HomeMy WebLinkAbout175 PINE TREE LN DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application '
TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT �—
OVED 1540 SULLIVAN AVENUE
ti Bldg.Permit#
644-2511 ext. 230
i
Date B ding Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT D A-- C N ( ` C
APPLICANT ADDRESS Q 1 /
�S O 1
APPLICANT PHONE#
O Yd N S i , OWNER C
OWNER ADDRESS Z-HIC
o, A. OWNER PHONE
C ESTIMATED COST$
b x � �IS THIS A CONTRACT COST? (%Yes _No
D�
o � '''' °� ��� FEE ENCLOSED$
f��s O�� TYPE OF JOB:
�R C _New Installation
teration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse Side)
TYPE BUILDING IS THIS APPLICATION ASSOCIATED WITit
RESIDENTIAL
BUILDING PERMIT APPLICATION? ❑ YES
❑BUSINESS CURRENT USE AND OCCUPANCY Ars eIVAARC
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL
❑ INSTITUTIONAL 4 g'— Q
❑FACTORY ENGINEER'S NAME — PHONE
❑ STORAGE
❑ GARAGE ADDRESS
❑MIXED USE
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD O
SIZE OF SERVICE )!mil SIZE OF MAIN CONDUCTORS O
NUMBER OF METERS / NUMBER OF DISCONNECTS AND RATINGS���- ollo
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES 0.3141--
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
/,4 r eol ex—)/A 0 .4o4 o-i
oC-4-�s I' a- N�_w (� /
S co— C S
E UNDERSIGNED HEREBY 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
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE O. �D STATE �f
SIGNATURE OF APPLICANT / DATE
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Town of South Windsor 175 Pine Tree N
Connecticut PARCELS
ROAD NAMES
' Date Printed: July 24,2006 BORDER
0 60 Feet ROADS
Property boundaries are derived from the Town of South Windsor Tax Assessor maps,digitized at a scale of 1 inch=100 feet,and include the same data limitations and disclaimer as the Assessors maps.
All other data portrayed is representation only and,due to inherent mapping limitations,should be used as a guide onty. The intent of this map is to present a graphical representation of property boundarie
and selected data,and the map is subject to change as more accurate surveys may disclose. Property boundaries mapped as of June 4,2001.
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South Windsor
BUILDING DEPARTMENT Ja °' a
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CERTIFICATION OF ZONING COMPLIANCE
Proposed building(s), use(s) and/or structure(s)
as shown on this plan appear(s) to be in
CQWrmance with current South WAMW
moons. Variances and special exqmom
may alply.
Date If--1 �v3
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Shirley Wilhelm-CRS Approval Confirmation: Request No. 386542 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 11/10/04 10:11 AM
Subject: CRS Approval Confirmation: Request No. 386542
Your approval of the following CRS Request has been successfully
processed.
CRS Work Request#: 386542
House No: 175
Lot No:
Street Name: PINE TREE LN
Town Name: SOUTH WINDSOR, CT
Inspector: CHRISTOPHER DOUGAN
Approval Date: Nov 10, 2004
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++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
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Town of South Windsor 175 Pine Tree N
Connecticut PARCELS
ROAD NAMES
611AD-.2-
Date Printed: July 24,2oos BORDER
0 60 Feet ROADS
Property boundaries are derived from the Town of South Windsor Tax Assessor maps,digitized at a scale of 1 inch=100 feet,and Include the same data limitations and disclaimer as the Assessors maps.
AD other data portrayed is representation only and,due to inherent mapping limitations,should be used as a guide only. The Intent of this map is to present a graphical representation of property boundarie
and selected data,and the map Is subject to change as more accurate surveys may disclose. Property boundaries mapped as of June 4,2001.
JUL 2 4 ZUUe
South Windsor
BUILDING DEPARTMENT
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fhis certriicd ihzt tnis pl.;n and sy,�ii ror U.tn� .re�;,,
`-Pit's of the proposed ►utlding or .iterations to b.,
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Issurd by the Ulilding Department during
pendency
�I this APtiction and final issuance of a building
Dermit.
