HomeMy WebLinkAbout14 Bancroft Lane (5) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: //�26,2
BUILDING DEPARTMENT
APP 1540 SULLIVAN AVENUE Bldg.Permit#
Sri L( Q 3 3/X— 644-2511 ext. 230 �6
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
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$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT e70,10A U.: CA
APPLICANT ADDRESS
APPLICANT PHO # LaR-7
O N S OWNER :=s7au GT!0 d_
q� OWNER ADDRESS
6 P• j..
OWNER PHONE
0
C ESTIMATED COST$ O C)�
IS THIS A CONTRACT COST? L-f Yes No
FEE ENCLOSED$
TYPE OF JOB:
�`S�R•C 0� mew Installation
Alteration/Addition/Repair
Revised 410IH2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑ YES ❑NO
&1_ SIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
1 �
TYPE OF INSTALLATION SIZE OF MAIN DRAIN
NO.OF TOILETS��STYLE_ NO.URINALS STYLE
NO.OF BATHTUBS 2 NO.OF SHOWERS I 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 NO
SIZE OF WINDOW 3A QL 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 i�IC)A�.� MANUFACTURER
DESCRIPTION OF WORK
I`1 ]�
TH 4,UNDERSIUNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS 10
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
—7 & _� T__ C =
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT rA A�L lV*__ DATE - aa)o 3