HomeMy WebLinkAbout100 Farmstead Drive (2) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT 1116
APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230 s �� ty
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
do
r✓H. �ek c tom� ,
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT i ho P114 w� L L
APPLICANT ADDRESS G ra In Q eW•
S - t�.�;v� s o Cam`
APPLICANT PHONE# YY
0 W N S F OWNER a4b 14�f w --
'4� OWNER ADDRESS 34
� 3 f
W OWNER PHONE
C ESTIMATED COST$ 3,.SV O.e 6
IS THIS A CONTRACT COST? Yes No
f� FEE ENCLOSED$ � ,
TYPE OF JOB:
OR-CO New Installation
, Q lteration/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
,oMRESIDENTIAL
❑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 �t cJ G Q�i 4 b a SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE I k k NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS i NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE _11r 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 7e IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
fir
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER /Z
WATER BEATER: TYPE I MANUFACTURER
DESCRIPTION OF WORK
w
THE UNDER IGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCIUBED AND TTT7'
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
zo It!3T I?l C�;i-----
CONTRACTORS LICENSE NO. TYPE STATE
e
SIGNATURE OF APPLICANT DATE f /J