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HomeMy WebLinkAbout265 EVERGREEN WAY ElEctric P 1 `ia0l %04tfl APPLICATION FOR BUILDING PERMIT Plumbing# W)/H 265EvergreenWay Date: // a CK H VAC # 1d30to Sprinkler# 1 L111 31125 FINAL APPROVALS _ -- Estimated Cost $ 261- � it Fee $ 1 L Z-b Building COMPLETE RED BOXED AREAS Permit OccupancyFee $ /U Affidavit Engineering TYPE OR PRINT ONLY j Eng.Insp. Fee $ it Appr. for CO. SIGN ON REVERSE SIDE /-il 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 Cc*-0 wit ' AW4,*a " Location of Work 201 d24 S Lot No. Applicant's Address 1(.e /Q'1&l u,J �Utr°Z A _y Tel.# *7 -35 3` Z� Z Town S6 u7'rSDr!u z-- A 2 Zip 6 2 l0 Lic.# Owner If OL 7 57 91 cliZ CteikW�ZiP` Architect Owner's Address / /J 8 2 .1V9 -3 ? Architect's Address/,(7-N -Sl'� $ T2 S G EH01 1")44 4 Z Zip 8'�7lZ/S Y_M'L) Zip 619 Sq. Ft. New Area: 1st FI. 2nd FI. 3rd FI. Total New Area Purpose of this permit /w Fi -�-_ %.- City Water Wello Septic System❑ Sewer❑ Ins: HO Area Basement Garage Z*q��Approved b Date Use Group Construction Type Revised 6/02 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut andthe Ordinances of the Town of , South Windsor and to notify the Building InVwhtchFth tion in the plans or specif ions of the Building for which this permit is asked,and agree that this buildingIs proper dis Jrom street lines,side yard lines,and required distances from all other zones and is locateng a s use�E Signe I hereby apply for a Certifi of Occupa for the in pplication for the permit. Sign i DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS Inspection / Approval Date By Appl Code Description Due Whom Code Comment r ------------------------------------------------------------------------------- **-31125-B 75,000 ' P02 UNDERGROUND 10/08/04 PJP A PO4 GAS TEST 11/08/04 CJD A B09 OTHER 11/15/04 CJD A MERCHANDISE B09 OTHER 11/15/04 CJD A DRAFTSTOP,IINSULATION,DROP CEILING B03 FRAMING (ROUGH) 10/22/04 JFF A INTERIOR WALLS WITH CONTRACTOR E03 ROUGH 10/22/04 JFF A INTERIOR WALLS WITH CONTRACTOR P03 ROUGH 11/01/04 JFF A COPPER DRAIN AND VENTS WITH CONTRACTOR B10 FINAL 11/23/04 PJP D GFI BEHIND SINK MOVE OR COVER,BR DOOR CLOSER LABEL PANEL EGRESS HARDWARE B10 FINAL 11/24/04 PJP A TEMPCO,PENDING MOD REGARDING SERVICE CLEARANC PENDING BUILDING CO P03 ROUGH 11/01/04 JFF A WITH CONTRACTOR, DRAIN VENT COPPER P02 UNDERGROUND 10/12/04 PJP A E03 ROUGH 10/26/04 PJP D B02 FOUNDATION 10/12/04 PJP D SLAB P10 FINAL 11/23/04 CJD N/A B10 FINAL O1/07/05 PJP A CLOSEOUT **-1411-5 6,900 Inspection / Approval Date By Appl Code Description Due Whom Code Comment ------------------------------------------------------------------------------- **-12306-H 12,720 **-11714-P 92,000 **-19209-E 10,000 **-19410-E 7,250 BUILDING INSPECTION DEPARTMENT TOWN of SOUTH WINDSO�R, CONNECTICUT C E R T I F C AS ET4 0 FS 4o j!- P A N C Y ZONE: , January 7 2005 'ry 4 x , This is to certify No. 31125 confor. Zvi � ix�,•__�Zia 5�.�V�a�: "� e nr_ ftt„pe Connecticut Basic Building c de an thei n ,ng z ' : .fit ons the., own c� ' .< s.,. South Windsor an t p r V p .r has ed below e....