HomeMy WebLinkAbout19 JEAN LN DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR 12 n�2�
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
B1 644-2511 ext. 230
Date B - ,
uil ing nspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
F:Tenant
5-eoxj Z4xe _
$0-$1,000=$15.00 Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof gnation Apt. No.
APPLICANT� /y /1-V C
APPLICANT ADDRESS /Q/ ✓?06C S7,
Gl< e 1/ `�' (o
APPLICANT PHONE# — OCd
OWN St OWNER v,11w 2(-'5
OWNER ADDRESS
a
r. F, OWNER PHONE 00 3—o) 13
04. /y
C � ESTIMATED COST$ �GrS 00
. a
� IS THIS A CONTRACT COST? >0 Yes _No
L� `;o _' ICJ FEE ENCLOSED$ —36
SO TYPE OF JOB: � I �
R-COC New Installation
Alteration/Addition/Repair
c,zlA00_7(43
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
96RESIDENTIAL BUILDING PERMIT APPLICATION? ❑YES Ja NO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑ GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION 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 SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
k
4-*W •ou rc I-A-ew.
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFoRm THE TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
►�'I o aQ �� 24a2;j y-r G7
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE G-7 a
Reino It, Hppppa Associates
Civil Engineers
Glastonbury, Connecticut
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.NOTEs Lot lines frae map on file in
Torun Clerk's Office entitled, "Plot Plan
Section -+ Pleasant Valley Homes
South Windsor, Conn."
Scale 10- hOl Irate 4-7-0 BONE
14ap No. 220-78 -\T Raw _ by Ref no E.
Hyyppa 6 Associates Glastonbury. CT.
pet PANQ E D FO 12
I hereby ce•tify th,t this mao anti survey were prepared in PLED.SANT /ALLEY uOV ES
iecordanc• with the standards of a Class A 2 survey as defined
ttw existing Code of P,arti-e for Standards of Accuracy of 5O UTb4 W I NDSOIZ, 0w N
and Maps, ad wted by the Connecticut Associstion of
Stxwyvra„ kmSCALE i.,*�• DATE
SCANNED
OA Ilye�Rl�iG DT/.j N
SIG. nP���MF �
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Civil caulnews
fir•: Glastonbveyt :Connectiwt
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H i Aisoclatss Glastonbury. CT.
yyPD+ PRt=PARED FOR ,,R ,
' I hwe certitY chit this map and wirvW were p�a�� Irr PLEASANT VALL�.Y uo�Es
� as defined
accordaoa with the standards of a Oaas A-2 survey
56UTN WIN�SOR, CON► m4
h ttw existing Cods of Pre%tice for Standards of Accuracy of
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erotica Plwaat valley paw
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Hyj►pps, Associates Mastombury. CT.
pQrPAREO FOR
hweby carWY thit We maP and sur4W NI P*PWW I" PLE&5 A NT VALLEY WO M E5
aoo0r. We vft tM standards of a Otaaa A•Z survey as daNnad UTN W 1 N1 0 R C ON►�
toda Ow Well Co of PrVtka for. Standards of Accuracy of 50
OW mys and Maps. S*g*id.by tM Oo woof Assodatbn a( C)C-A1-F- ►".d0' O are
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SOUTH WNDSok, c
REINO E. HYYPPAI S A
CIVIL ENGINEERS 8 LAND-' !
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rO T..• 3 401-47 DEPT. TOWN Cr a^rr! ,• ,;0:!
rh "All Id th t t'us plan and spec
rara
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tag tr^r w th emend nrnts stated r
tftd t.,I Ian aid I agree to com
rin.l�1 g ]t d at to laws and such I
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ttt+r d y the u.uldrng Depart^,enl
.f t I; .pFlicatton and finzl rssuar.; Y
"Mut. ,rnq
S.;Vved
'his plan 11 apnr,v,d sutlect to t
ord:ra and ordtl races rogulating L that
aumpltcd wrlh. 1 be
Conciltionally Approved
Tr. •.tR
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V"ding inspector —'
C hell
ReIno X. H77Ppa k A SSOCIAter
Clvll Engineers
Glastonbury, Connecticut
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JIMt Lot lines frm sap on file in
Twin Clerk's Office entitled, "Plot Plan
Section `i Pleasant Valley Hoses
South Windsor, Conn."
Scale 1"- 40' Date -cam 4-7-0 tON E
Map No. 220-76 -%T Rw. _ by Reino E.
Hyyppa 6 Associates Glastonbury, CT.
pQrPAR EO FOR
i hereby certify th,t this mao and survey were prepared i„ PLEASANT VALLEY I. OV ES
accordance with the standards of a Class A-2 survey as defined
M the existing Code of Pra-rice for Standards of Accuracy of 50 UTN W I NDSOR, COW N
lwvwp and Maps, adopted by the Connecticut Association of
LOW StKwyors. Inc. SCALE 1..m�• IDATE S -
►1-83
Raiao E. Hyyppa k A ssociatet
Clv!! Engineers
Glastonbury, Connecticut
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J10TE: Lot lima fros sap on file in
Toro Clerk's office entitled, "Plat Plan
Section -1 Pleasant Valley Hoses
South Windsor, Conn."
Scale P- 4ol Data -v-b L A-20 BONE
Map No. 220-78 -,T Rev. by Reno E.
Hyyppa s Associates Glastonbury. CT. ��
PQEPAREO FOR
I hereby certify th-vt this map and survey were prepared irl PLEASANT VALLEY uO V ES
wcordance with the standards of a Class A 2 survey as defined
n the existing Code of Pra^tire fcw Standards of Accuracy of 50 UTW W I NDSOR, CON N.
Ivvays and Maps, adopted by the Connecticut Association of
And Swveyoro6 one.
MONSOON MONSOON=
� .
� � k3
A P R O V E D
TOWN OF SOUTH WINDSOR
ENGINEERING DEPARTMENT
DATE: �D—oCe
SIG.:
R,sino R. Hnrppa k Associates
Civil Engineer
Glastonbury, Connecticut
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XOTEs Lot lines from asap on file in
Tarn Clerk's Office entitled, "Plot Plan
Section i Pleasant Valley Hanes
South Windsor, Conn."
Scale 1"- 40' Date A-20 -LONE
Map No. 22O-78 -%T R,w. - by Reino E.
Hyyppa 6 Associates Glastonbury. CT.
PQr,PL'R E D !=-O R
I hereby certify th,t this map arxi survey were prepared ire PLEASANT Vbk L LEY L• OV ES
accordance with the standards of a Class A 2 survey as defined
In the existing Code of Pra^ti-e for Standards of Accuracy of SO UT14 W I NDSO a,
kwveys and Maps, adopted by the Connecticut Association o/
land Surveyors. Mc. SO:ALE L,��. p aTe S
43-1cq- v:8
Revised
DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE
Bldg. Permit#
644-2511 ext. 230
Date Building Inspect
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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE# 2 C \
O W N S Fq OWNER '?cl1 b-e 4 A-
OWNER ADDRESS \ e-,,,Vj C\r o,
OWNERPHONE �—
C ESTIMATED COST$ C(�
IS THIS A CONTRACT COST? "�es _No
o s✓ FEE ENCLOSED$ s-
� r5� 9 1�OS TYPE OF JOB:
O R CO New Installation
Alteration/Addition/Repair
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION? ElYES#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 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 SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
I HE 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.
- - Z� --,,:-\ Q - c-7
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPRO D 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 Street No Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT —, P,
APPLICANT ADDRESS �L�/�W at✓�2_�T�P� ____
�lok," di�es7—cr �n rr,
APPLICANT PHONE# —
W Ni $F,q OWNER r`5 0
OWNER ADDRESS 17 c a f
Oe OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes _No
FEE ENCLOSED$ !!�Z fps v O
TYPE OF JOB: I S 35
SOR•CO I// �3
New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF LDING:
❑HEATING Uff RESIDENTIAL
(D�/C O COMMERCIAL
❑VENTILATION ❑INDUSTRIAL
HEATING
0 STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
❑HYDRONIC ❑WARM AIR 0 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) NET RATING(OUTPUT—BTUH)
TYPE OF FUEL
❑ OIL—GPM OIL TANK LOCATION :❑INSIDEO OUTSIDE CAPACITY
❑GAS—INPUT LPG TANK CAPACITY ELECTRIC—KW
AIR CONDITIONING DESIGN TEMP.OUTSIDE 'IS- OF INSIDE `Io' 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) 1,9�cV, FRESH AIR INTAKE(CFM)
(PLANS MUST ACCOMPANY APPLICATION)
FURTHER DESCRIPTION OF WORK 71�a �aZQ,-6 ,
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.
CO CTORS LICENSE NO. TYPE STATE
DATE SIGNATURE OF APPLICANT SOS-•-� Q1 6 S
COOLING LOAD ESTIMATE This estimate is suitable forl wfort air
Recommended Practice for Members)ol conditioning jobs not requiring specific
Self-Contained Air Conditioner Section of conditions of temperature and humidity.
Copy"tAl AIR CONDITIONING AND REFRIGERATING MACHINERY ASSOCIATION, INC.
C. ...... ........................I.................................. Buyer ..............................
Address ........ . !��00.5...................................................
........ Y),Iel............. .. .. Space to be used for.....
..... .
Estimateby..... ................Date................................ Approval....................................................;;:* D a to.9X
L People....................................................(Number Sitting or Moving Slowly) ............. ................... X 4W=
......(Number Working, Dancing or Similar Activity) .............../.................. X 860= ........6'
2. Windows Exposed to Sun........................................................(Total Sq. Ft.)...... X ..... A=
(Figure this item for the one sun exposure having largest window area)
L Lights and Electrical Appliances.............................(Total Watts in Use)................9.Q.P. ........ X &4
(Include in this item,only those applianc a not listed in Table B)
//
4. Other Heat Sources................................................................................................................. B= . :A oc"
• Sub-total—Sum.of Items i thru 4........................................................................................... . ............................
• Windows Not Included In Item 2..........................................(Total Sq. Ft.) ... ....... X ................... C ........................
r7
7. WaIls and Partitions............Sq. Ft.—Windows...................**....Sq. Ft. X ....5.......... c=
....................................................Sq. Ft.—Windows............................Sq. Ft. = X ...1.7......... C=
.................................................I...Sq. Ft.—Windows.............................Sq. Ft. =................... X ................... C= ........................
LFloor................................................................................................(Total Sq. Ft.)....Xp... x ....�.......... c= ...
e /J............. C= ...
9. Ceiling.............................................................................................(Total Sq. FQ...../6P.... X .✓. I
10. Ventilation or Infiltration...................................................(Cu. Ft. per Min.) .............. DX ................... E=
IL Sub-total—Sum of Items 4 thin 10................................................................................. =
IL Total Bm per hour Cooling Load to be used for Selection of Unit—Sum of Items 5 and 11..........................................=............................
COOLING LOAD FACTORS
WINDOWS EXPOSED TO SON—SOLAR RADIATION FACTORS FOR DIFFERENT ORIENTATIONS TO DR INSERTED AT A
Direction Windows Face NE E SE 3 6W W NW
Clear Glass (Single oi Double) No Protectiod......... 1
0 A ISO 160 105 160 ISO 120
Shaded Completely by Awnings.......... ........ ................... 310 50 46 so 43 60 so
Light Colored Inside Shades or Venetian Blinds........ 66 110 95 60 go Ito es
Glass Brick No Protwtion.......................... ......... 44 72 64 42 64 72
44
OTHER HEAT SOURCES TO BE INSERTED AT B
BeautyParlors .........................................................................Number of Operators..............................................X SOW=....................................
Electric Motors .........................................................................Total Name Plate HP.....................1.....................X Sow=....."A'.Rno............
tGaaBurners ................................................................................Number .......................................................................X 6000=....................................
tGlasaCoffee Mokers .................................................................NJ:r ......................................................................X *W=....................................
tCoffee Urns—Gas or Electric ................................................C Capacity In Gallons......................f...........X 1600=........ a..:........
tStmrnTable*—Electric ..........................................................Sq. Ft. Area of Top..................................................X $50=............................-_
t8teamTables--G. ...................................................................Sq. Ft.Area of Top..................................................X 1300=....................................
AdditionalHeat Sources ..........................................................................................................................................BTU/Hr.=
tFwtors for appliances*quipped with hood and positive exhaust should be reduced by 60%. Insert Total At B ......14 .. .... ..........
. .. .
WINDOW8,WALLS,FLOORS AND CKI1JN0 TRANSMISSION FACTORS I-OR VARIOUS OUTSIDE DESIGN TX-PZRATURZ8--0(8ZRT AT C
Outside Dry Bulb 9F.........................I so 1 81 1 88 1 89 1 90 1 91 19a M 94 1 05 96 *7 96 we 100 101 I lot LOS 104
Windows (No us)................................ 0 IS 12 a Is
wally—H 1: 7
savy Masonry ........................ 1 3
Walla—Average Masc .................... i s a 8 4 4 7
Wails—Insulted,=nr!.cr..Fram@ Frame:::: 2 2 4 4 4 4 5
Walls—Aver .... ............. 2 a a 7 7 7
Partition-1 do, Single Thickness...... o 7 7 8 1 1 1 11 11 12 12 13 14 It 25
Partition—Inside. Double Thickness.... s 4 r( 4 8 6 0 0 0 a 9 so
7 7 I
Partition—Display Window Back.......... 11 12 13 is 2 14 13 is is 17 17 17 1: 6 20 17 19 2! 22
Glass Brick (No Bua Exposure)............ 4 4 5 3 Z:yO 0 7 7 9 1* 150 ISO 11 11
Floor ...................................................... a a 3 3 2 a 8 4 5
Ceiling Under Unventilated Atdc*-::.*::] 121 221 21 12 12 It 12 IS 13 13 10 14 it 14 1: is is is 1:
C4illng Under Ventilated Attic*............ 7 7 a a 11 is is is is 14 14 14 25
Flat 14 14 2: 1: 150 10 10 1111 1: 17 17 27 268 1: 1 9 S ' . S , & , : 27 IS C21iMna Und-or 12' , "S' I , S . 3 J 3 It , 16 1 a
7
OAdJsert factor selected from this table U Coiling is insulated. Kxampls: 4" Insulation--4.2 X Selected Factor = AdJustod Factor.
