HomeMy WebLinkAbout140 Commerce Way (5) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WIlVDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPRO� 1540 SULLIVAN AVENUE
Bldg.Permit#
5-� 63 `��, 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �dz1,R4C;&e. f
APPLICANT ADDRESS
APPLICANT PHONE#
�O W N S Fq OWNER
OWNER ADDRESS
i1r OWNER PHONE
C ESTIMATED COST$S,000
* IS THIS A CONTRACT COST? ✓Yes No
f� fi FEE ENCLOSED$
TYPE OF JOB:
dSOR-C0� New Installation
P""Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATEDN A
BUILDING PERMIT APPLICATION? S 0 NO
0J RESIDENTIAL
Is1 BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑ STITUTIONAL
Q FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
rr
TYPE OF INSTALLATION el SIZE OF MAIN DRAIN '¢
NO.OF TOILETS STYL 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 /<YE O
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
c�
SIZE OF DUCTS SEWER OR SEPTIC TANK
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER: TYPFG aflC, MANUFACTURERAQJ O
DESCRIPTION OF WORK
44�/`6 dYlvS
THE UNDERSIUN HEREBY APPLIES FOR A PERMIT TO PERFORA4 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 TYPE _ST TE
SIGNATURE OF APPLIC DATE