HomeMy WebLinkAbout184 Fairview Drive DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR �� � (�
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
a e Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE ls�
�7a��, ' � �� ` f Q.
$0-$1,000=$15.00
Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
Apt.No.
Tenant Designation
or any fraction thereof
APPLICANT f' 1 a < (C C.0
At LICANT ADDRESS , i
0x Vq(� o�:T�0b 1?:s
APPLICANT PH000 # 0
OWNER
SZ4 OWNER ADDRESS V1
OWNER PHONE N'W bL4 C1
C ESTIMATED COST$ I4-0.CK7
V IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ 30• ��
�� TYPE OF JOB:
SOR•Co 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
BUILDING PERMIT APPLICATION? ❑ YES ❑NO
❑RESIDENTIAL
❑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 STYLE 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 ❑YES ❑NO
SIZE OF WINDOW 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 MANUFACTURER
DESCRIPTION OF WORK
oz�-� 620
THE UNDERSIGNED HEREBY APPLIES FOR A 'ERMIT 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.
(74
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE