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HomeMy WebLinkAbout195 BENEDICT DR Electric # APPLICATION FOR BUILDING PERMIT Plumbing# 195 Benedict Drive Date: .? da c HVAC # Sprinkler# 3-2655 FINAL AP OVAL -----� ----- Estimated Cost $ o e G E- o - - Permit Fee $ Building �� '� COMPLETE RED BOXED AREAS Engineering TYPE OR PRINT ONLY Occupancy Fee $ Affidavit Eng. Insp. Fee $ 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 L_Q?o S�J- �, / w Location of Work / �� 1 ;c 2:::),e Lot No. Applicant's Address (� _D jZ Tel.# A WS-/5;"'7 7 Town Coo c4--r7V (V i AJd.so a CT Zip o6G7 Lic.# Owners',,ec 4 ; rti Architect Owner's Address %9.S.f.c'5'A,kgd i c/ 0 2 Architect's Address Sccrr�g'!V-xAn(Sr' P .� Zip G c c'7 Zip Sq. Ft. New Area: 1 st A. 2nd FI. .3rd FI. Total New Area Purpose of this permit /U F Gc , zQQ:f G 1,4c .yc E City Water❑ Well❑ Septic System❑ Sewer❑ Ins: HO SP Cert. Area Basement Garage Approved by Date �� Use Group —Construction 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. Signed 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 DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Application is hereby:r BUILDING DEPARTMENT /q(,(" - 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 ate Building Inspector -- - - Application must be printed or typed FEE SCHEDULE G Location of Job: $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT A,-- C4er4711 c- APPLICANT ADDRESS APPLICANT PHONE# OWN S�� OWNER OWNER ADDRESS OWNER PHONE - - C = ESTIMATED COST$ 5/QU'' IS THIS A CONTRACT COST? _Yes ✓No FEE ENCLOSED$ S • ��� TYPE OF JOB: R•C New Installation teration/Addition/Repair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? 0 YES 0INO RESIDENTIAL ❑BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY El EDUCATIONAL MERCANTILE 0 FUTURE USE AND OCCUPANCY ❑INSTITUTIONAL O FACTORY ENGINEER'S NAME PHONE ❑STORAGE ❑GARAGE ADDRESS O MIXED USE (Other please specify) CITY STATE ZIP TYPE OF INSTALLATION/WIRING METHOD SIZE OF SERVICE 20U"" 7'S SIZE OF MAIN CONDUCTORS / sry NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS '— NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS y 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 ��fi'►� SG�y<cF �',s�vGE 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. :/-1832Y2C7— CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT_ k DATE 6 �� Shirley Wilhelm-CRS Approval Confirmation: Request No.438758 Page 1 From: <clpsvc@nu.com> To: <WILHEL@SOUTHWINDSOR.ORG> Date: 6/24/05 4:02PM Subject: CRS Approval Confirmation: Request No.438758 Your approval of the following CRS Request has been successfully. processed. CRS Work Request M 438758 House No: 195 Lot No: Street Name: BENEDICT DR Town Name: SOUTH WINDSOR, CT Inspector: CHRISTOPHER DOUGAN Approval Date: Jun 24, 2005 This e-mail, including any files or attachments transmitted with it, is confidential and intended for a speck purpose and for use only by the individual or entity to whom it is addressed. Any disclosure, copying or distribution of this e-mail or the taking of any action based on its contents,other than for its intended purpose, is strictly prohibited. If you have received this e-mail in error, please notify the sender immediately and delete it from your system. Any views or opinions expressed in this e-mail are not necessarily those of Northeast Utilities, its subsidiaries and affiliates(NU). E-mail transmission cannot be guaranteed to be error-free or secure or free from viruses, and NU disclaims all liability for any resulting damage, errors, or omissions. Electra: # APPLICATION FOR BUILDING PERMIT Plumbing# 195 Benedict Drive Date: _ HVAC # Sprinkler# 30983 FINAL R Estimated Cost $ � �E000-- SIGN Permit Fee $ yam.oO Buildin PLETE RED BOXED AREAS Occupancy Fee $ Enginee TYPE OR PRINT ONLY En . Ins . Fee $ g PAf pr. orC ON REVERSE SIDE ! ! Total Fee $ 41�•0 o TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant O A�N Location of Work q S n. Lot No. Applicant's Address Tel.# (&O-)(nH 5-5-(S� Town M(.l Zip ©l0 0 g S- Lic.# 309 000 Owner r o Architect Owners Address Architect's Address VOL/1&A OT Zip ve a1 Zip Sq. Ft. New Area: 1st FI. 2nd FI. 3rd FI. Total Ne Area Purpose of this permit �1-��'�C �� �L 1 S r- i f� b01 e4- Q %Ar GL CjEn 1 r2q,0M City Watero Well❑ Septic System❑ Sewer❑ Ins: HO J a t. At a Basement Garage —A4 Approved by ate Use Gr Construction 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 irywh h this buildina and its use is allowed. Signed 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 / Approval Date By Appl Code Description Due Whom Code Comment ------------------------- **-30983-B 3,000 B10 FINAL 02/28/05 JFF A WITH OWNER B10 FINAL 02/28/05 JFF A CLOSEOUT BU1LU1NG PZ MIT STATE OF CONNECTICUT 3z�� WORKERS'COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn.Gen.Stat. §31-286b) Property located at d r c i CD fZ Y In the town of I S 3G e C IVName of building permit applicant: cl 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 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 andstop here] Signature of pYlicant 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)