HomeMy WebLinkAbout135 Abbe Road (7) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PE a
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
PROVE 1540 SULLIVAN AVENUE
AA644-2511 ext. 230
Date - Building Inspector "
Application must be printed or typed
/ Location of job
Street No. Street Lot No.
FEE SCHEDULE
$0 - $1,000 - $12.00 Floor Apt.No.
Over $1,000
$12.00 per$1,000 OWNER
or any fraction thereof
ADDRESS `j
OWNERS PHONE# ����-- C)
APPLICANT Q C1
0W N $�. ADDRESS
. :` ESTIMATED COST$
IS THIS A CONTRACT COST?
YES NO
��► FEE ENCLOSED $�
OR-CO� ✓TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
Revised 10/96
APPLICATION FOR PLUMBING PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION YES /
✓RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTION
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION 2- ) 2 ,;�� SIZE OF MAIN DRAIN
NO. OF TOILETS ---") STYLE___�_\no NO. OF URINALS STYLE
NO. OF BATHTUBS_� NO. OF SHOWERS � NO. OF LAVATORIES
NO. OF CONDUCTORS�_SIZE \ _ NO. OF STACKS ( SIZE -3�5
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 WINDO S/NO
SIZE OF WINDOW 2-x2— IF NONE C.F.M. OF VENTILATOR
SIZE OF DUCTS Q"
OR SEPTIC TANK
SIZE OF WATER MAIN `1 SIZE OF WATER PIPING&RISER 5/kA,
WATER HEATER
TYPE n d c MANUFACTURE
TANKS SAFETY DEVICES
TEMPERATURE
CAPACITY RELIEF VALVE
TEST PRESSURE 2 0 WORKING PRESSURE V PRESSURE RELIEF VALVE S
TYPE MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. `o�� 2'S DATE -a -