❑ Sewer❑ Ins: HO t. Area Basement Garage Approved by toor— Use Group Construction Type Revised 6/02 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 fding its use is allowed. Signe c I hereby apply for a Certiff of Occupancy for the work described in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS PERMIT ri ncGn PER: PA 17-176 AND 1 1 TOWN OF SOUTH WINDSOR AFFIDAVIT OF ACTUAL COSTS PERMIT N0: qO6 I O-S- DATE — � The undersigned,being a duly authorized representative of, �Of/�✓ �ih ?Tt/ 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: Signature of Permit Holder• Name(Please Print) .-J Q //A/ Date: - c ■■rraraarrrarraaaaraarararraararrrarrraararraaaaaarrrararraaaraaaaraartrrratraaa■ 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 Electric # APPLICATION FOR BUILDING PERMIT Plumbing# 154KELLY ROAD Date: U' ��`-C HVAC # Sprinkler# 730687 •� FINAL APPROVALS _ - - --- —_-- -_ ---� Estimated Cost -— ------- -- _ - - - — — Permit Fee $ Building I COMPLETE RED BOXED AREAS Engineering TYPE OR PRINT ONLY Occupancy Fee $ Affidavit Eng. Insp. Fee $ Appr. for CO. SIGN ON REVERSE SIDE l -— -- --- --- - - --- 1jotalFee $� TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ �G� The undersigned hereby applies to do work according to the following: Applicant iU 1� t�J" Location of Work S ' LLV Lot No. Applicant's Address 1 Tel.# X6 L" 9 y b tf Town '% Zip 0607L( Lic.# Owner :7 . Architect Owner's Address U Architect's Address Zip Zip- -Sq. Ft. New Area: 1st FI. 2nd FI. 3rd FI. Total New Area Purpose of this permit- _t �l_ j� I, 1V Z City Water❑ Well❑ Septic System❑ Sewer❑ Ins: HO S Cert. Area Basement Garage Approved by - Date I 0' 1> 10 Use Group Construction Type -- Revised 8/02 I� 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 isallowed Signed r/ I hereby apply for a Certificate of Occupancy "for the wort described in t is application for the permit. Signed DO NOT WRITE BELOW THIS LINE ry�r INSPECTION COMMENTS l�JppIW S:f'✓1t1ux `!�` �� rli vt I STATE OF CONNECTICUT y WORKERS'COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn.Gen.Stat. §31-286b) XProperty located at Y'In the town of ,SD W*y)G 6:N— Name of building permit applicant: . )Pj PC(a `'-r, Please check one: 1.,�I am the owner of the above property. 2._I am the sole proprietor of a business. 2A.Name of business j 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] . VOMW '0 Signature o ap 'cant 2._I intend to act as a general contractor of 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 worker's'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) February 27, 2007 Nancy J. Matthews 154 Kelly Road South Windsor, CT 06074 Dear Ms. Matthews Re: Permit fees due for 154 Kelly Road It has come to our attention that there are outstanding fees for a building permit (installation of a pellet stove) that you took out on October 10, 2006. There is a $10.00 fee due for a Certificate of Use. We have applied the check for $45.00. The building permit will be processed as soon as we receive the remainder of the fee. No Certificate of Use shall be issued until you request a final inspection. Please call Alice at 644-2511 ext. 230, should you have any questions regarding this letter or to schedule the necessary inspections specified. Our office hours are 8:00 a.m. to 4:30 p.m. Very trul yours Christopher Dougan Chief Building Official C]D/pmm Cc: Connecticut Development, LLC 1136 Sullivan Avenue ` South Windsor, CT 06074 3i�� 1600628 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER BUILDING PERMIT DATE: 10/1 I/2016 GIS 1D:49500154 FEE: 60.00 MUNIS APPLICATION# 201601459 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: THD AT-HOME SERVICES ADDRESS: 154 KELLY ROAD ADDRESS: 908 BOSTON TURNPIKE UNIT# 1 OWNER: MATTHEWS NANCY J SHREWSBURY, MA 01545 154 KELLY ROAD SOUTH WINDSOR,CT 06074 DESCRIPTION OF WORK: INSTALL 7 REPLACEMENT WINDOWS. NO STRUCTURAL CHANGES. 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 10/11/2016 12:13 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE