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APPLICATION FOR ELECTRICAL PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT
APP v 1540 SULLIVAN AVENUE
1� 644-2511 ext. 230 Bldg.Permit#
Date Building Inspec r
Application must be printed or typed
FEE SCHEDULE Location of Jo
$0-$1,000=$15.00
Over$1,000= Street No. Street Lot No.
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �Y 1J mc�y e5e rJ
APPLICANT ADDRESS Ll
APPLICANT'S PHONE# '3 C>0- 60 -
OWNER r
�0� N SF4< OWNER ADDRESS I l h a
• Soon
Cs, OWNER PHONE �6 C� ' � 3 �, 70 11
C ESTIMATED COST$ 7 Ord
►� U IS THIS A CONTRACT COST? xYes No
FEE ENCLOSED$ 15
TYPE OF JOB:
O� • O� New
R C Installation
Alteration/Addition/Repair
Revised 03/05J10
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES ❑ NO
�I RESIDENTIAL CURRENT USE AND OCCUPANCY
❑ BUSINESS
❑ ASSEMBLY FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
❑ FACTORY
❑ STORAGE ADDRESS
❑ GARAGE
❑ MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBERS OF METERS NUMBERS OF DISCONNECTS AND RATINGS
NUMBERS OF PANELS NUMBERS OF DISCONNECTS REQUIRED? ❑ YES ❑ NO
NUMBERS 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
I\J C\44 RD(01 OU -Skej wly-In-r, +C-) �4 )fle —
Uk rn� . C'a n�1 �J 0 l.0 1 S n Y1 <c�
THE UNDERSIGNED HEARBY 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 PERFOR-
MANCE OF SUCH WORK
&t
CONTRACTORS LICENSE TYPE STATE
SIGNATURE OF APPLICANT DATE S ")
19
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RECEIVED
`^° MAR 31 2014
"'1� N no Ida '"'�'°� ^� t• South Windsor
•`•'p" 'R Buildin De ��;gent
a0�3.E1 �I n Rd w..
00.11111ro0Wmilm S"fte in .oe,o,,,yo. ...
v �trtln� MO NOM I11w and MCA* MOM••rN b.
„rvt hv tb BIYtlMK D•p--mm dow" Pit
• t+�M A! 9Nf Ipru� frr i 411MMr
c,rtnN,
of CERTIFICATION OF 70NING COMPLIANCE
»w l/►_y 1 /�i� Proposed buil( ng(s), usM a) j iaror structures) as
PIMP s w.ow .a w04�t t� tt- «„, , �lWn shown on this plan appears)to he ;n conformance
awe ` '�•'`� 19'y'�'' `• ;"`� �rt1 1K with current South Win-'.,ol regulitions. Variances
3' and ply.
Date 3
�nic,:ci;menOh,:.ur
. . .--- M► L�Q..41".� a I ' above �r��l.� ��,,1
cn
� �- �-5 O � ,► •� ,�o �' �S '�gyp, ,� ,�r �,�-�•a�
ON G 1 S I h r Y r
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o C�II�
MAR j M9
South Windsor
BUILDING DEPARTMEN r
TO THE B-:;LDIN6 DEPT. TGF:\ )r
This ccrtifi-d that this plan and sr—m,ic !i ,(u•
copies of the proposed building or alterations to ba
erected at
0)093 YC9 str—
t.i, ther with amend sh!t^d in arVic.tion ..,
ii d .ith piers and I .SFr, t+, conply with 11 zonni.
i•ti:,g and st<:tc 1tws a'!d s.cil irdcrs as shall -
ic r ,.d by tlla 0uu I:ng Gr p,:rt.—nt d.:ring p,,,.l ,
cr t,is a py/pn/l(t,'G Aat/ion`ana final issuance of a builain,
Senn lt.
$It ned
_J-.�.�_
�
This plan is ,Ptr.:,v,-d s�.:hirct to tho condition th':
onfrrs and crclt.Iances rcgul„vng building shell ue
c,onipiied .,nth.
