HomeMy WebLinkAbout176 Margaret Drive (4) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
/Cha Z 644-2511 ext. 230 (�
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
S �*-k1 - Q:7N
APPLICANT PHONE# �y `�._S
O W N S F OWNER c ,
q� OWNER ADDRESS �L)q
CIO
r OWNER PHONE
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C ESTIMATED COST$ 2--C�C��
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ f�)
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
BUILDING PERMIT APPLICATION? ❑YES,4 NO
RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
J MIXED USE
CITY STATE ZIP
iOther 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 2. IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SE OR SEPTIC TANK
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE C� (X S MANUFACTURER C�
DESCRIPTION OF WORK
�A \4c-�A a--eQ - (k - 4) 12 X-4
THE UNDERSIUNED HEREBY APPLIES FOR A PERM[IT TO PERFORNITHE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
2 U
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT Q � � DATE 2 G �--