HomeMy WebLinkAbout120 Bridlewood Road (6) c �
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DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application'
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
�s� 644-2511 ext. 230
Date Build Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
o�D 'cidli oo( • - l
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT ��-
APPLICANT ADDRESS
Li-c(c5&t Dd o
APPLICANT PHONE# --
OV N S OWNER E'i *t
Fq� OWNER ADDRESS
14
OWNER PHONE
ow
C ESTIMATED COST$ f� -
IS THIS A CONTRACT COST? -XYes No
FEE ENCLOSED$ �jQ.
�f
TYPE OF JOB:
OR C New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
J24ESIDENTIAL I
BUILDING PERMIT APPLICATION?XYES ❑NO
❑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)
TYPE OF INSTALLATION SIZE OF MAIN DRAIN
NO.OF TOILETS 3 STYLE b644QVINO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES
a
NO.OF CONDUCTORS SIZE NO.OF STACKS C;2 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 XYES>(NO
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS (::S:E!7:!;R SEPTIC TANK fe
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE 6a fC&1 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 CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK. _
�,Cob � C/
CONTRACTORS LICENSE NO. TYPE STATE
c SIGNATURE OF APPLIC , DATE F ,05