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HomeMy WebLinkAbout16 COUNTRY VIEW DR Ek.,tric # APPLICATION FOR BUILDING PERMIT Plumbing# n HVAC# (0 CZ� VK w 1u - Date: Sprinkler# Estimated Cost $ 3 cvJo• FINAL APPROVALS Permit Fee $ 9 Buildingd,E V-03:2 y COMPLETE RED BOXED AREAS Engineeri Occupancy Fee $ Affidavit TYPE OR PRINT ONLY Eng. Insp. Fee $ Appr.forCO. ► SIGN ON REVERSE SIDE A S Total Fee $ 4 TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant ELVE01IJ A ' fi , ` Location of Work Lot No. Applicant's Address /6 CO(//,)7-AV Axr' �/1 &R/ 6 A Tel # 0 16 S -16 y Town 5;0(/7'/y I,(Ajj/1502 Zip Lic.# Owner E L1/nj Al AA19 �} Architect Owner's Address /G Cd UN T'2j_ U/1C74V 0rArchitect's Address Zip C7(>0?'E9 Zip Sq. Ft. New Area: 1 st Fl. 2nd Fl. 3rd Fl. Total New Area Purpose of this permit 471 Q City Water Well _] Septic System J Sewer J ,26r7601j'7 Ins: HO SP Cert. Area Basement Garage Approved by Date 11 Use Group'"Zt&.� Construction Type Revised 1108 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. kigned -e� 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 INSPECTION FIELD SHEET 08/02/17 1rinted by Foreshaw, Dayshell 09 17 56 INSPECTION: 94662 5 PERMIT: STATUS: APPLICATION: 201700476 LOC: 16 COUNTRY VIEW DRIVE SOUTH WINDSOR PROPERTY ID: 24300016 OWNER: ABAZA ELMA & ELVEDIN CONTRACTOR: REQUEST BY: PROJ DESC: REROOF--25 SQ. WORK ORDER: INSPECTOR: [JCS i RESULT: ;PASS'-'� REQUESTED: U5/08/17 PRIORITY: SCHEDULED: 05/08/17 AM COMPLETED: �Datie� Time UNPAID FEES 00 MILEAGE: 00 TIME: TRAVEL ONSITE COMMENTS: Electric # i7600-1 APPLICATION FOR BUILDING PERMIT Plumbing# `/ HVAC# i CA" Y I e.w �n �/e- Date: 29,70 Sprinkler# 00101 Estimated Cost $� FINAL APPROVALS BuildingPermit Fee $ COMPLETE RED BOXED AREAS Occupancy Fee $ Engineering . TYPE OR PRINT ONLY Eng. Insp. Fee $ Affidavit „ , ► SIGN ON REVERSE SIDE t Appr.forCO. '\ Total Fee $ ?7 � t TO THE BUILDING ARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ �' ��1 The undersigned hereby applies to do work according to the following: Applicant C-TifC Z)IQK,, L.LC Location of Work n LotNo. 3 p Applicant's Address 01 n -00cid ax,-ik ✓1-/C 2vU Tel # 8100-- - 13 Town LoU✓�) _- Zip b(a00Z Lic.# H/C- 063,539c/ Owner E-lWlQ AbOW Architect Owner's Address/& ems, Yj 00,j Or,ve Architect's Address ��y'� (� rods of Zipl1(n0-3y Zip- Sq. Ft.New Area: t st FI. 2nd FI. 3rd FI. Total New Area 2,b kQ Purpose of this permit InSkI14-bDn 441 Zo.4 moll P✓ 4.S-ilrGrt G►-1 44- 4l 63f,!�au ) It q 3 i-»ttjLte s /vt✓e,--tr 3 City Wate Well 7 Septic System :1 Sewer Ins: HO SP Cert. Area Basement Garage Approved by I " ate 3 t Use Group Construction Type Revised 1108 1 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 ilding and its use is allowed. Signed I hereby apply for a Certificate of 0 pancy for the work described in this application for the permit. Signe DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS DD � DD -TEC SOLAR Your Family. Your Home. Your Solar. Town of South Windsor Building Department 1540 Sullivan Avenue South Windsor, CT 06074 Regarding: Permit application for 16 Country View Drive South Windsor, CT 06074- Elma Abaza The person who attached their signature to the Permit Application, Pete Walsh is indeed authorized by Mickey Toro to sign the permit application in lieu of Mickey Toro. Sincerely, ick Toro 1 Griffin Road South •Suite 200 • Bloomfield, CT 06002 Phone 860.580.7174 • Fax 860.580.791E INSPECTION FIELD SHEET 06/09/17 Printed by Foreshaw, Dayshell r 09 52:44 INSPECTION: 93511 F_NAT+»�! PERMIT: STATUS APPLICATION: 201700241 LOC: 16 COUNTRY VIEW DRIVE SOUTH WINDSOR PROPERTY ID: 24300016 OWNER: ABAZA ELMA & ELVEDIN CONTRACTOR: REQUEST BY: PROJ DESC: INSTALLATION OF ROOF MOUNTED PV SOLAR SYSTEM WITH 4 ARRAYS WORK ORDER: INSPECTOR: -ROSE . : RESULT: PASS REQUESTED: 05/I5/17 PRIORITY: ,.....,_ SCHEDUNPAID FEES; 05/17/17 PM 00 COMPLETED: �/17/17' ` Time MILEAGE: 00 TIME: TRAVEL ONSITE COMMENTS: JOSH 0 860-580-7174 ALL INSPECTIONS: INSPECTED INSPECTOR RESULT INSP DESCRIPTION 05/17/17 ROSE PENDING E010 ELECTRIC FINAL WIRING TO COMPLY TO SPEC. OUTLINED IN SUBMITTAL DWG QUERY ON DISCONNECT 06/06/17 ROSE PASS E010 ELECTRIC FINAL RECEIVED REVISED DWG. OK TO RELEASE TO EVERSOURCE. APPLICATION FOR ELECTRICAL PERMIT DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: BUILDING DEPARTMENT t b \O K i APP O 1540 SULLIVAN AVENUE . ►-� 644-2511.ext. 230 Bldg:Permit# t ?0 6 j c Date Building Inspector . Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000=$1 s.00 1�� Cnuiqfvy ylf4l Over$1,000= Street No. S Lot No. $15.00 per$1,000 or any fraction thereof Tenant Designation Apt:No. APPLICANT _ C - Tf C SO la r L L C APPLICANT ADDRESS / C-� APPLICANT'S PHONE W �0 — SW o �pW N S�q OWNER /�G' gh/'zg ADDRESS 162 .� /e CA C F OWNER PHONE &j!�,O — 9G ,^- . ��(o O Q ESTIMATED COST$ �j7 I- -57 IS THIS A CONTRACT COST? '-'IT Yes No FEE ENCLOSED•$. 570 TYPE OF JOB: 7 2 0 9 dSOR•CO New Installation 2,6/t 7 Alteration/Addition/Repair Revised 03/05/10 APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? O YES O NO SIDENTIAL CURRENT USE AND OCCUPANCY ❑ BUSINESSO. ASSEMBLY FUTURE USE AND OCCUPANCY ❑ EDUCATIONAL ❑ INS h l UTTONAL ENGINEER'S NAME PHONE ❑ FACTORY ❑ STORAGE ADDRESS ❑ GARAGE O MIXED USE CITY STATE ZIP (Other ple*se specify) TYPE OF INSTALL ATION/WIRING METHOD.&I S& 1I 77Un C,,C "I C1 10c . m��' .f�V Sa lo•� systew, cc�ltG �,n� y3 �r�c�vl�S /,��P,-}.ems SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBERS OF METERS NUMBERS OF DISCONNECTS AND RATINGS NUMBERS OF PANELS NUMBERS OF DISCONNECTS REQUIRED? O YES ❑ NO NUMBERS OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FDCTURES NUMBER OF.HEAT CIRCUITS NUMBER'OF A IC CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK THE UNDERSIGNED HEARBYAPPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFOR- MANCE OF SUCH WORK Ll9 79;'9 Q PLC _ CT CONTRACTORS LICENSE TYPE STATE SIGNATURE OF APPLICANT DATE 0 i � 013 LAP 1 Griffin Road South STE 200 Bloomfield, CT 06002 860-580-7174 Town of South Windsor Building Department 1540 Sullivan Avenue South Windsor, CT 06074 Regarding: Permit application for 16 Country View Drive South Windsor, CT 06074- Elma Abaza The person who attached their signature to the Permit Application, Pete Walsh is indeed authorized by Aaron Loitz to sign the permit application in lieu of Aaron Loitz. Sincerely, Aaron Loitz STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION iBe it known that AARON D LOITZ 20 IEIGHLEY POND RD EAST HAMPTON,CT 06424 i I i has been certified by the Department of Consumer Protection as a licensed i ELECTRICAL UNLIMITED CONTRACTOR ` License #EL C.0197899-E1 i Effective: 10/Ol/ZO1G Expiration: 09/30/2017 c Jo at6h A.Harris,Commissioner a. ' Electric # APPLICATION FOR BUILDING PERMIT Plumbing# Date: $ d'a HVAC # 16 country View Dri vP Sprinkler# _ 32827 - ------- - - Estimated Cost $�7 3 •�� Building AP ROV, i _ _ -- Permit Fee $ Engineering COMPLETE RED BOXED AREAS Occupancy Fee $ /a TYPE OR PRINT ONLY Eng. Insp. Fee $ Affidavit 1 SIGN ON REVERSE SIDE Appr. for C( I' '6 L ----- -- -------- -- -- - - --' Total Fee $ moo• TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ o The undersigned hereby applies to do work according to the following: Applicant J��an MccLl Location of Work Applicant's Address I �P C �1 el.# fv`/-df-g// Town 5 Zip C(2() 7 5( Lic.# Owner Fbuk Ctn6 -J:K---,(an/),;? hitect Owner's Address 1(D Co�ta*-f V leu) Architect's Address Zip Zip Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd A. Total New Area Purpose of this permit Pe l S'�nVQ City Water❑ Well❑ Septic System❑ Sewer❑ Ins: HO SP Cert. Area Basement Garage Approved by Date Use Group-�t`onstruction 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. SigneOG02AA0 ffiCCb&6g'd- C/ 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 M Inspection / Approval Date By Appl Code Description Due Whom Code Comment --------------------------------------- **-32827-B 3,373 B10 FINAL 09/06/06 CJD A 3 07•_37:2g � 328 330 8 .71' t f -- 30' STORM SEWER EASEMENT ID' STO M SEWER EASEMENT — �.--- —329 LAT AREA a�jJV�I 10,234 &K ery h LOT 27 = FIN. AR: FL X- LOT 29 v 32s. I A s � I 320/ [ - EXIST*4 �. —• bids.line Rs 2T0.00' t� E 324 � � 3 ar -- 326 N 61 d 0•34' w ;;:.:storm snow weer a Junet n11 e .....w......— _� • ... .....:�-.ram_ 322 Grt•�rr� �s �n+co•tvL:ram � ITT T►Its ,T�M�. REFERENCE ASBUIl.T Pbf Pkv% Cam's"v'ow Dc LOT 28 Country View Estates, Phos! One OrcpWy Of TAM. Wldinq C& Country View Estates South Windsor, Conn Now., IWO Rw 3-26-8' 1~=400 --South Windsor, Conn. Certified Class A-2. B, A. R. Lombardi', Assoc+ate; Inc PROPERTY OF T&M BUILDING CO. APRIL. 269 1983 SCALEI If■40' i HEREBY XRnf rlyls MAP TD RE SU867ANTI -�ORR Ur. It Robert T. Dayton, Conn. L. 8157 .* ! 7—T-) dP� 67�-37,25" �328 f G 330 8 •7!' r I 30' STORM SEWER EASEMENT IS' STO M SEWER EASEMENT LOT AREA {� 10,234 S.R LOT 27 FIN. OAR. FL0. LOT 29 � 1 s / v 326.80 P ro A / ! i 1 / - EXIST"-' t 32 .Ste-• — `•��..�. _• �-•�• — bl"line s•os•-Is_oo" � R•27S.o0' _ — 324 L•44.40 326 N S to .34 w a �;;; •tor1� Meter free e +�"• jureON -322 GR••or.+a is wcortP%-:rat AT Tags .T�N�. REFERENCE aSBUIL.T Pict Pian, Country View DE LOT 28 Country View Estates, PAose One Property Of TAM Bonding C X Country View Estates South Windsor, Conn Now, 19M Rest 3-26-81 'N=40' South Windsor, Corn. Certified Cioss A-2. By, A. R.Lombardi%"Assoclatvv'*Inc PROPERTY OF T&M BUILDING CO. j 1 ' '1 ' APRIL. 269 1983 SCALE_ 1==40' /H£R£9Y IrR77f'1-tr#/S MOP 1� SYlBJ�7'AIlrT/ �ORR obe Rrt T. Dayton, Conn. L': 8157 r,*,-A,It\] -A P PRO V OF SOUT", -.,(7!N,=T:RING D " cb S 670-37_25" 328 330 8 .71' E I ' M SEWER EASEMENT 15 STO :0' STORM SEWER EASEMENT I LOT AREA 1,,234 S-F LOT 27 A z FiP:. GAR. FLR. LOT 29 327.5 I om3 q, S � o �_ROPQSED 3 s p 'oN� / ( OUSE \ r m 50' 1� 20 b 24' 2e' — 326 32 ` s 24 4 16' .�'bld9 llM A=09--15'-00" I !o 52' R=275.00' D I — — 324 L=44.40' 3 til6 0'-34" W-- �ctorm 326, s �' water � . -_- — can. c junco x rrb - -- cb - /-_ - - 322 tEFERENCE PLOT PLAN FOR Plot Plan, Country View Dr. LOT 28 country View Estates, Phase One Property Of T8M Building Co. Country View Estates -,outh Windsor, Conn. Nov., 1980 Rev. 3-26-81 I"=40' South Windsor, Conn. ..ertified Class A-2 By A. R.Lombardi Associates, Inc. PROPERTY OF T&M BUILDING CO. MAY 3, 1962 SCALE: I"= 40� ' HEREBY CERTIFY THIS MAP r� gConn. MRIRS�) 9% CA �NEcobert T. Dayton, L.S. dP9 HAR 2 0 6oud) VVindsor ULDINIG DEPARTMENT TJ C�Oifll,d 7 1 the er-clad at IIE .1th amendm-Its, stall—; 1, Piln ant I ae;rer to c,",I ly ,j I M.; anal state laws and such o,ders zi ,-,j by the PuildIng Department during p this application and fin3I Issuance of a In it. ;ned (f?1?,14—;;9� -i plan w Is approved clk, to the condaln,, •Prs and ordinances regulating bulWing shd:l ,plird with. diflonally Approved Tho" filed -!t,y .-oilding Inspect" cf�rK jq7gg OF ZONIII'�G :Proposed WX as shcwn oil Or conform--,3C n 31/ .111ay a p"'I Date 211-1 19 A C-x�- T- -` '7-f- 7-- 3 67•-37'23" E 328 330 I 30' STORM SEWER EASEMENT IS' STO M SEWER EASEMENT ILOT AREA 19,234 S.F. LOT 27 Z FIN. OAR. I<LR. LOT 29 326.80 _ . 9 ro s 320/ I ' — EXISTWC+ HMO \ ---Ste _._� _ bi In* 0809-10'-00" I i R•275.00' t 324 o L=44.40' s' ' I — 6 Ole 32d, N Ole '- c asap s" spa. Juno kc rt• Ga••a#•rar �s �n►co.t�.:rt + AT TN1s 'rWir. REFERENCE AS BUI LT Plot Plan, Country View Dr. LOT 2-8Country Visa Estates, PAoss One PrgwtyOf T&M Building Co. Country View Estates South Windsor, Conn. Nov., 1980 Rev 3-26-81 1'0=401 South Windsor, Conn. Certified Class A-2 By A. R.Lombardi Associates, Inc. PROPERTY OF T&M BUILDING CO. i i yEREBYawmr ryes Map APRIL 269 1983 SCALE, 1"=40' S7J8.&TANT/�:. CORREL`T. i I a f Qt Robert T. Dayton, Conn. L. I57 dp9 i II w t � cb • 3 67•'37, E 328 330 8 .71' I 30' STORM SEWER EASEMENT 15' STO M SEWER EASEMENT ILOT AREA le•234 S.F. LOT 27 /� z FIN. GAR. FLR. LOT 29 / m 326.80 _ • tCo •/ ��� 0 � of C s m — EXISTING N0 \ 328 `• —. ._-• bld$.Ilse As09=18'-00" I i Rs275.00' I =� Ls44.40' 324 8 OW 326 — N 81• -34� VV ; s;:o::$tam water e sOil. Juno FRIlliq IM eb ."-.-oo.......«--�•-� �.....--322 Ko'TE' GQI.a�rJC9� �i 1►JCph(P�tT� + AT TNIS - lmw. REFERENCE ASBUILT Plot Plan, Country View Dr. LOT �� Country View Estates, Phase One Property Of Tam Building Co. Country View Estates South Windsor, Conn. Nov., 1980 Rev: 3-26-81 1',=405 South Windsor, Conn. Certified Class A-2 By A. R. Lombardi associate, Inc. PROPERTY OF T&M BUILDING CO. / HEREBY�R7IFY, THIS MAP APRIL 261, 1983 SCALE, 1"=40' TOSU6b7"AIUT! RR Robert T. Dayton, Conn. LIR 8157 dpQ C7"-� AP R_OV1ED TO\V^I 077 ^± IT;I WINDSOR DATE:�_�,___._ SIG.: ' 67 23,1 328 330 a •71' M;Y ! 30' STORM SEWER EASEMENT 15' STO M SEWER EASEMENT + -3as ILOT AREA r LOT 27 /1 FW. AAR. FLU. LOT 29 a 32e.8O r $ .9 O r . / - EXIST"G r A s. aw two i R 27d 00 324 326 N A 1' ......ts IIw -- � ASBUIL r; REFERENCE �- Plot Pion, Country View Dr LOT 28 Country Mew Estates, Phase On* PmWy Of TSM WIdng Cm Country View Estat y. f . South Windsor•, Conn Nov., 19W Rest 3-26-e1 1"=40' South Windsor, CO Certified Class A-2 BV A. R. Lombardi Associgtes, Inc. PROPERTY OF T&M BUILDI J •� ' / APRIL' 269 1983 SCALE=+ / MEI4JrBY!XR77FY THIS MAP R x Robert T. Dayton,, Caren. L.S. a157 ;1F, cb S 67'-37=25" E 328 330 I 30' STORM SEWER EASEMENT 15' STO M SEWER EASEMENT _ 328 ILOT AREA 18,234 S.F. LOT 27 /I Z FIN. GAR. FLR. LOT 29 / m 327.5 O I � O cc ap p O PROMSED SIN m HOUSE 328/ nt 24' 50' ` 20 I 24' 28' I ! _ 16 Dldp.lineoil I .c� R=275.00' L=44.40' ;Dl — 324 326. — i N 8167.081-34 W ---- „r---_ =storm -------- � � water c son. Junct x rth REFERENCE PLOT PLAN FOR Plot Plan, Country View Dr. LOT 28 Country View Estates, Phase One Property Of TaM Building Co. Country View Estates South Windsor, Conn. Nov., 1980 Rev. 3-26-81 I°=40' South Windsor Conn. Certified Class A-2 By A. R. Lombardi Associates, Inc. PROPERTY OF T&M BUILDING CC /MEREBY XRTIFY THIS MAP MAY 39 1982 SCALE, 1"=4 C T SUB ANTE RR T �1 Robert T. Dayton, Conn. L.S. 7 dp —J�wlc<YL • ► cb 11, 328 330 8 •�l' I 50' STORM SEWER EASEMENT 15' STO M SEWER EASEMENT -T I LOT AREA 18,234 S.F. LOT 27 LOT 29 � z FIN. GAR. FLR. I 327.5 �• co • v ED o P pR0QS i� / I p N— HOUSE 0 / m 50' �� 20 328 24 2 28' 4' 16, bldg.IIrA V l� 4=090-15'-00 I 37 , R=275.00' NO52 L=44.40' :n J ---- — 324 • i I _ • 3 6 08' 326. - _ N 81• '-34" W : storm -- _ — __ i��"'G woter c son. junct x cb -Y"'-1'�..��� 322 2EFERENCE PLOT PLAN FOR Plot Plan, Country View Dr. LOT 28 Country View Estates, Phase One , Property Of Tam Building Co. Country View Estates I outh Windsor, Conn. Nov., 1980 Rev 3-26-81 I"=40' South Windsor, Conn. lertified Class A-2 By A. R. Lombardi Associates, Inc. PROPERTY OF T&M BUILDING CO. i HEREBY CERTIFY THIS MAP 0- MAY 3, 19 82 SCALE, I"=4 0' Q.8 SUB ANTI RRE tobert T. Dayton, Conn. L.S. 7 -dP9 A P R © V E 0 TOWN Or SOUTH 1rVINnSOR ENGINEERING D=PART....-NT DATE: 8 iO-gv SIG.: _�."II«4� 1C 1C cb S 67'-37.25++ E 328 330 ;0' STORM SEWER EASEMENT 15 STO M SEWER EASEMENT ILOT AREA i/ 18,234 S.F. LOT 27 A Z Fit,. GAR. FLR. LOT 29 327.5 00 0 co o I� PRPQSEDCL o N HOUSE 20 / m 50' 1� - e 328 24 28' 24' --,---3l6 \ s 16' —'bldline I •-n A=090-15'-00" I , R=275.00' s� 3 52 L=44.40' :D I — 324 s _ 3 6_0& 326. !t 81• '-34" W _ storm --- -- = -� Water c can. junct x nfi _ cb — �-� _ - - 322 ?EFERENCE PLOT PLAN FOR Plot Plan, Country View Dr. LOT 28 Country View Estates, Phase One , Property Of TBiM Building Co. Country View Estates ,outh Windsor, Conn. Nov., 1980 Rev. 3-26-81 I"=404 South Windsor, Conn. ',ertified Class A-2 By A. R. Lombardi Associates, Inc. PROPERTY OF T&M BUILDING CO. ' HEREBY CERTIFY THIS MAP MAY 39 1982 SCALE t I"=40' TQ-8€SUB c'TAIVTl9 RRE J�► ; ' tobert T. Dayton, Conn. L.S. QS7 dP9 bulLL1NU YriK1V11'1' STATE OF CONNECTICUT WORKERS'COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn.Gen.Stat. §31-286b) Property located at In the town of�0� �,(' I.f SCE Name of building permit appIicant--'.:::5-ei3nr1Q- fY*,W11U-S9R,�1Z Please check one: 1. 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§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"swom 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] S' ature 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 coverage. Signature of applicant Subscribed and sworn to before me this day of ,200 . (Notary Public/Commissioner of the Superior Court) 1700101 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER BUILDING PERMIT DATE: 03/27/2017 GIS ID:24300016 FEE: 375.00 MUNIS APPLICATION# 201700241 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: C-TEC SOLAR ADDRESS: 16 COUNTRY VIEW DRIVE ADDRESS: 1 GRIFFIN ROAD SOUTH OWNER: ABAZA ELMA&ELVEDIN SUITE 200 16 COUNTRY VIEW DRIVE BLOOMFIELD,CT 06002 SOUTH WINDSOR,CT 06074 DESCRIPTION OF WORK: INSTALLATION OF ROOF MOUNTED PV SOLAR SYSTEM WITH 4 ARRAYS AND 43 MODULES/INVERTERS. 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 3/27/2017 8:22 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE 1700366 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER BUILDING PERMIT DATE: 07/17/2017 GIS ID:24300016 FEE: 45.00 MUNIS APPLICATION# 201700476 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: ABAZA ELMA&ELVEDIN ADDRESS: 16 COUNTRY VIEW DRIVE ADDRESS: 16 COUNTRY VIEW DRIVE OWNER: ABAZA ELMA&ELVEDIN SOUTH WINDSOR,CT 06074 16 COUNTRY VIEW DRIVE SOUTH WINDSOR,CT 06074 DESCRIPTION OF WORK: REROOF--25 SQ. 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 7/17/2017 2:47 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE 1700081 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER ELECTRICAL PERMIT DATE: 03/27/2017 GIS ID:24300016 FEE: 570.00 MUNIS APPLICATION# 201700241 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: C-TEC SOLAR ADDRESS: 16 COUNTRY VIEW DRIVE ADDRESS: 1 GRIFFIN ROAD SOUTH OWNER: ABAZA ELMA&ELVEDIN SUITE 200 16 COUNTRY VIEW DRIVE BLOOMFIELD,CT 06002 SOUTH WINDSOR,CT 06074 DESCRIPTION OF WORK: INSTALLATION OF ROOF MOUNTED PV SOLAR SYSTEM WITH 4 ARRAYS AND 43 MODULES/INVERTERS. 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 3/27/2017 8:23 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE