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Home My WebLink About20 BERLE RD DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# A licati /� TOWN OF SOUTH WINDSOR pp BUILDING DEPARTMENT 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date B ing 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$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT ]2AV I J�! APPLICANT ADDRESS APPLICANT PHONE# O W N St OWNER C OWNER ADDRESS a OWNER PHONE C ESTIMATED COST$ Do e IS THIS A CONTRACT COST? _Yes �o FEE ENCLOSED$ — 1� TYPE OF JOB: �S R-C o New Installation Alteration/Addition/Repair APPLICATION FOR ELECTRICAL PERMIT (continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A dRESIDENTIAL BUILDING PERMIT APPLICATION? ❑YES Ga'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/WIRING METHOD SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES ❑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 HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK cl/ts v, 74/�9-� 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. T CONTRACTORS LICENSE NO. aTYPE //STATE SIGNATURE OF APPLICANT nn%� / V DATE (p"13 _D6 bUlLU1NU YLttP11'1' STATE OF CONNECTICUT WORKERS'COMPENSATION COMMISSION Building Permit Affidavit for Property Owners or Sole Proprietors (Conn.Gen.Stat. § 31-286b) � 6FnGJF 1 ,p Propertylocated at /', In the town of '0, W 14/P-401"Ll— Name of building permit applicant: D14d IP 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 and stop herb] Signature of applicant �C 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. A640L, Signature of applicant Subscribed and sworn to before me this day of ,200 . (Notary Public/Commissioner of the Superior Court) L nil ............................... lIX34 N N E 0 /S►2rA : 3Q,O 37 4 b J � � yJ h J 0 a ff cco Q � � Y 7. 83� —8 a 6` to a ii 2o.9Z e ` Gvz`';;� - ; o _ 4�� fOR BUILDING PU�ii�� `o! R i 2 G 2 M.S. i J er A 4. J� RLc ?��• SoUTH W►�j05oR� EE! ttQ Loi- o I 01J MAA E1JT1T1_r' � �-y S v FZ V�Y w� 'FbR CA R L 0 P R E S T I L E O� Ri ZE R0AD J �UTH V�/1tJDS0 L C01�1 �• SGAL1^' 1"- \,-71)L 6-� S,.,GI�.,��tz1UG �3 1 9 7 O J CA L a a Nj/F- Las-r GA,L ; A _j *3o+ South Windsor BUILDING DEPARTMENT l0 fill jiiU4'njL this aartirsed that thin plan r=s a1.•cmc..tlons .�ue ao'iea or the or ♦lterou, t. tM erected at fir (� '.treat toastber with amendments stated in .tpplic ,in and Iliad with plan and 1 agree to comply with eU toning. Yulldint and state Inwe and such orders is spmo be issued by the Building Department during ono 31 this application and final issua a of is updtna permit. rilis pprovad su Dleet to this condition that <be"isrs and rdlnances regulating bullding shall ba ae.wtpilod with. CandltlooWly Approvalg fhesa filed with •ullding InsaKctor ----- Clerk Oat• _•�7?._�L� CERTIFICATK1ri OF ZONIP10' ^^'ll ppj Proposes; Lic"". ) , ur stnjc—Ifd(s) as shown on this 0r. ;ppjar(s) to be in conformance *4' runant Sour; Windsor regulations. Variances and special excepticis may apply. Date MU is 1 g or ment Officer i �a� Electric 4 APPLICATION FOR BUILDING PERMIT Plumbing# 20 Berle Road Date: HVAC # Sprinkler# 30815_ FINAL PR — Estimated Cost Building COMPLETE RED BOXED AREAS Permit Fee $ Occupancy Fee $ /U• Enginee 'n TYPE OR PRINT ONLY Eng.Insp. Fee $ Affidavit SIGN ON REVERSE SIDE Appr. for CO) o v Total Fee $ TO THE BUILD NG DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant 1 `location of Work ♦ Lot No. Applicant's Address ' "Tel.# Town T Zips O S' 'djc.# O O Owner Architect a— owner's Address r' Architect's Address $0. w104[o! CT Zip 040'1K Zip q. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area 'j#4 Purpose of this permit CbalwtN fit 11 1 AIV&,IL W+ is t Os City Water❑ Well❑ Septic System❑ Sewer❑ Ins: HO e W. Are Basemen4 Garage Approved by 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 eet lines,side yard lines,and required distances from all other zones and is bcated in ich s building and it all Signed • I hereby apply for a Certificate of INWRLITEtIBELOW hework descri n this a cation for the permit. Signed D THIS LINE INSPECTION COMMENTS Inspection / Approval Date By Appl Code Description Due Whom Code Comment ------------------------------------------------------------------------------- •+-30815-B 8,435 BO1 FOOTING 07/23/04 PJP A W/CONTRACTOR 4 PIERS B10 FINAL O1/04/05 JFF A B10 FINAL O1/06/05 JFF A CLOSEOUT y