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HomeMy WebLinkAbout163 NORTHVIEW DR~—~% Electric #APPLICATION FOR BUILDING PERMITPlumbing#- FINAL APPROVALS Enginegring ggialfgrtco .-$ TO THE BUILDING DEPARTMENT,TOWN OF'SOUTH WINDSOR,CT (Addltlonaczmy sTheundersigghereby A apigmx‘hmlies to do work/&-,v/z/u7<accordin%t(o z ‘s-fwzrthe f IIOW16V}g: K 3&1 no 3 $ Total Fee JApplicantwe15mm)U Location ofvvork /63 Mo‘W'a—J ‘)&LotNoApplicant‘s Address /O K ’U-S}HU'DL ST Tel #&‘“°”53¢'7 *3?Town M MQ M‘éSWk cf ’Zip °¢°oqL Lici#03"{’2 6 Owner Micbhfé-L_£66’K’V$¢v\)‘Architect Owner’s A'ddress /03 Nv‘mwé'w DK Architect‘s Addressg-p0 IwOSaL CK-Zip Ooo"?Y ZipSq.Ft.New Area:ist Fl.2nd Fl.3rd Fl.Total New AreaPurposeofthispermitmtp1’KcF ”nap e30 {7 #/‘%‘+%n I€¢IF ’77 fxlé’ruuf bE&A 7 a €ACM écw 2 "‘-U'4 City Water :1 Weii 3 Septic System 3 Sewer :J Garage Construction Type g6),(é/j/O gé/Revrsed 1108 a.uv nun mu w av;w 'a_5w€rdl Wlluacwr UI'PI'IHWPEI mplwef.- Ins:HO SP Cert.Area BasementApprovedbyDateUseGroup '{Sign ind stay kierei‘' .i‘f '-I 2 W pfapglicqnt 2.__I'mtend to aptgs-a genegalcontiactozorprincipal einployer.Applicant must .eitliei'' galwdeawmm ofworkgrs'pampensation insurance orsign the a$davit.ow..‘‘ -:_I h§tvbysww‘md.M¢ailwiurmduheymofofwom‘cumpensa&pn insma'ncexforev'exy'WjWwoma-mbmhdshedggawmwfkwiémmh_accordancewxththewm'Gompepsaion Act-(Chaptw‘568),p _‘.-{mama m_pur_summ§3i-'z75 ease-omen of:corporation “ammo:,.parm mgdoctmoeoxoludedmmwmwwiwimhomm o aw]:u etotofabusmessisnotmqouedtohavecovmgeunlesshe ’S'ofapplican Subscribedand swomtobefommethis '.day of ;200_.- (Notary Pubiicl Commissioner ofthe Superior Court) COMPLETE RED BQXED AREAS TYPE OR PRINT ONLY>SIGN ON REVERSE SIDE<