HomeMy WebLinkAbout1002-1014 SANDSTONE DR BLDG 10Electric # APPLICATION FOR BUILDING PERMIT
Plumbing# 1008 Sandstone FDate: ____L0/Zl/l0HVAC#
Sprinkler# 1000545 Estimated Cost $ 19q 5FINALAPPROVALS
Building COMPLETE RED BOXED AREAS Permit Fee
Occupancy Fee $Engineering TYPE OF PRINT ONLY Eng. Insp. Fee $Affidavit
SIGN ON REVERSE SIDE
1Appr.forCO. Total Fee 2"
TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant i LocationofWork LotNo.
Applicant's Address 3`15A C enu3iCod -Si-. UOOfCes4P—r, MA ot4o7 Tel # 40t-40-?U7—
Town WCCC 2r, MA zip O l(e07 Lic.# 565522
Yk r CDOwner \/Cxker ) i 3nL& Architect
Owner's Address 100% ScefldSfOrle Dr Architect's Address
zou+h Windsor,CT zip o
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. UAN1111, CLOSED
Purpose of this permit =1rlsfQl fit rp kw—ewe( W[r1fkl m PER:
cbanotea AND
J CGS
r i
City Water 0 Well Septic System 0 Sewer
Ins: HO SP Ce Area Basement Garage
Approved by Use Group Construction Type
loo(L( Revised 1108
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
I hereby apply for a Certificate of Oc cy for thew escribed in this application for the permit.
Signed
DO RITE alS LINE
INSPECTION COMMENTS
PERFM T C! OSEQPERKPP17-176
AND
CGS 29,393
INSPECTION FIELD SHEET 04/10/23
a
Printed by Middleton, Morgan 11 55 22
INSPECTION: 85039 FINAL PERMIT:
STATUS:
APPLICATION: 201600471
LOC: SANDSTONE DRIVE
SOUTH WINDSOR
PROPERTY ID: 80100000
OWNER: PLUM RIDGE ASSOC
CONTRACTOR:
REQUEST BY:
PROJ DESC: ROOF REPLACEMENT.
WORK ORDER:
INSPECTOR: WS-B RESULT: PASS
REQUESTED: PRIORITY:
SCHEDULED: COMPLETED: 04/06/23
UNPAID FEES: 00 Date Time
MILEAGE: 00 TIME: TRAVEL ONSITE
COMMENTS:
INSPECTED BY ADAM CHROSTOWSKI TO CLOSE OUT OLD PERMIT RECORD
4116 LL >P-' -ays w Oa\S
Electric # APPLICATION FOR BUILDING PERMIT
Plumbing#
HVAC# Sa CIS rLe_ --1)0Ye P7 00. Iwo Date: Ak
Sprinkler# v 0 2 32 Estimated Cost $
FINAL APPROVALS Permit Fee I oa1BuildingCOMPLETEREDBOXEDAREASOccupancyFee $Engineering TYPE OR PRINT ONLY Eng. Insp. Fee $Affidavit
Appr.for CO. SIGN ON REVERSE SIDE
Total Fee
TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $#0001 s(itr,
The undersigned hereby applies to do work according to the following:
Applicant bC '1 Location of Work L
n
Lot No.
Applicant's Address Tel # nil 0712 (
p
Town Zi Lic.# 0
Owner V Architect
Owner's Address Architect's Address
V,C v\ C7 Zip000-14 Zip
Sq. Ft.New Area: 1 st FI. 2nd Fl. 3rd FI.Total New Area
Purpose of this permit 20CE
City Water'J Well J Septic System Sewer
1 01lD66qjj
Ins: HO SP Cert. Area Base ent Garage
Approved by Date IX lp Use Groupl Construction Type
1 Revised 1108
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 61 d( rn
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
APPLICATION FOR HVAC PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT i l/o U 27
APPR V 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.Permit#
Date Building Inspecto
Application must be printed or typed
FEE SCHEDULE
F
Location of Job:
0-$1,000=$15.00 G vt /i'I e Td,
Over$1,000= Street Lot No.
15.00 per$1,000
or any fraction thereof ignation Apt.No.
APPLICANT j/.v n, tl
APPLICANT ADDRESS
1;7- 0 6 0- y
APPLICANT'S PHONE# 2'" 07
OWNER r f G-r /'V
q
W N SFq< OWNER ADDRESS /0/2
OWNER PHONE mac -
ESTIMATED COST$ f g 3 . o .2
n.j U IS THIS A CONTRACT COST? Yes L-- o
FEE ENCLOSED$
TYPE OF JOB: QSI
OR• ..co l/New Installation
Alteration/Addition/Repair
Revised 03/05/10
APPLICATION FOR IIVAC PERMIT(Continued from reverse side)
TYPE OF SYSTEM: TYPE OF BUILDING:
HEATING Z-TT_SIDENTIAL
oluC 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.)
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 OF INSIDE OF DIFFERENCE OF
TOTAL HEAT GAIN(BTUH) HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT(INC UDINAKE&MODEL NO.)rLG MAKE
tr-ca, C .
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 `G h f CG 'S' s s O
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.STATE
SIGNATURE OF APPLICANT
TYPE
DATE /
DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
I Q 2-2BUILDINGDEPARTMENTy
APPR v 1540 SULLIVAN AVENUE Bldg.Permit#644-2511 ext. 230
Date Buildin or
Application must be printed or typed
Location of Job:FEE SCHEDULE
ie—nant
0-$1,000=$15.00 o. Street Lot No.
Over$1,000$
15.00 per$1,000oranyfractionthereofDesignationApt.No.
APPLICANT nc1W 2 ___
APPLICANT ADDRESS 2 M,&lk S
r 3401 " CGS (DoLOLD
r
APPLICANT PHONE# O gC91S—J —(ZjC 1
OW N SF-4
OWNER I CGV-t,, -4/-O 1
OWNER ADDRESS S-r-t
CO)
cc) OWNER PHONE
C ESTIMATED COST$
W, V
IS THIS A CONTRACT COST? —Yes _No
FEE ENCLOSED$ S U
S O
TYPE OF JOB: _4 3(POR•C Nye Installation
Alteration/Addition/Repair
el y obc f3
Revised 4/01//2002
APPLICATION FOR PLUMBING 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 OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS 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 TOII,ET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES 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 LEI-e— MANUFACTURER w i IDDo
DESCRIPTION OF WORK
l Cc L
THE UNDERSIGNO rMREBYS FOR A PERMIT TO PERFORM THEE AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK
a>> s/L Q--I C-I
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
APPLICATION FOR HVAC PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
1 oho
Bldg. Permit644-2511 ext. 230
Date Building Inspeltor
Application must be printed or typed
FEE SCHEDULE ff
ocation of Job:
C) SCLO cj ---rtv$
0-$1,000=$15.00 I I L ('iWe
Over$1,000= I Street No. Street Lot No.
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT C,1 rJ W l4Qc-4 o.,jt Ct. [ I i71 l NC
APPLICANT ADDRESS I&q
APPLICANT'S PHONE# &&C - ?*A& - <&ft
OWNER C,AN` I Tyr e N
At OW N St q< OWNER ADDRESS 10 /O aaSp"<0 S"VP R
OWNER PHONE
Cy a ESTIMATED COST$ d 0 C) o "
V IS THIS A CONTRACT COST? s No
FEE ENCLOSED$
TYPE OF JOB: 3
S01 CO New Installation
Alteration/Addition/Repair
Revised 03/05/10
APPLICATION FOR HVAC PERMIT(Continued from reverse side)
TYPEYSTEM: TYPE OF VILDING:
EATING 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 OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) OF(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEAPNG EQUIPMENT(INCLUDING MAKE&MODEL NO.)
v FCaWr y 3
GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH) d2 N Y3(J
TYPE OF FUEL
oiL GPM OIL TANK LOCATION:,2<NSIDE 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 APPL(ICSATION)
FURTHER DESCRIPTION OF WORK 6QUA4
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.
Q
TYPE STATE
SIGNATURE OF APPLICANT CGS DATE ! Z
DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
D DBUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
J 1 K4--644-2511 ext. 230
Date Buildi g lnsp—W
Application must be printed or typed
FEE SCHEDULE Location of Job:
E S.0,^j S4.nc$
0-$1,000=$15.00 Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof gnation Apt.No.
APPLICANT M i Kt- 7'd`r'M
APPLICANT ADDRESS --All-Plumbing R per Imo.
P.O. Box 85;
APPLICANT PHONE#Tolland, CT 06084-..,"'1.
O W N S F,q
OWNER C.V r 1 - a r I c/1
OWNER ADDRESS j S[L
T1t c- r 1 V
S. Nxf A ej — Gt 0 6 a7
r OWNER PHONE 86 0 - 7$a! 3 S 1 D
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes —No
T > FEE ENCLOSED$
f
d TYPE OF JOB: 2SORCONewInstallation
Alteration/Addition/Repair
Za12o ( l 2`
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
Ia RESIDENTIAL
BUILDING PERMIT APPLICATION? ElYES NO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
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 WC&t--t A lz u—tVr SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE NO.URINALS STYLE
NO.OF BATHTUBS NO. OF SHOWERS 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 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
ej te.
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
c/+4 4L r P_ 44, VC, 9al(eA F 1 c,J'I G LAP Ct}Cr itCAJ (A
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DrSCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
2A l 19 5 I P -I c.+
CONTRACTORS LICENSE NO.
I
TYPE STATE
SIGNATURE OF APPLICANT DATE
e
APPLICATION FOR HVAC 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: q00 t 1
NU
APPROVED: BLDG.PERMIT (MBER:
DATE INSPECTOR
LOCATION OF WORK: Ic, scnas-b-
APPLICANT: OWNER:TYPE OF STRUCTURE:
r
o NEW BUILDING
NAME: I H 2 ;n I-[Pq r NAME: U 1 1 z 'f l l / ADDITION
PHONE NUMBER 9 t3- T Z 7' Y 7?S PHONE NUMBER: q 3 25
T
STING BUILDING
ADDRESS: (U J DX 35 V ADDRESS: /o 0 8 , 4 Lz e--
hid. O I&3? u, .SJ-I k LV 1,, d TYPE OF USE:
ENTIAL COMMERCIAL
HVAC INFORMATION: FURTHER DESCRIPTION OF WORK:
TYPE OF SYSTEM: j&zATING r tdc
HEATING:
TOTAL HEAT LOSS(BTUH) F (HEAT LOSS SHEET REQUIRED)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDE MAKE AND MODEL NO.):
O, 1 f-J HG( lilt (27j
ESTIMATED COST: v
AIR CONDITIONING:
DESIGN TEMP:OUTSIDE °F INSIDE °F DIFFERENCE F" FEE ENCLOSED:S I
TOTAL HEAT GAIN(BTUH) HEAT GAIN SHEET REQUIRED)
DESCRIBE ALL COOLING EQUPMENT(INCLUDE MAKE AND MODEL NO.):
s FEE SCHEDULE:$IS PER SI,000 OF THE ESTIMATED COST.
2•-'
7 ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS
S 1 ' OFTHE PERMIT FEE)
OVER. (.26 CENT EDUCATIONAL FEE INCLUDED AS PART
THE UNDERSIGNED NEARBY 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.: 3 1 I o TYPE: ;S- 1 STATE:CT
SIGNATURE OF APPLICANT: ilia DATE: 3'
DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR CC)CBUILDINGDEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Ins for
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$1,000
or any fraction thereof nation Apt.No.
APPLICANT
MANT
DRESS 136 X
APPLICANT PHONE# O7G C,
W N S OWNER -t/167,01 e-s k;Vq S A, .)
O q OW14ER DRESS
OWNER PHONE t!5
CO ESTIMATED COST$ J 9!1-1 G• C/O
IS THIS A CONTRACT COST? r Yes
FEE ENCLOSED$ O • p
1
5 O-•//
TYPE OF JO
R C New Installation
Alteration/Addition/Repair
Revised 4/01//2002
a 00
APPLICATION FOR HVAC PERMIT (Continued from reverse side)
TYPE OF SYSTEM: TYPE OF Bj!jLDING:
OlfEATING WKESIDENTIAL
A/C COMMERCIAL
3-VEENTILATION INDUSTRIAL
HEATING
STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDROMC QlfAARM AIR UNIT RADIANT HEATER
EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION
DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT LOSS(BTUH) F(HEAT LOSS SHEET MUST ACCOMPANY
APPLICATION)
DESCRIBE ALL HEATING EQUIP N INCLUDING MAKE&MODEL O.)
GROSS HEATING CAPACITY(INPUT—BTUH) NET RATING(OUTPUT—BTUH) /Q Ac 0
TYPE OF FUEL
91'OIL—GPM OIL TANK LOCATION : INSIDEO 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 Ls<i Y r s /f+!-C
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.
3c,3 ;7,9Z
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT Z— 0' 67
APPLICATION FOR HVAC 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 Y:
P BLDG.PERMIT NUMBER
DATE ECTOR
LOCATION OF WORK: /D T 5nojf/i'I-e-
APPLI ANT: OWNER:TYPE OF STRUCTURE:
r
NEW BUILDING
NAME:/i'K/cwf O• ! 5j -1 r NAME: , y
ll s//1 / O ADDITION
PHONE NUMBER PHONE NUMBER d(9 IOti b( Z W,6 S-TING BUILDING
ADDRESS: Z s', ADDRESS: /o/er-
117 TYPE OF USE:
C—/o
dRESIDENTL4L COMMERCIAL
HVAC INFORMATION:
p
FURTHER DESC/RIPTION OF WORK:
TYPE OF SYSTEM: o HEATING eZ/ S+^ "'a/ aG-1-e-5S X,
HEATING: tA O'C Co."
TOTAL HEAT LOSS(BTUH) T (HEAT LOSS SHEET REQUIRED)
DESCRIBE ALL HEATING EQUIPMENT(INCLUDE MAKE ANDMODEL NO.):
G G GGESTIMATEDCOST:f
AIR CONDITIONING:
DESIGN TEMP:OUTSIDE °F INSIDE 'F DIFFERENCE F° FEE ENCLOSED:S
TOTAL HEAT GAIN(BTUH) HEAT GAIN SHEET REQUIRED)
DESCRIBE ALL COOLING EQUPMENT(INCLUDE MAKE AND MODEL NO.):
L FEE SCHEDULE:$18 PER S1,000 OF THE ESTIMATED COST.
SIJ`.'sli; u yGdob,L /IA S 7- ,,,oZ 'd AV,4-!•I/ ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS
1115z -Gl 9X0- 4- Z GL! A)
S1.00 OVER (26 CENT EDUCATIONAL FEE INCLUDED AS PART
s— OF THE PERMIT FEE)
THE UNDERSIGNED HEARBY 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 PEERFOMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO.: 2jd 37 6 TYPE: STATE:
SIGNATURE OF APPLICANT: DATE: D