HomeMy WebLinkAbout20 OVERLOOK RD Electric #. 20 over loo c,PFMACATION FOR BUILDING PERMIT
Plumbing#
HVAC# 11000485 [Date: 9'Zb— �1
Sprinkler# Estimated Cost $ 0. 60
FINAL APPROVALS Permit Fee $ 7S'
Building. COMPLETE RED BOXED AREAS Occupancy Fee $
Engineeng TYPE OF PRINT ONLY Eng. Insp. Fee $
Affidavit ► SIGN ON REVERSE SIDE -4
Appr.forCO. `� Total Fee $ % e,
TO THE BUILDING ARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant ►ly a _LocationofWork ov-eot Gtr0/1_ LotNo. .Z.O
Applicant's Address &11 14 4AJ S r Tel # j'G0—4Ocf-d Pq O
Town SO ` A—efarz r—T, —zip Zip o 6 a 7 Lic.#MC0. 04 0 ZZS—b
Owner Jon Sy(i it it Architect
O"er' Address Z6 oww&ook Architect's Address
_ S&Z Cr Zip 40-1 zip 0407
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit
IZO F 166
City Water J Well J Septic System J Sewer J 261)0 1 Kb
Ins: HO crt. Area Basement Garage
Approved by Date 2(." �� Use Group Construction Type
aev+sea i oe
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 y..rd lines,and required
distances from all other zones and is located in whi this b ilding s use is allowed.
Signed
ZVI/ I -
I hereby apply for a Certificate of 46ccup y or the work described in this application for the pa rmit.
Signed
D NOT WRITE BE W THIS LINE
INSPECTION COMMENTS
BUILDI1IG PERMIT. f i
STATE OF CONNECHCUT
WORKERS'COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Proprietors
(Conn.Gen.Stat.§31-286b)
Property located at_ 10 C QQ P 6Z,y.-f l�Q�
In the town
Name of building permit applicant:
Please check one:
L I am the owner of the above property.
2. I am the sole proprietor of a business.
2A.Name of business_AAe c-✓
r
2B.Federal Employer Identification Number(FBIN)
.............................................................................................................:......
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 t_I do not intend to act as a general contractor or principal employer.
[Sign and.stop here)
Signature of applicant
2.,L I intend to act as a genial contractor or principal employer.Applicant must either
provide a certificate of workers'compensation insurance or sign the affidavit
Wow.
........................................................................:...........................................
Affidavit
I hereby swear and attest that I will require proof of workers'compensation insurance for every
contractor,subconttactor,or other worker.before he/she engages in work on the above property in
accordance with the'Workere 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 ole,pro netor of a business is not required to have coverage unless he
Ales his intent to acre
t o pliant
Subscribed androff to before me this day of q i ,200 .
(Notary Pub 41 Commissioner of the Superior Court)
INSPECTION FIELD SHEET 04/13/12
Printed by Peart, Dayshell 11:39 09
INSPECTION: 43021 FINAL PERMIT:
STATUS:
APPLICATION: 201101110
LOCATION: 20 OVERLOOK ROAD
SOUTH WINDSOR
PROPERTY ID 67500020
OWNER: STARK JONATHAN E
CONTRACTOR:
REQUEST BY:
DESCRIPTION: NEW ROOF.
WORK ORDER:
INSPECTOR: ROSE RESULT: PASS
REQUESTED: 03/06/12 PRIORITY:
SCHEDULED: 03/06/12 PM COMPLETED: 03/06/12
UNPAID FEES 00 Date Time
TIME: TRAVEL ONSITE
COMMENTS
11000485 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER BUILDING PERMIT
DATE: 09/26/11
GIS ID:67500020 FEE: 75.00
MUNIS APPLICATION# 201101110 BUILDING DESCRIPTION:
APPLICANT LOCATION
NAME: STARR TIMOTHY v ADDRESS: 20 OVERLOOK ROAD
ADDRESS: 621 MAIN STREET OWNER: STARR JONATHAN E
SOUTH WINDSOR,CT 06074 20 OVERLOOK ROAD
Y - SOUTH WINDSOR,CT 06074
7 3
DESCRIPTION OF WORK: NFEW ROOF.
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
9/26/2011 10:01 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE