HomeMy WebLinkAbout17 Castlewood Drive DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WIlNDSOR
BUILDING DEPARTMENT
APPR--� 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511-ext. 230 - - - - -- �' S0-10
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS 1-I C.ccS -e,uj by-
APPLICANT PHONE#
O
W N S OWNER
4< OWNER ADDRESS
OWNER PHONE
ESTIMATED COST$
U IS THIS A CONTRACT COST? Yes L-�No
FEE ENCLOSED$ ` o
TYPE OF�Vow
R-Cp Installation
Alt�mtion/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATEDXITH A
BUILDING PERMIT APPLICATION? YES ❑NO
RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY S► m 4-oym,
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
i1
TYPE OF INSTALLATION SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE NO.URINALS STYLE
NO.OF BATHTUBS l NO.OF SHOWERS IS NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE J
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
i
WATER HEATER: TYPE
C- MANUFACTURER
DESCRIPTION OF WORK rr
� In. �L a,�1 C�-t � b'�v � Cc.11 `b—��l 5 v►�,� f �c
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCR1BED AND iTTT'
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 �=C_ DATE 2 0