HomeMy WebLinkAbout18 Castlewood Drive (5) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: //0 El?
BUILDING DEPARTMENT
AP ROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street N Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE#
0 W N S OWNER
q� OWNER ADDRESS
OWNER PHONE
ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
r FEE ENCLOSED$ 7 y
TYPE OF JOB:
�SOR S C � New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUII,DING IS THIS APPLICATION ASSOCIATED WITH A�
BUILDING PERMIT APPLICATION? ❑YES f O
RESIDENTIALENTIAL
❑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 2 Z �--� SIZE OF MAIN DRAIN
NO.OF TOILETS _STYLE 1j NO.URINALS STYLE
NO.OF BATHTUBS \ NO.OF SHOWERS N 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 a YES ❑NO
SIZE OF WINDOW Z _2 IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS C:SE�WS R.SEPTIC TANK
SIZE OF WATER MAIN ` SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCR I ANDISTO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
a—.(-)a� .��) R P \ C77
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT s *c► DO ` 3:.& (n DATE ^Z--