HomeMy WebLinkAbout12 Kelly Road (7) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Applic Y:
TOWN OF SOUTH WINDSOR a
BUILDING DEPARTMENT
APPR 1540 SULLIVAN AVENUE Bldg.Permit#
�zq644-2511 ext. 230 � �y
Date B g Inspector
Application must be printed or typed
FEE SCHEDULE 1,pcation of Job:
.&kL
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT _%hll 57 IaJawiy
APPLICANT ADDRESS 6 Q/ �
ff40z4,9r,::o
APPLICANT PHONE# 000-6z3-6cco�
O
W N S OWNER y
'44C OWNER ADDRESS foot,
C1li2 �62
O - OWNER PHONE
C ESTIMATED COST$ 000
z IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ �-
111r TYPE OF JOB:
�VOR- � New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOC IA D 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)
N
TYPE OF INSTALLATIONA &/d � SIZE OF MAIN DRAIN
NO.OF TOILETS -3 STYLEC Tj NO.URINALS a 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 W S ❑NO
SIZE OF WINDOW Z IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER TYL
WATER HEATER: TYPE ��� °� MANUFACTURER ��-
�y
DESCRIPTION OF WORK
THE UNDERSIUNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS T=�
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICEN NO. TYPE ST TE
SIGNATURE OF APPLICAN DATE Z