11 Insulation-4.4 X .............. = ......... 2, Insulation--o-S X ............. = ............. 41 Insulation-4.2 X .............. ...............
VENTILATION OR INFILTRATION QUANTITY TO ZZ INSERTED AT D
CAacuUft Requirements for Both Ventilation and Infiltration. and Use Larger Quantity Cu. Ft. per Minute (CFM). Use No Less CFM than Required by
LOW Ord,...ca. and no less than amount drawn from space by exhaurt tam if used.
VENTILATION BZQulAZM3CNTB INFILTRATION
SMOKING No. OCCUPANTS C.F M. RoomMeIght (L)=Iength (W)=Width (G)=W&UFactor
oo;�with one outside wall (G)=I
None .......................................... X 7YI =..................
.. Two outside walls (G) 1.5
L41911t .......................................... X 13 = .................... Three or more outside walls (G)=2
Heavy ....................................... X 40 = .................... C.F.M.=(H)............X(L)..... ......X(W)... X(G)........
60 ............
VENTILATION OR INFILTRATION FACTOR FOR VAISIOU WESIDN DESIGN TEMPERATURES IN 9F.W.B. TO BZ INSERTED AT
OVULAO Wet Bulb OF............................ 44 46 SO 67 J_LAP 49 70 71 72 73 74 73 76 71 is 79 Be
69 feeta . ............................................... 0 1 3 S 11 14 17 so 23 27 so 33 37 41 iLj
M � -
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE
644-25 Bldg.Permit#
_ U
Date Building Lnsf566tor
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.0 per$1,000
there I �
or any fractionn thereof .Tenant Designation � Apt.No.
APPLICANT '•`��:11 1 t c-4 r► LI-L
APPLICANT ADDRESS Q Q�r�1j Q er�� D2
APPLICANT PHONE# 00 G kR— d j ti I
"eOW N SF,q OWNER
< OWNER ADDRESS 1C( `Sew r�y�J e
co� » OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? _Yes No
FEE ENCLOSED$ 3
011.
_ O�� TYPE OF JOB: aj
R.C New Installation (O
Alteration/Addition/Repair
Revised 4i01in002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH�/
BUILDING PERMIT APPLICATION? O YES 0 NO
A RESIDENTIAL
0 INS
ASSEMBLY CURRENT USE AND OCCUPANCY
U MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
U INSTITUTIONAL
0 FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIJCED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD J:k / — �l�G 9 o 4e
SIZE OF SERVICE acx-jO , SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES Q NO
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 BEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
I lip Ate
II
WCw �t �t LCSC ,rw; i(yve I W/t!Jti dl.v"
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICU'BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT DATE
1
TOWN OF SOUTH WINDSOR JUL 2 9
100g
AFFIDAVIT OF ACTUAL COSTS
BUILDING DEpgRTMEI,,
PERMIT NO: �las�7� DATE
The undersigned, being a duly authorized representative of,_ A4-Az jz��� ,5 e—
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 11, 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:
$ /C/O0 0J
Signature of Per Holder:
Name(Please Print)
Date:
■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrarrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr�rrrr■
State of Connecticut]
] ss South Windsor
County of Hartford]
Personally appeared �6 as aforesaid,
Signer and sealer of the fcrregoKg 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
1200219 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER PLUMBING PERMIT
DATE: 06/08/12
GIS ID:47100019 FEE: 30.00
MUNIS APPLICATION# 201200743 BUILDING DESCRIPTION:
APPLICANT- LOCATION
NAME: HANY P&H INC. ADDRESS: 19 JEAN LANE
ADDRESS: 8 RIVER STREET OWNER: POWERS ROBERT E&JACQUELINE P
VERNON ROCKVILLE,CT 06066 19 JEAN LANE
SOUTH WINDSOR,CT 06074
DESCRIPTION OF WORK: ADDING I%2 INCH COPPER GAS LINE FOR NEW GAS COOKING STOVE IN
KITCHEN.
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
6/8/2012 11:24 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE