HomeMy WebLinkAbout10 CARDINAL WAY LOT 2APPLICATION FOR HVAC PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT#
Applic ' n r BUILDING DEPARTMENT N00 351540SULLIVANAVENUE
644-2511 ext. 230 Bldg. Permit#
Date ding Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$15.00
Over$1,000=Street No. Street Lot No.
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT k k C
APPLICANT ADDRESS u\\\VM, Cw-4
APPLICANT'S PHONE#
OWNER U C.<-u
oW N SFq< OWNER ADDRESS 0
OWNER PHONE
O ESTIMATED COST$ 1 0 0 0
b
C
IS THIS A CONTRACT COST? " Yes No
nS+ FEE ENCLOSED$ 5°
TYPE OF JOB:
dSOR,CO New Installation
L.Alteration/Addition/Repair
Revised 03/05/10
APPLICATION FOR HVAC PERMIT(Continued from reverse side)
TYPE OF SYSTEM: TYPE OF UILDING:
HEATING RESIDENTIAL
A/C 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 F INSIDE F DIFFERENCE F
TOTAL HEAT LOSS(BTUH) F(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDING MAKE&MODEL NO.)
GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH)
TYPE OF FUEL
OIL-GPM OIL TANK LOCATION: INSIDE OUTSIDE CAPACITY
GAS-INPUT LPG TANK CAPACITY ELECTRIC-KW
AIR CONDITIONING
DESIGN TEMP: OUTSIDE F INSIDE F DIFFERENCE F
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 U-\-6 C2 c-cwa\\
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.
Us, 2--1S
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT Y,,Q I DATES( / \ r
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GJe ACORD CERTIFICATE OF LIABILITY INSURANC 10'0/0NtoaKuIs5CENoTEuISSUEDAMATTEROFTEBoardofBuildingReginaOriSandStandardsoNLrANOCONFERSNoRIGHTSGATTHECERTIFICATEDowding, woriartr 6 Dimock Inc HOLDER.TMCERTIFICATE DOES NOTAMEND,EXTEND OROneAshburtonPlace-Room 1301 139 Vnion Street ALTER THE COVERAGE AFFORDED BY THE POLES ULOW.U9 Boston.Massachusetts 02108 thoneslla OEocc
Pltone.lc0-87S-151] fa:T140-175-01121 INSURERS AFFORDING COVERAGE
Home Improvement Contractor Registration fD 69MR: 11,99=32 INS CO
Registration: 127530
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t ter farm aSURERcType: Private Corporation 2 Neat Road Inc.unSwRoExpiration: 11A2008 TA 124355 R ingt:on CT 01025
wawa e:KLOTER FARMS INC COVERAGES
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MAIMS WDE O eeotal WMEV WN—p - 15,000
PERSOWLaAOYRYIRV 81,000.000
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STATE OF CONNECTICUT +'DEPARTb1ENT OF CONSUMER PROTECTION I ALLOAIEDALIMS
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Be it known that x .e00 U
KEITH E KLOTER
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ELONEAE-POLMU r 16500,000
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RICHARD D MOCK
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1. UTILITY LOCATIONS AND INVERT ELEVATIONS TAKEN FROM AN rL I 1
I
3
INSPECTION REPORT PROVIDED BY THE CONTRACTOR. Q L
250 T 1 I h 257A8
1 _
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2. ALL ITEMS DEOICTED ON THIS PLAN HAVE BEEN VERIFIED IN r^ \a IS'S r UTHEFIELDASTOLOCATIONELEVATIONANDCOMPLETENESS. v/
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25,080 sq. ft.
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3 PARCEL ZONED RESIDENTIAL AA-30. N0I1 .57 cc. 1 B t67't6'36"
Oj 209.00 nb." '
F`
20• STREET TREE 256 20•252 254 EASEMENT IN FAVOR 1
J OF THE TOWN OF-
REFERENCE NOTE: SOUTH WINDSOR t
BOUNDARY AND TOPOGRAPHIC INrCRMATION ARE TAKEN FROM PLANS
ENTITLED "DEMING HILL ESTATES" SOUTH WINDSOR, CONNECTICUT. 10' C.L.& P. EASEMENT-
PREPARED FOR JMJ CONSTRUCTION. BY DESIGN PROFESSIONALS. INC.
DATED OCT. 10. 1996. REV. TO SEPT. 11, 1997, SHEETS 6-19
t
THIS SURVEY AND MAP HAS BEEN PREPARED IN ACCORDANCE WITH SECTIONS 20-300b-1 THRU 20-300b-20
OF THE REGULATIONS OF CONNECTICUT STATE AGENCIES - "STANDARDS FOR SURVEYS AND MAPS IN THE
STATE OF CONNECTICUT" AS ENDORSED BY THE CONNECTICUT ASSOCIATION OF LAND SURVEYORS. INC
THIS SURVEY CONFORMS TO HORIZONTAL ACCURACY CLASS A-2
TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS MAP IS SUBSTANTIALLY CORRECT AS NOTED HEREON dMJ CONSTRUCTION COMPANY
658 ELLINGTON ROAD
12882 SOUTH WfNDSOR, CT 06074
RICHARD P. MARTEL LIC. No TEL 282-0628
850) 291-8755
PREPARED FOR WROVEIAENT LOCATION MAP
SHEET
I utarss OTHEIIg19E NOTED.EUSTWO LITYUTY REVISIONS GRAPHIC SCALE Deming Hill Estates RECOM A&-R&V 1LOCATIONSASSHOWAREBASEDONWEST6esign1
sYiaxMn
j%j7IESn AlVnriEnvao ro
N THEnnELD .
40 0 20 40
OPEN SPACE SUBDIVISION - SECTIONS 1& 2
2 ALL yTE1n ARE TD BE"
T
M
NS UCTI 1ofessionals, Inc. OF
WY A Ll"SD LAND SURVEYOR P"OR TO
DRAW Bl.` 37PB .E>B Na:9pSPub
1LotNo. 2 - Cardinal Way
THIS PLAN iS MVALD UNLESS 67 WEAAS rHE 1 inch -- 40 feet civic engineers • planners • surveyors
AND ORIONAL BOUIUIRE
CONNECTICUT LIrED er. IW9V DAM YAY 12 1"0
of TIIE PROFESSIONAL D OINFER/SURKYOR. NO. DATE DESCRIP17ON BY 165 south satellite rood, south virWsor, Connecticut 06074 SOUTH MNOSOR
DECEE VE
OCT 17 2007 D
South Windsor
BUILDING DEPARTMENT
PIE B':•.9uS'v Vp'. 101
s certill'd that th,. olan anm spcC i6coti,—o r Irv-
es of the proposed building or a!teratiuns to be
rested at
5tree+
thee with nmendments stated in appttc ion and
itvd with plain and 1 agr^e to ed n:Giy w+ all zoning.
16nq and state la»s Arid s,cv orders es shall
t
be
d by ''e Suildind Uepariment during pendencys
this application and final issuance of a building
Hermit.
V 7 L
5tpncd
s titan Is approvcd s jeet to the eond!t on that
o-d rs And ordinances rcgutating building shall Do
c .r!la.: ,:nth.
Conditionally Approved These filed with
uinlding Inspector Clers
I,te fio.
CERTIFICATION
S
OF ZONING r%nMpLIANCEprOpOcTdasJw)r tfcc() r
cc_
its plan apr. J
current in
mG,
V"'iances and spec; ,i a :car ns
Date I
arm
Zoning Enforc ernent Officer
7
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1 UTILITY LOCATIONS AND INVERT ELEVATIONS TAKEN FROM AN X23e 93 n.e'
INSPECTION REPORT PROVIDED BY THE CONTRACTOR. ry 4 02 I I Q
2. ALL ITEMS DEOICTED ON THIS PLAN HAVE BEEN VERIFIED IN 250 I h 5706
THE FIELD AS TO LOCATION ELEVATION AND COMPLETENESS. 4 15'S Y. Q
25,U80 Sq. ft.Ex IITT DW0 V
3 PARCEL ZONED RESIDENTIAL M-30 I0.
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i , 57 cc.
N' 6 J'?6'36"
IN, 209.00 _ X2S644 ,
20' STR?F t TREE 258
REFERENCE NOTE.
252 t. 254 EASEMENT IN FAVOR 20
Of THE TOWN Of
SOUTH NANDSOR
BOUNDARY AND TOPOGRAPHIC INFORMATION ARE TAKEN FROM PLANS
t
ENTITLED 'DEMING 4111 ESTATES, SOUTH WINDSOR, CONNECTICUT,
PREPARED FOR A J CONSTRUCTION, BY DESIGN PROFESSIONALS, INC. 10' C.L.& ° FASFMENT-
DATED OCT. 10. 1996, REV. TO SEPT. 11, 1997. SHEETS 6- 19
THIS SURVEY AND MAP HAS BEEN PREPARED IN ACCORDANCE WITH SECTIONS 20-300b-1 THRU 20-300b-20
OF THE REGULATIONS OF CONNECTICUT STATE AGENCIES - 'STANDARDS FOR SURVEYS AND MAPS IN THE
STATE OF CONNECTICUT' AS ENDORSED BY THE CONNEC11CUT ASSOCIATION OF LAND SURVEYORS, INC
THIS SURVEY CONFORMS TO HORIZONTAL ACCURACY CLASS A-2
TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS MAP IS SUBSTANTIALLY CORRECT AS NOTED HEREON
W CON57RUC77ON COMPANY
658 £LL/NGTON ROAD
12882 SOUTH WINDSOR, CT 06074
RICHARD P. MARTEL IC, No TEL 282-0628
U0413S oTNE"w NOTED.EXST NG urki" REVISIONS 860) 291--9755
I'4FPAR p FOR SHE[ ,
DAk-*eL
AS sMAI) AN BASED
0 eT&J GRAPHICS SCAB .o esign DemAw Hill Estates lP c B® d4
LOCATION
A1LVAVOULDEE
FWLD AUb ALL
OR rcG r"SIR
5
D,A Te nE ,G :.o.sTTEucTTow 17All
CFKW
S
AN '
G BE
OR P
w THE FIELD otessionais Inc. OM VACS RMDMMON - SKMOM 1 2
e, A uawsiD LAND vnerTvaa r+aNONt To f OF
cols TAuc TIC"
T>M PI AN a RVMUD uuEI55.T SEARS 'F.E Lot Ado. 2 - Cardinal Wad A• ,a+,.:
rRSIGNN SEK ANO OI0aNA1"A 1URf d :,,p• cv.. tn9nK•e • PlOn new • 7Uw eyVry
aN mE RNOfE39oN,A1 ulaN¢R/3uRv[vDw. NO DATE DCSCRIP 77ON BY 165 south satellite rood, south windsor, connecticut 06074 SOUTH MNDSOR CONNECTICUT C ED or 09Y DA 1G IIAr 14 1f-
MAY 1996
South Windsor
BUILDING DEPARTMENT
TO THE B31lDING DEPT. TOWN Of SCUtH ,A.r.
This certified that this plan and specifieAions are rn
oopirs of the proposed building or alterations to b.
erected ttnnL`T// AKi7ikt LA)4_= Stree,
together with amendments stated in application am
filed with plan and I agree to comply with ell zoning,
Building and state laws and such orders as shall br
Issued by the Building Department during pendency
of this application and final Issuance of a building
permit.
igned i /
Yhis la- pproved act t he condition that
orders and ordfnanees regulating building shall b l
c—plied with.
Coae/tionally Approved These fHed w"
luiiding Inspector IC1110111111
tita e•"i
SV'
NOTES LEGEND
1. THE BUILDING LOT SHALL K LOAMED, SEEDED, AND MLK.CHED
1MATHSTRAWPRIORTOISSUANCEOFC.O (IF THE SEASON DOES O IRON PIN TO BE SET
NOT PERMIT SEEDING, TFIEN THE LOT MUST EVE STABILIZED WITH o MONUMENT TO BE SETSTRAWOREROSIONCONTROLNETTINGTOPREVENTMINTERAND
SPRING EROSION.). PROPERLY INSTALLED EROSION AND SEDIMENT 109 - EXISTING CONTOURCONTROLSMUSTBEINPLACETOCONTROLANYEROSIONAND
SEDIMENTATION PROBLEMS- THE BUILDER/OWNER IS RESPONsWE PROPOSED CONTOUR
FOR ALL STABILIZATION REOUIREMENT5
K 287.3 PROPOSED SPOT GRADE
2 ROOF LEADERS TO BE DISCHARGED ON SPLASH PADS- SILT FENCE
3. ALL ROADWAY UTIUTIES ARE TO BE INSTALLED IN COMPUANCE
MATH THE APPROVED 'PARTRIDGE MEADOW II' SUBDIVISION PLANS.
4. FM3ME 1 GRADING AROUND THE HOUSE SHALL ALLOW A 3 INCH
DROP IN GRADE AT A DISTANCE OF 6 FEET FROM THE FOUNDATION
AS SPECIFIED IN THE STATE OF CONNECTICUT BASIC BUILDING CODE
5. PARCEL ZONED RESIDENTIAL AA-30.
1
r I
I 1VI^20
I SET POSTS AND 2. STAPLE THE MAIK 7'16'36" W
kS TO
ANGLE. POSTS EXCAVATE A 6'ae' MESH FT0aNO TOVWE
OR STANJTY POST UPS.OPE FROM POS'M FENCCW -- THE ENO OF THE POST 209.00'
AND SEls
OLEAl11NG. IJ
es• BSI i 'YARD r
T2' MIN.
recce
T W t W
Ir
rF "
3. ATTACH FILTER FABRIC TO 4. SACKFILL THE W s1 I L.T g L
T r THE W K FEMQIC AND E X TEND TRENCH AND COMPACT 1 t CN JV. ,^
L-Aj
A,kRI:. IT AD THE TRENfl+ HF EXCAVATED SOIL. L N
f
i I Ip( .,i 25Z5
i.T I M
H p Z Jc a
BAl](F'ill
COMPACTED
N
r '
Z'
2
2.5,080 Sq. ff C3
O 0.57 ac. N 6T16' wCONSTRUCTIONOFSYNTHETICFILTERBARRIER1II
x 269 20• STREET TREE ; —r..kTf 1
REFEREMM NOTE. 1 OF THENT I%%
OF !tI_—.------ Q
BOUNDARY AND TOPOGRAPHIC INFORMATION ARE TAKEN FROM PLANS En.
SOU I'S
ENPTLED 'DEWING HILL ESTATES". SOUTH WINDSOR. CONNECTICUT. 5A/ j
PREPARED FOR JMj CONSTRUCTION. BY DESKGI PROFESSIONALS, INC. 10' C.L& P EASEMENT AA/Tt-T)<A(,KI1Uu Af'f-7A.1
DATED OCT. 10• INS, REV. TO SEPT 11, 1997. SHEETS 6-19.F*:-7!59 I FQRI!
IL
THIS SURVEY AND MAP HAS BEEN PREPARED IN ACCORDANCE YRTI-I SECTIONS 20-300b-1 THRU 20-300b-20 0 ' d1'J 4 i P
OF THE REGULATIONS OF CONNECTICUT STATE AGENCIES - 'STANDARDS FOR SURVEYS AND MAPS IN THE d aE
STATE Of CONNECTICUT- AS ENDORSED BY TITS CONNECTICUT ASSOCIATION OF I AND SURVEYORS, INC. i q- y
TWS SURVEY CONFORMS TO HORIZONTAL ACCURACY CLASS A-2. F
t
TO T14E BEST OF MY KNOWLFDGF AND BELIEF, THIS MAP IS SUBSTANTIALLY CORRECT AS NOTED HEREON. 1;
N/ CONSTRUC170N COMPANY N0 11 g Is
658 &LINGTON ROAD sTFR ' ,•'12BB2 SOUTH wmDSOIR, CT 06074 0,
RICHARD P. M TEL LIC. No.7EL. 282-062e SAL, `
I. muss or4lAwx woTm Doom untTY glMg0118 RAO) 291-8755 DEPENDENT RESURVEY PREPARED FOR SHEE'
LOCATIONS
af
A:
N"
ON 9INU 40
GRAPHIC SCALE .
a esign DemAw Hill ,&rotes LO"AVAAMt eF bTTOL All I]eiTeR.VRi/T7tE
2ALL A 1
eY A UCWW LAB}OW4 PAW TO ofessionais, Inc. or v t 2
ewsTnuc"t TM ir. t~'M,
Iw
v AA: „eery r
OF
s ""ftm Is.
l
uo vftm a AILMe Tit civil erTgMeen • p annen • surveyors
WLotNo. 2 — Cardinal ad
eKSseN iAA me pplIee AA elmAmms 1 inch = 40 feet
aF THE PeORIAeOtAI OiMEE71/S{RYCTOR MO. DAIS DESCII IM By 165 south satsUfte road, south •Tindsor, r_onnecticut 06074 SOUTH WINUSOR CON14ECTICUT Sr 46M a ,U ;?. 9 7
w
Ea
u
y.
ld
n C II
OC i 1 i 1991
South Windsor
BUILDING DEPARTMENTrpf
TO THE BUILDING DEPT. TOWN OF SOUTH WINDSt)kP -
This certified that this plan and specifications are trw•
copies of the proposed building or alterations to neerectedat
i1L_
1O 1 Streertogetherwithamendmentsstatedinapplicationan.filed with plan and 1 agree to comply with all sohin,n s +'"Building and state laws and such orders as sh,it hissuedbythe8uildingDepartment
of this a
P nl during pend..,
19g PP ation and final issuance of • bub4 ,
rS O permit.
OVSOR Signed
EQZ. This plan is approved subje t to the condition tn,
orders aau ordinaucrs regulating buildingcompliedwith.
stUtl w
Conditionally dpprbyed
np Tba" filled wW,
V
Nu1WIh4 inspecxw C,y,rA
Datal 41
i
ATION FOR BUILDING PERMIT
Electric # 11 Cdrdinal Way
Plumbing#731194
Date:
HVAC #
Sprinkler#
FINAL APPROVALS Estimated Cost $
Permit Fee
Building COMPLETE RED BOXED AREAS 1 !
Engineering TYPE OR PRINT ONLY Occupancy Fee $
Affidavit
g Eng. Insp. Fee $
A r. for co. I SIGN ON REVERSE SIDEPP
9 je J 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 -bPt ti N &u `j E fV Location of Work Lot No.
Applicant's Address (6 CID iN W `! Tel.# 4 3
Town S b yr ti W i N m fS c Zip 6 6 -7 Lic.#
Owner 'iZ Pr IJ CC- iti I rc y '{ C in Architect
Owner's Address to w R4 Architect's Address
S o -Q Tu kP 1 NbS C)1Z Zip 660 7 Zip
Sq. Ft. New Area: 1 st FI.2nd FI. 3rd FI. Total New Area
Purpose of this permit -:T--N-S TA LC t-t E 6 Cam' i z lG L A'd
City Water Well Septic System Sewer
Ins: HO Cert. Area Basement Garage
Approved by Date Use Group Construction Type
Revised 6102
1 Q
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.
Signed u-`-
1 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
r
L P1^ V' ,
INSPECTION FIELD SHEET 10/19/10
Printed by Kehoe, Alice 15 51 54
INSPECTION: 9337 FOOTING PERMIT:
STATUS:
APPLICATION: 200701699
LOCATION: 10 CARDINAL WAY
SOUTH WINDSOR
PROPERTY ID: 16600010
OWNER: NGUYEN DANG VAN & HUONG L
860-648-1783
CONTRACTOR:
REQUEST BY:
DESCRIPTION: INSTALL KLOTER SHED (10 FT X 12 FT)
WORK ORDER:
INSPECTOR: DOUG RESULT: N/A
REQUESTED: PRIORITY:
SCHEDULED: COMPLETED: 10/06/10
UNPAID FEES 00 Date Time
TIME TRAVEL ONSITE
COMMENTS
ALL INSPECTIONS
INSPECTED INSPECTOR RESULT INSP DESCRIPTION
10/06/10 DOUG N/A B002 FOUNDATION
10/06/10 DOUG N/A B003 FRAMING (ROUGH)
10/06/10 DOUG N/A B004 INSULATION
10/06/10 DOUG N/A B005 FIREPLACE / CHIMNEY
10/06/10 DOUG N/A B006 WOOD / GAS STOVE
03/26/09 FLAN FAIL BO10 FINAL
10/06/10 ROSE PASS BO10 FINAL
10/06/10 DOUG N/A E001 ELECTRIC SERVICE
10/06/10 DOUG N/A E002 ELECTRIC UNDERGROUND
10/06/10 DOUG N/A H003 HVAC ROUGH
10/06/10 DOUG N/A P002 PLUMBING UNDERGROUND
10/06/10 DOUG N/A P003 PLUMBING ROUGH
10/06/10 DOUG N/A P004 PLUMBING GAS TEST
10/10/08 ROBI PASS Z003 CO PLANNING INSPECTION
RECEIVED
JUN 15 2020
YVindsor Building Dept
Electric # APPLICATION FOR BUILDING PERMIT
Plumbing#
HVAC# Date:
Sprinkler# f Estimated Cost $
FINAL APPROVALS Permit Fee
Building COMPLETE RED BOXED AREAS Occupancy Fee $Engineering TYPE OR PRINT ONLY Eng. Insp. FeeAffidavit
Appr.forCO. 000. SIGN ON REVERSE SIDE
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 Location of Work Lot No.
Applicant's Address tLt tCCST-V C P Too # V/3 -23V-5V3:
Town W,5 Q Zip Lic.# ff5Q'_0 V,5
Owner Architect CA,
Owner's Address Q C_A0LC'c4 k(Y6, Architect's Address A3/a
Zip Zip
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit QeKnQQC U
1
City Water Well Septic System Sewer
Ins: HO SP Cert.Area Base ent Garage
Approved b Date " ' Use Grou Construction Type s
Revised 1108
oa 957
Q
yY I
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.
Signe
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
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4
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