� Approved for Oc ac q T jT ME R v Use Group: M Constr. Type: 2C � ` t i►i:;t Notice If this ce i t Y y`sY,� oy; uplicate should be obtained �Ti e a $u ding epartment Any change or exteasi fMUKU-e n approved requires a new certificate of occupancy. DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT tDate PP V 1540 SULLIVAN AVENUE 644-2511 ext. 230 Bldg.Perna-- 11 a5 Buildin nspector Application must be printed or typed FEE SCHEDULE Location of Job: F c✓ �S u� � ty$0-$1,000=$15.00 Street Lot No. Over$1,000= $15.00 per$1,000 j�y� vv, �or any fraction thereof gnation J Apt.No. APPLICANT Ro o ,— Q APPLICANT ADDRESS {` ,D PA rz I�- l QC P f16 C ` O G APPLICANT PHONE# -" It 0,0 N Se 4 Fq OWNER k,4 (Lea r 0h t J OWNER ADDRESS ] N I Co m I OWNER PHONE g(pb -- LI 13 C � ESTIMATED COST$ U G 4 IS THIS A CONTRACT COST? j Yes _No o �� FEE ENCLOSED$ 13S`fl 00 SO- CO�� TYPE OF JOB: R YNew Installation _Alteration/Addition/Repair Revised 4/01H2002 J APPLICATION FOR PLUMBING PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A 0 RESIDENTIAL BUILDING PERMIT APPLICATION? ❑YES ❑NO 41 BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE El EDUCATIONAL FUTURE USE AND OCCUPANCY ❑INSTITUTIONAL O FACTORY ENGINEER'S NAME PHONE ❑ STORAGE ❑GARAGE ADDRESS ❑MIXED USE (Other please specify) CITY STATE ZIP TYPE OF INSTALLATION SIZE OF MAIN DRAIN NO.OF TOILETS STYLE NO.URINALS STYLE NO.OF BATHTUBS NO.OF SHOWERS C� NO.OF LAVATORIES NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS NO.OF OTHER FIXTURES KIND ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW ❑YES 0 NO SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR SIZE OF DUCTS SEWER OR SEPTIC TANK SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER WATER HEATER: TYPE MANUFACTURER DESCRIPTION OF WORK THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IrrU— 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 �V DATE IG& •- (! DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT Application is herb : TOWN OF SOUTH WINDSOR PERMIT# BUILDING DEPARTMENT 199,09 D 1540 SULLIVAN AVENUE Bldg.Permit# ov 2 2 200 644-2511 ext. 230 -3 . Date sp r Application must be printed or typed FEE SCHEDULE Location of Job- $0-$1,000=$15.00 FTenant Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof gnation Apt.No. APPLICANT F L U l-LT R'I L APPLICANT ADDRESS e- L. APPLICANT PHONE# f-t-1 3 5 6 -7 -5 y c' O W N St OWNER OWNER ADDRESS t, 1'(0 \ O \ b ,r OWNER PHONE C ESTIMATED COST$ U o O x IS THIS A CONTRACT COST? Yes _No FEE ENCLOSED$ �y• U 5 - O�� TYPE OF JOB: O 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 ASSOC ED WITH A El RESIDENTIAL BUILDING PERMIT APPLICATION?V YES ElNO 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 2 O 4 SIZE OF MAIN CONDUCTORS 3 O C- NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS Z REMOTE DISCONNECT REQUIRED? ❑YES--E!NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES G NUMBER OF OUTLETS ZZ NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS 4- Z, 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. �E' 1 1 `a --�, q ► ss 12-- t C T" CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE q DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: j BUILDING DEPARTMENT I GROVE 1540 SULLIVAN AVENUE fV 644-2511 ext. 230 Bldg.Permit# Date Building Inspect Application must be printed or typed FEE SCHEDULE rTenantDesignation Location of Job: $0-$1,000=$15.00 Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof A:t.N Ksa APPLICANT ,n /e APPLICANT ADDRESS _f u� �j 3' IF 0 APPLICANT PHONE# O W N S j , OWNER L,/ n,"�C rn_ L OWNER ADDRESS O OWNER PHONE C ESTIMATED COST$ � IS THIS A CONTRACT COST? Yes _No FEE ENCLOSED$ ���y_ Uo f��SO .C� TYPE OF JOB: R X/ 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 e ' ❑ASSEMBLY ❑MERCANTILE L3 EDUCATIONAL FUTURE USE AND OCCUPANCY ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE ❑ STORAGE ❑GARAGE ADDRESS ❑MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD ` Lk I CArM K/, 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 I 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. rr 11 11 11 DESCRIPTION OF WORK !'van`.S � S a aej 5 cc, 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. I0116 3 ) C i CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICATS DATE J( /h DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT Applicat' e y. TOWN OF SOUTH WINDSOR PERMIT# BUILDING DEPARTMENT APPR D 1540 SULLIVAN AVENUE 644-2511 ext. 230 Bldg. Petmit# !; )5 Building I pector Application must be printed or typed FEE SCHEDULE Location of Job: rvEC Srimy Sv3 1, 0 6 $0-$1,000=$15.00 Street No. Stree Lot No. Over$1,000= $15.00 per$1,000 �oic1 Stan�_ � rFc,•rc�y or any fraction thereof Tenant Designation Apt.No. APPLICANT AVphC'F:p 1'Y1y-&An,cj S rU'1c.� LLC APPLICANT ADDRESS IS (A APPLICANT PHONE# ,SO)N N SFq OWNER 5a�Nrn Uh!5j1; C.jr a OWNER ADDRESS ri OWNER PHON�E�7 4-1 v4c t) OESTIMATED COST$ /a .00 # IS THIS A CONTRACT COST? Yes _No IL FEE ENCLOSED$ 9S. TYPE OF JOB: R C New Installation Alteration/Addition/Repair Reviged 4/01/000? APPLICATION FOR HVAC PERMIT (Continued from reverse side) TYPE F YSTEM: TYPE OF BUILDING: HEATING ❑RESIDENTIAL A/C 0 COMMERCIAL ❑ VENTILATION ❑ INDUSTRIAL HEATING ❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. ❑HYDRONIC ?&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) DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.) L C'-N%ox Czc� CZa �ap v h GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH) TYPE OF FUEL ❑OIL--GPM OIL TANK LOCATION :❑ INSIDE❑ OUTSIDE CAPACITY PNAS—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) 7(` O--o VENTILATION DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT) TOTAL SIZE OF SYSTEM(CFM) � —CV RESH 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- S--I 35Wjq �S - I cl CONTRACTORS LICENSE N TYPE STATE SIGNATURE OF APPLICANT DATE /0 ` /-� " C9 I/ DEPARTMENT DECISION APPLICATION FOR SPRINKLER PERMIT TOWN OF SOUTH WINDSOR PERMIT# Applic @ : BUILDING DEPARTMENT APPROV 1540 SULLIVAN AVENUE DOEBldg.Permit# �, 644-2511 ext. 230 6 1 ( a i Date Building Inspe r Application must be printed or typed FEE SCHEDULE Location of Job: F S•-rTE 2(os$0-$1,000=$15.00 Street Lot No. Over$1,000= $15.00 per$1,000or any fraction thereof gnation Apt.No. APPLICANT �••-.s L• .�+eg H.. �o ff L 7�1E G��/�4—4L ne APPLICANT ADDRESS •� ox Zfs'a APPLICANT PHONE# B(►o - Z¢(v- 7711 0 W N $F,q OWNER OWNER ADDRESS • OWNER PHONE C = ESTIMATED COST$ IS THIS A CONTRACT COST? ' Yes _No FEE ENCLOSED$ TYPE OF JOB: SO R•C O� -'New Installation _Alteration/Addition/Repair Revised 4/01//2002 w 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 WTTH A ❑OSEMBLY BUILDING PERMIT APPLICATION? S ❑NO alWERCANTILE ❑EDUCATIONAL CURRENT USE AND OCCUPANCY ❑ INSTITUTIONAL ❑FACTORY FUTURE USE AND OCCUPANCY ❑ STORAGE ❑ GARAGE ENGINEER'S NAME PHONE ❑MIXED USE (Other please specify) ADDRESS CITY STATE ZIP KIND OF INSTALLATION SIZE OF MAIN DRAIN 2+ WATER PRESSURE AT STREET(PSI) *Ns b 7 ARE SPRINKLER HEADS ALTERED? ❑YES 3-1 0 IF YES,CHECK ALL THAT APPLY: ❑ADDED ❑DELETED ❑ALTERED IF MORE TfiAN 3 HEADS ARE ADDED HYDRAULIC CALCULATIONS ARE PROVIDED BY(CHECK ONE) ❑'PROFESSII�11ONAL ENGINEER ❑INSURANCE COMPANY WATER FLOW zt' WATER PRESSURE AT SPRINKLER HEADS(PSI) /B•17 ARE PUMPS REQUIRED? ❑YES GYRO IF YES,CHECK ALL THAT APPLY: ❑FIRE ❑BOOSTER ❑OTHER ARE STANDPIPES PROVIDED? ❑YES eNO IS A SPRINKLER SYSTEM PROVIDED? urfES ❑NO SPRINKLER SYSTEM MAIN WATER SUPPLY RATING 00 o GPM TOTAL DYNAMIC HEAD(TDH)OF FIRE PUMP PSI DESCRIPTION OF WORK Alf�- F 9,= syi�r•-�� FYsrE* rV4 T�x'Y /�— yt-Aws Atc�c.c s s0a•-IrT 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. F-105-10 �/ 4!:�-r CONTRACTORS LICENSE NO. E STATE SIGNATURE OF APPLICANT DATE ALLSTATE PO. Box 2350 Hartford, Connecticut 06146 , FIRE SPRINKLER (860) 246-771 1 ■ FAX (860) 246-7707 I INC. November 5, 2004 Town of South Windsor South Windsor, CT Attn: Building Official Re: Application for Permit Job#7604 Gentlemen: In accordance with the Public Act 91-95,this letter authorizes the below named agent to sign the above referenced application for Thomas L. Jacquel (License#F10590) Fire Sprinkler Contractor-Allstate Fire Sprinkler, Inc. P.O. Box 2350 Hartford,CT 06146 Project Name: Cold Stone Creamery @ Evergreen Walk Location: 201 Evergreen Way- Suite 265 Authorized Agent: David K. Thompson Thank you for your cooperation, Thomas L. Ja ue , President -14r *40C■.0 Certified Small Business Enterprise A &\�0CMSM � Conn. Contractor's License #F 10590 � LACEY BROS . RETAIL CONSTRUCTION , INC . 3048 S . CLIFTON SPRINGFIELD , MO 65807 P : 417 - 823 - 9500 / F : 417 -- 823 - 9510 VACSIMILE TRANSMITTAL SHEET To: Frotm Shirley,Chris,Dimeae in Building Dept. Matt Hovey—Project Manager FAX NUMBER.' Date: 860-644-3781 11-24-04 COMPANY: TOTAL NO.OF PAGES INCLUDING COVER: City of South Windsor,Ct + PHONE NUMBER: SENDER'S REFERENCE NUMBER; 860-644-2511 Cold Stone Creamery—South Windsor Rew. YOUR REFERENCE NUMBER: NOTESICOMMENTS, Ms.Shirley,Chris, Lacey Brothers Retail Construction is requesting a variance in cock from the state of Connecticut to allow the water service that enters the building to remain in its current location. This location infringes on the electrical service clearance.requirements. If variance is not able to be granted, Lacey Brothers Retail Construction will rectify the problem by re- locating one of or part of the services the&ectioa of the engineerd +ngineer on record. Thanks in advance for your consideration of this request We look forward to your positive response. Sincerely, Matt Hovey l A 909'ON Sf3H10d8 A30VI NVt8 :6 ti00Z 'VZ, AON WE 11/24/2004 WED 10:03 FAX 860 644 7280 South Windsor Town Hall Z 001/003 MN AT`t tij m a++ STATE OF CONNECTICUT DEPARTMENT OF PUBLIC SAFETY DIVISION OF FIRE,Eh1ERGENCY AND BUILDTNG SERVICES OFFICE OF THE STATE BUILDING INSPECTOR P. 0. BOX 2794 MIrDDLETOWN,CT 06457-9294 Telephone: (860)685-8310 Fax: (860) 685-8365 REQUEST FOR MODIFICATION INSTRUCTION SHEET 1. The applicant must sign and date modification form. 2. Building Official must comment and sign form per Section 29-254, Connecticut General Statutes. Application will be returned if signed by other than the Chief Building Official, Acting Building Official or Provisional Building Official, 3. One set of construction documents must accompany the request if they are needed to help illustrate a modification request. 4. A cover letter explaining your circumstance is recommended if it cannot be clearly explained in this form_ 5. Please type all responses,or if not possible,print legibly. Complete application in its cntirety. Any missing information may result in dclays. Return completed application to the above address. 6. If you have questions about what is required, call the Office of the State Building Inspector at (860) 685-8310. MODCVR Rrv.8/21/�0 111I County Club Road P.O. Box 2794 Middletown,CT 06457-9294 An EqualOppertuniry,Employe#- Z ' d OL09 ' ON Sd3HIOH A33VI NVtE :6 too Z ' tZ , AON 11/24/2004 WED 10:04 FAX 860 644 7280 South Windsor Town Hall 1&02i009 STATE OF CONNEMCUT FILE# DEPARTMENT OF PUBLIC SAFETY OFFICE OF THE STATE BUILDING INSPECTOR P.O. BOX 2794 MIDDLETOWN,CT 06457-9294 TELEPHONE: (860)685-8310 FAX: (860)685-8365 REQUEST FOR MODIFICATION OF THE STATE BUILDIING CODE FOR OFFICE USE ONLY I. Name and Location of Building LL - a0Z EWX6A-Ff-A1 x1, L tom" 50 ©bo 7 y No. Street Town State Zip 2. Building Owner 3. Applicant's Name C W/05 !elephone Applicant's AddressEC> (Include Finn Name if Applicable) No. Street Town State Zip Name of Person to ContactA,#77- ��U�� Telephone7/7 (For information If rrquired) 4. A. Date of Application for Building Permit t t I �)I t B_ Applicable Code(Title and Date) 5. Use Group (� A_ Was there a change of occupancy' ❑ Yes 0 No B. If yes from to 6. Building Construction Classification CC 7. Square Foot Area of Building(Total) JT /L Maximum Square Foot Area per Floor 8. Number of Stories C'i )c= 9. Check Applicable Designation: New Building Q Existing ❑ Addition ❑ Other(Explain) 10 Fire protection at subject premises(Check appropriate headings) Smoke Detection [] Heat Detection Extinguishers Sprinklers ❑ Standpipes ❑ Other(identify) E ' d 9L09 ' ON S83HI080 A30C NO E : 6 tooZ 'tZ , AON 11/2V2004 WED 10:04 FAX 860 644 7280 South Windsor Town Hall 1A003/003 REQUEST FOR MODIFICATION OF THE STATE BUILDING CODE Page 2 11. Describe alarm system(s)at premisesSTD 3 SI�X� �r�CT 12. Building Code Section that modification is requested from AV E L 400 13. Modification Sought 14. Applicant's Signature Date Signed - 2, 15. Important Requirement Failure to provide the following information will delay modification process. The Building Official must comment below on the modification request as per Connecticut Gcneral Statute 29-254(b). *Note: Must be signed by Chief Building Official,Acting Building Official or Provisional Building Official. ❑ Support Request D Do Not Support Request The decision on this request is left to the Office of the State Building Inspector. Please contact the undersigned. Building Official's wnrten comments.if.desired. Building Official (Printed) Town *Building Official Signature Date Signed Building Official's Telephone Number Best Time to Contact MODAPP Rc�,8/11/K V ' d 9L09 'ON SEHIOH ADVd NOS :6 ti00Z ' tZ , AON