Conditionally Approved These filed with
Building Inspector jClery
Dato f ,�5R N-
CE
RTI ICATION OF ZONING COMPLIANCE
Proposed building(s), use(s) and/or structure(s)
-ia shown on this plan appear(s) to be ii]
�liformance with current South 1-v td ••,r
.bulations. Variances and special excep:,ons
:1iay apply.
Date — 3)3J96
RFI
in forcement Off low.
Electric # APPLICATION FOR BUILDING PERMIT
Plumbing# _ 2093 Ellinton Road
HVAC# I Date: --o `
Sprinkler# 9003 27 Y
` FINAL APPROVALS Estimated Cost $
Building COMPLETE RED BOXED AREAS Permit Fee $ 1 d• 4
Occupancy Fee $ 10. 0
Engineering TYPE OR PRINT ONLY Eng. Insp. Fee $
Affidavit ► SIGN ON REVERSE SIDE t
Appr.forCO. 49 1Total Fee $ �d, �O
TO THE BUILDING ARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $
The undersigned hereby applies to do o k ording to the following:
Applicant ocalion of Work Lot No.
Applicant's Address Tel #
Town 1 Zip Lic.ii
Owner S,S Architect
Owner's Addressi Architect's Address
Zip Zip
Sq. Ft.New Area: 1 st FI. nd Fl I I 3rd FI. Total New Area
Purpose of this permit p
City Water❑ Wel Septic System D Sewer
Ins: HO V SP Cert. Area Basement Garage
Approved by Date ��?-O Use Group Z� Construction Type \(�
gi Revised 1108 \ 1
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 hich this b�ildin�g;.a�nd its use is allowed.
Signed
I hereby apply for a Certificate of Occupancy for� work described in this application for the permit.
Signed _ � 1
DO NOT W BELOW THIS LINE
INSPECTION COMMENTS
� r
INSPECTION FIELD SHEET 11/30/09
Printed bw_ Peart, Dayshell 11 50 26
1
INSPECTION: 25289 FOOTING PERMIT:
STATUS:
APPLICATION: 200900930
LOCATION: 2093 ELLINGTON ROAD
SOUTH WINDSOR
PROPERTY ID: 30302093
OWNER: FORGHETTI PAMELA J
CONTRACTOR:
DESCRIPTION: KLOTER FARM SHED
WORK ORDER:
INSPECTOR: ROSE RESULT: N/A
REQUESTED:
SCHEDULED: COMPLETED: 10/20/09
UNPAID FEES 00 Date Time
TIME: TRAVEL ONSITE
COMMENTS
4.
ALL INSPECTIONS
INSPECTED INSPECTOR RESULT INSP DESCRIPTION
10/20/09 ROSE N/A B002 FOUNDATION
10/20/09 ROSE N/A B003 FRAMING (ROUGH)
10/20/09 ROSE N/A B004 INSULATION
10/20/09 ROSE N/A B005 FIREPLACE / CHIMNEY
10/20/09 ROSE N/A B006 WOOD / GAS STOVE
10/27/09 ROSE PENDING B010 FINAL
11/19/09 ROSE PASS B010 FINAL
10/20/09 ROSE N/A E001 ELECTRIC SERVICE
10/20/09 ROSE N/A E002 ELECTRIC UNDERGROUND
10/20/09 ROSE N/A H003 HVAC ROUGH
10/20/09 ROSE N/A P002 PLUMBING UNDERGROUND
10/20/09 ROSE N/A P003 PLUMBING ROUGH
10/20/09 ROSE N/A P004 PLUMBING GAS TEST
10/19/09 CARS PASS 2003 CO PLANNING INSPECTION
' BUILDING PERMIT. 00 j ol-
STATE OF CONNECTICUT
WORKERS'COMPENSATION COMMISSION
Building Permit Affidavit for Property Owners or Sole Pro rietors
(Conn.Gen.Stat. §31-286b)
Property located at - .20
In the town of
Name of building permit applicant:
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
' 2B.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 c1b one:
1 I do not intend to act as a general contractor or principal employer.
[Sign and op here]
f
Si 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 to accept coverage.
Signature of applicant
Subscribed and sworn to before me this day of ,200 .
(Notary Public/Commissioner of the Superior Court)
❑ SCHEDULED DELIVERY DATE ` 7
❑ CUSTOMER TO CALL TO SCHEDULE INVOICE 100727
K I ote r Farms, Inc. DOOR ON: ❑Driver Side ❑Passenger Side ❑
216 West Road (Rte 83) ❑ DATE RO# DUE DATE
ORDER _
Ellington, CT 06029 ,STOCK#� s-_0
860/871-1048 fax: 860/871-1117 SA S ERSON PO# DATE DELIVERED
www.kloterfarms.com
❑ CUSTOMER PICK-UP
DELIVERY
Customer N me
Deliver To
-
0
City State Zip
S o tiJ L a'4G 7
Phone:Home Work Ext. Cell or Pager Email or Fax
BUILDING SIZE STYLE SIDIINNG TRIM SHUTTERS
t SHINGLE COST
QTY DESCRIPTION UNIT
❑ KIT BUILT �74'J'
/a"CRUSHED STONE PAD ❑ FROST PROTECTED PIER FOUNDATION
DELIVERY CHARGE
CUSTOMER AGREES WITH THIS ORDER AS WRITTEN AND ASSUMES SUB TOTAL ;X30
FULL RESPONSIBILITY FOR THEIR PROPERTY DURING DELIVERY. SALES TAX LC n
In the event of unusual delivery conditions,such as unlevel site,obstructive trees or fences,delivery may exceed the
normal 30 minutes at site and result in an additional charge of$80 per hour.A small deposit on custom orders guaran- WIDE LOAD PERMIT '25/'50/`75
tees price for up to one year.However,construction of your custom order will begin when 1/3 deposit has been received TOTAL DUE �,
and a delivery date has been scheduled.Kloter Farms will issue a credit slip on any cancelled order less re-stocking fee.
/ LESS DEPOSIT _
W-CtIeCk #�� ❑Cash V BALANCE DUE
CUSTOMER APPROVAL ON DELIVERY
MC []VISA ❑Discover
❑ Financed O'014TRY ST0 4�6
G ,tom
Family Owned &Operated
SATISFACTION GUARANTEED SINCE 1980
Open Year Round Monday-Saturday R F
We appreciate your business! Quality is the foundation on which we build.
14000134 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER BUILDING PERMIT
DATE: 04/09/2014
GIS ID:30302093 FEE: 60.00
MUNIS APPLICATION# 201400312 BUILDING DESCRIPTION:
APPLICANT,ry`,tiJ b LOCATION
NAME: GIARD CHRISTOPHER W ADDRESS: 2093 ELLINGTON ROAD
ADDRESS: 2093 ELLINGTON ROAD: OWNER: GIARD CHRISTOPHER W
SOUTH WINDSOR,CT06074` 2093 ELLINGTON ROAD
SOUTH WINDSOR,CT 06074
DESCRIPTION OF WORK: 21 FT.•ABOVE GROUND POOL.
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
4/9/2014 3:13 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE
1400118' TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER ELECTRICAL PERMIT
DATE: 04/28/2014
GIS ID:30302093 FEE: 15.00
MUNIS APPLICATION# 201400312 BUILDING DESCRIPTION:
APPLICANT , LOCATION
NAME: ANDERSEN ELECTRICAL SERVICES ADDRESS: 2093 ELLINGTON ROAD
ADDRESS: 42 MONTAUK DRIVE: OWNER: GIARD CHRISTOPHER W
VERNON ROCKVILLE;CT 06066 2093 ELLINGTON ROAD
SOUTH WINDSOR,CT 06074
DESCRIPTION OF WORK: 21 FT.-ABOVE GROUND POOL.
WIRE NEW POOL,REUSE OLD SHED WIRING TO WIRE POOL PUMP.TIME CLOCK WILL
BE IN BASEMENT.
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
4/28/2014 11:16 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE