HomeMy WebLinkAbout264 KELLY RD Electric# APPLICATION FOR BUILDING PERMIT
Plumbing.# Date: I l 'l g V S
HVAC # 264 Kelly or.�a
Sprinkler# 32168 8 _
FINAL AP — -------- Estimated Cost $�z
-----COMPLETE
-- - -- -- -- --- Permit Fee $ �.
Building COMPLETE RED BOXED AREAS 1 i Occupancy Fee $
Engineering TYPE OR PRINT ONLY i Eng. Insp. Feeffi $
Affidavit ► SIGN ON REVERSE SIDE / o
Appr. for CO ' b - ---- --.. - -- -- --- 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 TV.o,A S \Location of Work L o p es Lot No.
'Applicant's Address '3: 6 4 �-Tel.# 4 6-2 16!j—
Town S o %4 Ai n S n Zip 0 C=.o '7 �}- Lic.#
Owner-T�,o N. A S l ,s 1J Architect
Owner's Address S a M L Architect's Address
Zip Zip
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit T'- 1 ._ QLAU i- S�trflre
City Water❑ Well Septic Systemo Sewer
Ins: HO Cert. Area Basement Garage
Approved bye - Date �� (S' 'G� 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 street lines,side yard lines,and required
distances from all other zones and is located in which this building and its use is allowed.
%igned`-c-� �A,--r 't�1 A—Q& -
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
i
Inspection / Approval Date By Appl
t Code Description Due Whom Code Comment
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**-32168-B 2,800
B10 FINAL 12/15/05 CJD A
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