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HomeMy WebLinkAbout2400 TAMARACK AVE CENTRAL CT GI SUITE 101 <O�M•11 p [ O � APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 (PHONE) 860-644-2511 EXT.230 DEPARTMENT DECISION PERMIT NUMBER: APPLICATION IS HEREBY: APPROVED: BLDG.PERMIT W S 1 .>>,I P--4' �W DATE INSPECTOR LOCATION OF WORK: Noo AVc E)on-c in -a" Wwlx��cr Connect;w� CT &17 Sv /-� /b / APPLICANT: OWNER: TYPE OF STRUCTURE: ►,/ '`, ❑NEW BUILDING NAME: 41EA6 \ - ,. Y, NAME:� � /"L�DTLrf� ❑ADDITION PHONE NUMBER: �)� 1�' I PHONE NUMBER: EXISTING XISTING BUILDING ADDRESS: i D ADDRESS: Dc'•x�[J�� .K \ 1-L�I n Jj ��� 4 } ����L �T TYPE OF USE: l ❑RESIDENTIAL ACOM ERCIAl. C,zsp.�,� �,�3aay-coo ELECTRICAL INFORMATION: -F�•U�RTTH�E�R DESCRIPTION OF WORK: � TYPE OF INSTALLATION: ` .^,..,m.lGt,7..,� CfF i�G-f.�/Y�I[t�tl..i.1�5 4- SIZE OF SERVICE: F�J.7,1`7`�`�tJV�!_I CH��/�,r©� l�/T1v.Gr- SIZE OF MAIN SERVICE: V4�r A-l�. HU-'(O� 0) LF� NUMBER OF METERS: 4' - l , NUMBER OF PANELS: NUMBER OF LIGHT CIRCUITS: ESTIMATED COST:S NUMBER OF SWITCHES: NUMBER OF LIGHT FIXTURES: FEE ENCLOSED:S 00 NUMBER OF A/C CIRCUITS: /1/ CF - E E ULE:$18 PER$1,000 OF THE ESTIMATED CST. NUMBER OF POWER CIRCUITS: ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS$1.00 OVER (.26 CENT EDUCATIONAL FEE INCLUDED AS NUMBER OF OUTLETS: PART OF THE PERMIT FEE) THE UNDERSIGNED HEAEBY 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 PERFOMANCE OF SUCH WORK.CONTRACTORS LICENSE NO.: TYPE: STATE: Cl SIGNATURE OF APPLICANT: DATE: DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WiNDSOR BUILDING DEPARTMENT (�7 APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# -- 644-2511 ext. 230 Wjb -K Date I Building Ins or Application must be printed or typed FEE SCHEDULE �A n Location of Job: T vti1� r= Pr�(ri L{ �/o vr�/c7!�/, $0-$1,000=$15.00 fTenant o. Street Lot No. Over$1,000= $15.00 per$1,000 -z� or any fraction thereof Designation Apt.No. APPLICANT � 4a���}--�?. �72�`7 APPLICANT DRESS VO �5 2 Y1 �� ci APPLICANT PHONE# (�Zo �1 -XSU O W N St OWNER - GD OWNER DRESS � K6/P/!, ctP Oa OWNER PHONE 62y �Om C ESTIMATED COST$ -4y S�_ IS THIS A CONTRACT COST? _Yes _No a �� FEE ENCLOSED$ � r�bSOR.Co TYPE OF JOB: �" l -"/New Installation _Alteration/Addition/Repair Revised 4/01//2002 w APPLICATION FOR RVAC PERMIT (Continued from reverse side) TYPE OF§V-S TEM: TYPE OF BUILDING: FElING �SIDENTIAL OMMERCIAL ILATION O INDUSTRIAL HEATING ❑ STEAM LOW PRE*URE LIMIT LBS. HIGH PRESSURE LIMIT LBS. ❑HYDRONIC Ud WARM AIR ❑UNIT RADIANT HEATER EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION) ESCRIBE ALL TING EQUIPMENT(INCLUDING MAKE&MODEL NO.) Imo_ �i��1 GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH) TYPE OF FUEL ❑OIL—GPM OIL TANK LOCATION :❑ INSIDEU OUTSIDE CAPACITY ❑GAS—INPUT LPG TANK CAPACITY ELECTRIC—KW AIR CONDITIONING DESIGN TEMP.OUTSIDE OF INSIDE 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) FRESH AIR INTAKE(CFM) (PLANS MUST ACCOMPANY APPLICATION) FURTHER DESCRIPTION OF WORK 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. CONTRACTORS LICENSE N E STATE i SIGNATURE OF APPLICANT DATE "F 3 0�_ 20 UNL -r lb 14-3 1N��ti o Y' / MECHANICAL FURNACE GAS HEA SCHEDULE FLOW RATE STATIC PRESSURE ELECTRICAL DATA DX COOLING GAS HEATING BASIS OF DESIGN TAG SUPPLY OA FAN RPM EXTERNAL MCA MOCP SENSIBLE TOTAL INPUT OUTPUT Weight NOTES CFM CFM IN WG AMPS AMPS VOLTAGE MBH MBH MBH MBH MANUFACTURER MODEL OR SERIES RTU-1 3,400 301 0 0.8 24.0 30 480 3 60 95 103 150 121 TRANE YHC102A4RMA 1,200 ROOF CURB, ECONOMIZER RTU-2 4,000 7477 0 1 26.5 35 480 3 60 93 117 200 162 TRANE YHC120A4RMA 1.400 M 4 0 1 26.5 35 480 3 60 93 117 200 162 TRANE YHC120A4RMA 1 400 0 1 26.5 35 480 3 60 93 117 200 162 TRANE8 0 0 1 51.0 60 480 3 60 199 268 250 203 TRANE 00 0 1.5 57.0 70 480 3 60 236 1 300 250 203 TRANE YFD301C4HG 2 600 TOWN OF SOUTH WINDSOR AFFIDAVIT OF ACTUAL COSTS PERMIT NO: �?Od O 6 �? DATE 171/z-316 The undersigned, being a duly authorized representative of,_ _72 = 15�A 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 Ii, Section 14-31, (a)thru(e),(see attached). 1 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. I here4Y certify that the actual cost of the work performed under this permit is: Signature of Permit Holder: Name(Please Print) Date: raaatarraraaararrrraraaarrarrarrrrarraararaarrrrarrrraraaarrrraarrararrrrra�arar■ State of Connecticut] ] ss South Windsor Date: County of Hartford] Personally appeared , as aforesaid, Signer and sealer of the foregoing 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 DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE 644-2511 ext. 230 Bldg.Permit# )0- is' 7, 1 D e 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$1,000 (r.0(w ar4levLo`v c or any fraction thereof Tenant Designation / Apt.No. APPLICANT 6,- APPLICANT ADDRESS APPLICANT PHONE# _r C^C SOW N SF,q OWNER k-VQtL r'iriKh k1l cJjrij OWNER ADDRESS Pr--r— OWNER PHONE �-6 t%' C ESTIMATED COST$ �, IS THIS A CONTRACT COST? Yes _No FEE ENCLOSED$ TYPE OF JOB: SCR•CO "ew Installation Alteration/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? ❑ YES O NO ❑RESIDENTIAL ❑BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY 0 MERCANTILE FUTURE USE AND OCCUPANCY ❑EDUCATIONAL ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE OSTORAGE O 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 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. / CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT y DATE DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMI�'# Application is hereby: TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE 1 644-2511 ext. 230 Bldg.Permit# Da Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: F;Tenant $0-$1,000=$15.00 Street Lot No. Over$1,000$15.00 per$1,000 or any fraction thereof gnation Apt.No. APPLICANT F yi l4 e�/-C,{ T �i• C cy APPLICANT ADDRESS .3 t LO 1 S 7� I, Y431-o I C f , 6 010 APPLICANT PHONE# -40 -&`1 S ", '( Z 1 ! I �OYr N SF-4 OWNER ��/dr nt .-,� {3�cu�`c�� ,�S`SGC• ( lv d OWNER ADDRESS CIO) OWNER PHONE 'S ry •� i� C ESTIMATED COST$ -S 1 ct-C •� r * IS THIS A CONTRACT COST? Le:�-Yes _No r � FEE ENCLOSED$ a t/ S O TYPE OF JOB: CC� �R C New Installation' _Alteration/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? ❑ YES ❑NO ❑RESIDENTIAL ❑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 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. /cLjFz; 7 C"r r CONTRACTORS LICENSE NO TYPE STATE SIGNATURE OF APPLICANT CI DATE i' DEPARTMENT DECISION APPLICATION FOR SPRINKLER PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR �t f0 BUILDING DEPARTMENT -1� APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# lb 644-2511 ext. 230 aY Date Bld ing inspector Application must be printed or typed FEE SCHEDULE Location of Job: Font�D- �.+�,.n . �. K$0-$1,000=$15.00 Street Lot No. Over$1,000$15.00 per$1,000or any fraction thereof n Apt.No. APPLICANT 444 S rztnr 1--k` e-1 . ket_s� APPLICANT ADDRESS �1 h1E5TDa� J '' APPLICANT PHONE# O N S f OWNER q� OWNER ADDRESS �' (;0) ,r OWNER PHONE C ESTIMATED COST$ l notq, 00 IS THIS A CONTRACT COST? Yes _No r G FEE ENCLOSED$ R1)"d U 1� TYPE OF JOB: vd� l�SOR-`Cod New Installation ✓Alteration/Addition/Repair aa,a o u 5 Revised 4/01//2002 APPLICATION FOR SPRINKLER PERMIT (Continued from reverse side) TYPE OF BUILDING TYPE OF CONSTRUCTION USE GROUP NO. OF STORIES ❑RESIDENTIAL BUSINESS IS THIS APPLICATION ASSOCIATED WITH A ❑ASSEMBLY BUILDING PERMIT APPLICATION? ❑ YES ❑NO ❑MERCANTILE ❑EDUCATIONAL CURRENT USE AND OCCUPANCY ❑INSTITUTIONAL ❑FACTORY FUTURE USE AND OCCUPANCY ❑ STORAGE ❑GARAGE ENGINEER'S NAME PHONE ❑MDG;D USE (Other please specify) ADDRESS CITY STATE ZIP KIND OF INSTALLATION SIZE OF MAIN DRAIN WATER PRESSURE AT STREET(PSI) ARE SPRINKLER HEADS ALTERED? ❑YES ❑NO IF YES,CHECK ALL THAT APPLY: ❑ADDED ❑DELETED ❑ALTERED IF MORE THAN 3 HEADS ARE ADDED HYDRAULIC CALCULATIONS ARE PROVIDED BY(CHECK ONE) ❑PROFESSIONAL ENGINEER ❑INSURANCE COMPANY WATER FLOW WATER PRESSURE AT SPRINKLER HEADS(PSI) ARE PUMPS REQUIRED? ❑YES ❑NO IF YES,CHECK ALL THAT APPLY: ❑FIRE ❑BOOSTER ❑OTHER ARE STANDPIPES PROVIDED? ❑YES ❑NO IS A SPRINKLER SYSTEM PROVIDED? ❑YES ❑NO SPRINKLER SYSTEM MAIN WATER SUPPLY RATING GPM TOTAL DYNAMIC HEAD(TDH)OF FIRE PUMP 4 PSI I DESCRIPTION OF WORK 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. CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE iectr>Ic# � � APrLICATION FOR BUILDING PERMIT 2400 Tamarac Avenue Plumbing# Gastroenterology 800498 Date: HVAC # MIT -C,i�OS Sprinkler# FINAL APPROVE; PA 17; ' --- -1 Estimated Cost $ BuildingCOMPLETE RED BOXED AREAS Permit Fee $� -AND � Occupancy Fee $ 1D Engineering 29 TYPE OR PRINT ONLY Eng. Insp. Fee $ A r. for CO. ► SIGN ON REVERSE-SIDE 3� PPp -- - - - - - -J Total Fee n $ TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant `i t H , C�Al - �12,� Location of Work d 11601 ',Am 444C-o— AvE. Lot No. Applicant's Address aZC-0 r►s4Are- D2j UE, Tel.# Town Aya ., ci Zip_04-cn/ Lic.# Owner A1FA&4gg,J 44p>cC *t$c:AM& � c LL Architect j uj Nt A&^44t7EC7Z4Z"-. Owner's Address ZAV ISi/E.i 7�a;�-'� Architect's Address d00 -P2i✓f-- 9/0rJ c;i Zips 4t20---) C 1 Zips Sq. Ft. New Area: 1st FI. 2nd FI. 3rd FI. Total New Area Purpose of this permit :QvTE CI OL s cvt- �� C ��¢.az, fa-�� n�•�i �4-i g ) ly cr CCi�yGL— City Water Well❑ Septic Systemo Sewer Ins: HO SP Cert. a Basem Garage Approved by Date Use Grou Construction Type S Revised 8/02 0?Q��0l�(� y l�by i I hereby agree to conform to all the requiremenZLits necticut and the Ordinances of the Town of South Windsor and to notify the Building Insperr specifications of the Building for which this permit is asked,and agree that this building is tfrom all street lines,side yard lines,and required distances from all other zones and is located in allowed. Signed I hereby apply for a Certificate of Oc p cy for t work d ribed in this application for the permit. J I Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS Pk��� ANQ ,;GS 29-3 ., TOWN OF SOUTH WINDSOR AFFIDAVIT OF ACTUAL COSTS PERMIT NO: WjggT DATE The undersigned, being a duly authorized representative of, ( 6D16> LC-t-,�TvA, CZ I 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 II, Section 14-31, (a)thru (e), (see attached). I understand that verification for accuracy of actual costs may be made at an time b the Building Official Y Y Y 9 through an appraisal of the work at the expense of the property owner. I hereby certify that the actual cost of the work performed under this permit is: $ Signature of Permit Holder: Narnc(Please Print) 11 Date: /� J ..mammon..............................mammon.................................was a State of Connecticut] ] ss South Windsor Date: County of Hartford] Personally appeared , as aforesaid, Signer and sealer of the foregoing 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 INSPECTION FIELD SHEET 01/19/21 Printed by Middleton, Morgan 14 49 29 INSPECTION: 16785 FM ABOVE CEILING PERMIT: STATUS: APPLICATION: 200801264 LOC: 2400 TAMARACK AVE. SOUTH WINDSOR PROPERTY ID: 89302400 OWNER: EVERGREEN MEDICAL ASSOCIATES LLC CONTRACTOR: REQUEST BY: PROJ DESC: INTERIOR BUILD OUT OF CENTRAL CT GASTROENTEROLOGY SUITE WORK ORDER: INSPECTOR: SUMM RESULT: PASS REQUESTED: PRIORITY: SCHEDULED: COMPLETED: 12/12/08 UNPAID FEES: 00 Date Time MILEAGE: 00 TIME: TRAVEL ONSITE COMMENTS: ;` 77.-_ _ L PERMIT CLOSED =} 17-176 PER: PA 17-176 AND -LIS 29-393 CGS 29-393 ALL INSPECTIONS: INSPECTED INSPECTOR RESULT INSP DESCRIPTION 12/12/08 SUMM PASS F005 FM PENETRATIONS/SEPERATION 01/13/09 SUMM PASS F015 FM FIRE ALARM TEST 01/13/09 SUMM PASS F025 FM EMERGENCY/EXIT LIGHTING 01/13/09 SUMM PASS F035 FM EXITS 01/13/09 SUMM PASS F040 CO -FIRE MARSHAL INSPECTION T j' CLOSED -3A 17-176 AND ;:GS 29-393