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,rder% and ordinances regulating building shall
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STATE OF CONNECTICUT
WORKERS' COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn.Gen.Stat. §31-286b)
Property located at U { , D ��(�9__,�
In the town of 1�lC6(1�(-
Name of building permit applicant:
Please ch kne:
1. 7�I am the owner of the above property.
2._I am the sole proprietor of a business.
2A.Name of business
213.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]
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 t accept coverage.
no U I Y-)�K4
ignature of applicant
Subscribed and sworn to before me this --)ay of ,200_.
(Notary Public/Commissioner of the Superior Court)
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 FTenant
Street ]No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof gnation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE#
O W N St,q OWNER
OWNER ADDRESS
U) .a OWNER PHONE �Ja'� OJZS�-it
0
C ESTIMATED COST$ V 7�;� d!�
V - IS THIS A CONTRACT COST? -/ Yes _No
FEE ENCLOSED$
s o TYPE OF JOB:
R C _New Installation
�- lteration/Addition/Repair
Revised 4/01//2002
i
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF Sj;STEM: TYPE OF BYILDING:
Ql4lEATING DRESIDENTIAL
❑A/C ❑COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
MYDRONIC ❑WARM AIR ❑UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) °F(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT—BTUH) 1� 6 c�pn NET RATING(OUTPUT—BTUH) ,1�'a►•
TYPE OF FUEL
U-dIL--GPM OIL TANK LOCATION :"SIDE❑OUTSIDE CAPACITY
❑GAS—INPUT LPG TANK CAPACITY ELECTRIC—KW
AIR CONDITIONING
DESIGN TEMP.OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
TONNAGE COOLING CAPACITY(BTUH)
VENTILATION
DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT)
TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM)
(PLANS MUST ACCOMPANY APPLICATION)
FURTHER DESCRIPTION OF WORK Rc�A,"n, � 2,ar,e. O`� \r"
THE UNDERSIGNED HEREBY 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
PERFORMANCE OF SUCH WORK.
3�tD,55
CONTRACTORS LICENSE NO. YPE STATE
SIGNATURE OF APPLICANT DATE 5-Z�
LlG�.-GaS�I
Slantl ;n. lif dronirBILL
red
Job Name:175 PINE TREE CustGERS Engineer: Salesman:ED TAYLOR
Address: City: State• Zip: Phone:
Indoor Design Temperatu7&.0 Outdoor Design Temperattft(D F Altitude(Elevation): 0
HEAT LOSS CALCULATIONS
1st Floor
BEDROOM MSTR CLST BATH _Floor Totals Job Totals_ -t
Room Height(ft) 12.00 8.00 8.00 L
Room Length(ft) 15.00 13.00 10.00
Room Width(ft) 13.00 6.00 10.00
Doors&Glass(sq ft) 24.00 6.00 6.00 T 1
Door&Glass Factor 0.6500 0.6500 0.6500
Exposed Wall Length(ft) 28.00 19.00 20.00
Exposed Wall Factor 0.0700i 0.0700' 0.0700
Cold Partition Length(ft) J �-
-r
Cold Partition Factor
__
Ceiling Factor 0.050 0.0500 0.0500
Floor Factor 0.0300 0.0300 0.03001 1
Infiltration Factor 0.0180, 0.0180 0.0180 } r
Indoor Temperature(F) 70.00 70.00 70.00'
Heat Loss(BTU/HR) 6,661 2,211 2,8551 11,727 11,727
BASEBOARD SELECTIONS
1st Floor
Fine/Line 15(lin.ft.) 12.51 4.01 5.5i 22.0,-- 22.0�
selected r L
Fine/Line 30(lin.ft.) 11.5� 401 5.0 20.5' 20.5
selected +
Multi/Pak 80(lin.ft.) 9.5� 3.0 4.0 16.5 16.5
selected ---
-1- Copyright(C)2000 Slant/Fin Corporation 100 Forest Drive Greenvale, NY 11548 (516)484-2600 www.slantfin.com
�, ..�.„ ,.F.�.......,�.-,..,,,.may
f
S/antlF. 9-C chronic Ex : re
Job Name:175 PINE TREE Customer: BILL ROGERS Engineer: Salesman:ED TAYLOR
Address: City: State: Zip: Phone:
Indoor Design Temperatu70.0 Outdoor Design TemperattDf2 F Altitude(Elevation): 0
HEAT LOSS CALCULATIONS
1st Floor
BEDROOM MSTR CLST BATH Floor Totals �- Job Totals
Room Height(ft) 12.00 8.00 8.00
-- --
Room Length(ft) 15.001_ 13.00' 10.001
Room Width(ft) 13.001 6.00 10.00, T
Doors&Glass(sq ft) 24.00 6.001 6.001
Door&Glass Factor 0.6500� 0.6500; 0.6500
Exposed Wall Length(ft) 28.001 19.001 20.00'
Exposed Wall Factor 0.07001 0.0700r 0.07001
Cold Partition Length(ft)
Cold Partition Factor r
Ceiling Factor 0.0500 0.05001 0.0500,
Floor Factor 0.0300� 0.0300 0.0300r
Infiltration Factor 0.0180 0.0180 0.0180' j
Indoor Temperature(F) 70.00 0 70.00�
Heat Loss(BTU/HR) 6,661t 2,211 2,855 11,7271 11,727
BASEBOARD SELECTIONS
1st Floor
Fine/Line 15(lin.ft.) 12.5 4.0 5.51 22.0 22.01
selected
Fine/Line 30(lin.ft.) 11.5 4.015.0 20.5 20.5
selected
Multi/Pak 80(lin.ft.) 9.5 3.01 4.0 16.51 16.5
selected
-1- Copyright(C)2000 Slant/Fin Corporation 100 Forest Drive Greenvale, NY 11548 (516)484-2600 www.slantfin.com
DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
ERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR M�Clio
DEPARTMENT
APPR07VED 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
Date Buildin Inspdcton
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE# �
O w N 3 F,q OWNER
OWNER ADDRESS
OWNER PHONE I'vo 7 .--
C ESTIMATED COST$
IS THIS A CONTRACT COST? vYes _No
FEE ENCLOSED$
r�OSOR-CO
CO� TYPE OF JOB: 3t//
New Installation rU
'./Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATE--DIIW����ITH A
R/ESIDENTIAL BUILDING PERMIT APPLICATION? l�'YES ❑NO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION�c� �Y� t�Z.>J ��•a � SIZE OF MAIN DRAIN .�
NO.OF TOILETS ` STYLE NO.URINALS STYLE
NO.OF BATHTUBS ` NO.OF SHOWERS , NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE
AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS
NO.OF OTHER FIXTURES KIND
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW ❑YES ❑NO
SIZE OF WINDOW IF NONE C.F.M. OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
SIZE OF WATER MAIN V�`� SIZE OF WATER PIPING&RISER 3[�t,
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY 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
PERFORMANCE OF SUCH WORK.
: 0(Dk4�n 1 �t 7k,
CONTRACTORS LICENSE tNO.
TYPE STATE
SIGNATURE OF APPLICANT DATE
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERNHT PERMIT#
Applioati TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
PRO 1540 SULLIVAN AVENUE
Bldg.Permit#
Zd 644-2511 ext. 230
Date Bu'di sp,,
Application must be printed or typed
FEE SCHEDULE Location of Job:
7S' leiv15� lrc�
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof ,Tenant Designation Apt.No.
APPLICANT i.<J �rt
APPLICANT ADDRESS C' L..c n F
C-T cxa'�L-?C?
APPLICANT PHONE# 6 7 Co
OW N 3� OWNER Y� I�'1 �Y �
% q< OWNER ADDRESS
OWNER PHONE
ESTIMATED COST$ _307J�
a _ IS THIS A CONTRACT COST? Yes L— S
�G FEE ENCLOSED$ yr.6T)
s � TYPE OF JOB: -'
OR C New Installation
�tion/Addition/Repair
Revisod 4/01/=02
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑ NO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑ GARAGE ADDRESS
❑MIXED USE
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD /2y rrr e
SIZE OF SERVICE Q SIZE OF MAIN CONDUCTORS
NUMBER OF METERS / NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS ` REMOTE DISCONNECT REQUIRED? ❑YES E31I0
NUMBER OF LIGHT CIRCUITS .. NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES 5� NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
//-- DESCRIPTION OF WORK
-, � bad/✓rr� ✓��� � �.� ���',-� 17�ur sm�.� �% ,-,�,5
THE UNDERSIGNED HEREBY 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
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE cSTATE
SIGNATURE OF APPLICANT �' 'Iry % �?�'/ DATE J " / E—RI ()q
Electr c # 175 P A ePffl�eT19,N FOR AN f IT
Plumbing# 900039 Kav .
HVAC # IF�jr�p 1 "7nnQ
Sprinkler#
FINAL APPROVALS -- - — _ - Esrimated w i
Building COMPLETE RED BOXED AREAS Perml �LG DEP
Engineering TYPE OR PRINT ONLY Occupancy ee $
Affidavit ' ' Eng. Insp. Fee $
J ---- -..._� '
A r. for co. f ► SIGN ON REVERSE SIDE
PP Total Fee ($----��
TO THE BUILDING DE ARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost)y
The undersigned hereby applies to do work according to the following:
Applicano/ "49/�/ CIIIII iv.I.-G-A%cw Location of Work/25 /��N�' '/.� Z!it/ J, No.
Applicants AdAess3-k) ?1,4--v f;e- /j'�/1/l l����irz62�i--0/ a,6704,�� Tel.# J 3-
Town ,t1NZ'f/ ��� C° Zip 15-;� � Lic.#�1,C• G�v3�`�y
Owner Architect
Owner's Ad ess /7S %�f/���F/£ ���, Architect's Address
S . G-✓i:�//JS�=� Zip Zip
Sq. Ft. New Area: 1st FI. 2nd FI.t 3rd FI. Total New Area ,3,;20
Purpose of this permit 441
,��i.�.�-,121 ,q .�"2) :sue �i��S Ci;o�r l yt f!r�.reL UG✓�� ��'-K-S
City WaterW Well❑ Septic System❑ Sewero
Ins: HO SP Cert. Area Basement Garage
Approved by 4 ate 3 T,6 -(,-(1 Use Group Construction Type
Revised W02
I hereby agree to conform to all the requirements of the Laws of the State of Connecticut:ind 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 � l� L__j/
/ -}�� `J
I hereby apply for a Certificate of Occupancy for the work described in this alp lication r thepermit.
Signed ZZLZ
-_ ��
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
�rZ t[� i
INSPECTION FIELD SHEET 10/13/09
Printed by Kehoe, Alice 16 07:48
INSPECTION: 26853 FINAL PERMIT:
STATUS:
APPLICATION: 200900088
LOCATION: 175 PINE TREE LANE
SOUTH WINDSOR
PROPERTY ID: 72300175
OWNER: MURPHY JASON E & LENNORE F
CONTRACTOR: HANDYMAN CONNECTION
860-533-3225
DESCRIPTION: AN ADDITION OF BEDROOM OVER GARAGE
WORK ORDER:
INSPECTOR: ROSE RESULT: PASS
REQUESTED: 10/13/09
SCHEDULED: 10/13/09 AM COMPLETED: 10/13/09
UNPAID FEES 00 Date Time
TIME: TRAVEL ONSITE
COMMENTS:
CONTR AWAITING WINDOW ON ORDER (NEAR JACUZZI)
ALL INSPECTIONS
INSPECTED INSPECTOR RESULT INSP DESCRIPTION
B001 FOOTING
B002 FOUNDATION
04/21/09 ROSE PENDING B003 FRAMING (ROUGH)
06/24/09 DOUG PASS B003 FRAMING (ROUGH)
06/30/09 ROSE PASS B004 INSULATION
06/04/09 ROSE PASS B004 INSULATION
B005 FIREPLACE / CHIMNEY
B006 WOOD / GAS STOVE
10/13/09 ROSE PENDING BO10 FINAL
05/19/09 DOUG FAIL BO10 FINAL
E001 ELECTRIC SERVICE
E002 ELECTRIC UNDERGROUND
05/28/09 ROSE PASS E003 ELECTRIC ROUGH
06/24/09 DOUG PASS E003 ELECTRIC ROUGH
P001 WATER HEATER REPLACEMENT
P002 PLUMBING UNDERGROUND
P003 PLUMBING ROUGH
P004 PLUMBING GAS TEST
Revised 4/01//2002
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
D
APPR!Builig
1540 SULLIVAN AVENUEBldg.Permit#
644-2511 ext. 230
Date 41,,p ,
Application must be printed or typed
FEE SCHEDULE Location of Job:
--I S
$0-$1,000=$15.00 F=Tenant
Street ]—No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof gnation A
APPLICANT rc�,„o,_,�. Q � .•, C® _.
APPLICANT ADDRESS
APPLICANT PHONE#
O W N 8 F,q OWNER
OWNER ADDRESS
Ob OWNER PHONE 614 g D 0 CA
QS
C ESTIMATED COST$ 3 n n C�
IS THIS A CONTRACT COST? —Yes _No
FEE ENCLOSED$ y�,� o
r��sJJ�� TYPE OF JOB: r7 ZO I d 0 1 L�1?
O R•C O New Installation `T J v
IVAlteration/Addition/Repair
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF UILDING:
❑ HEATING JARESIDENTIAL
❑A/C ❑ COMMERCIAL
❑VENTILATION ❑ INDUSTRIAL
HEATING
❑ TEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONIC ❑WARM AIR ❑ UNIT RADIANT HEATER
E ISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
V.1 Q mL C—oc� C\cK .c" y��—C
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT-111�)JH) C�
TYPE OF FUEL
❑OIL—GPM OIL TANK LOCATION :❑ INSIDE❑ OUTSIDE CAPACITY
❑GAS—INPUT LPG TANK CAPACITY ELECTRIC—KW
AIR CONDITIONING
DESIGN TEMP.OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT GAIN(BTUH) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
TONNAGE COOLING CAPACITY(BTUH)
VENTILATION
DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT)
TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM)
(PLANS MUST ACCOMPANY APPLICATION)\
FURTHER DESCRIPTION OF WORK C N() nc�N n6 n rt o (
THE UNDERSIGNED HEREBY 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
PERFORMANCE OF SUCH WORK-
-.?- v S,' - -Z�
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT ����scr r��- � �� � DATE OT \ U
Electric# APPLICATION FOR BUILDING PERMIT
Plumbing# 175 Pine Tree Lane Date:
HVAC #
Sprinkler# 32742 Ua
FINAL APPROVALS f—F1�10- �SIGN
-- ; Estimated CostBuilding IPLETE RED BOXED AREAS Permit Fee Fe
Engineering TYPE OR PRINT ONLYEncuIns cyFee $
g pAffidavit ON REVERSE SIDE Appr. for CO. — --- - - - - -- ' Total 1-ee
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ 6'e�G�>
The undersigned hereby applies to do work according to the following:
Applicant C—PmDf, n2f=LjLocation of Work _/� -q-aLNo.
Applicant's Address I—! - _ Tel.#
Town CSCU. k C\y )C a7-)(— 2 Zip - Lic.#
Owner SC -'(Y)C _ _Architect
Owner's Address 5�';�_ Yl{_'. Architect's Address
Zip Zip
Sq. Ft, New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit 1 ( (U Qtl Lf .�
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO SP Cert. Area Basement Garage
Approved b Datez VA1 Use Grou a , Construction Type
Revised W02
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 Inspecto o any alteration in the plans or spec tications of the Building for which this
permit is asked,and agree that this building is to e I sled the proper distance from all street lines,side yard lines,and required
distances from all other zones and is located in this building and its use allowec+.
SignY—f
ed
I hereby apply for a Certificate of ncy for the work described this applicaZi for the permit.
I
Signed
DO N&WRITE BELOW THIS LINE
INSPECTION COMMENTS
1000380 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER HVAC PERMIT
DATE: 10/18/10
GIS ID:72300175 FEE: 45.00
MUNIS APPLICATION# 201001412 BUILDING DESCRIPTION:
APPLICANT LOCATION
NAME: IMPERIAL PLUMBING CO.,INC. ADDRESS: 175 PINE TREE LANE
ADDRESS: 648 SULLIVAN AVENUE OWNER: MURPHY JASON E&LENNORE F
P.O.BOX 875 175 PINE TREE LANE
SOUTH WINDSOR,CT 06074 SOUTH WINDSOR,CT 06074
DESCRIPTION OF WORK: CHANGING BOILER UNDER WARRANTY.
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
10/18/2010 4:03 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE