HomeMy WebLinkAbout121 Maskel Road (5) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: �5-6BUDDING DEPARTMENT !
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
G 644-2511 ext. 230 a I/M
bate7 Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
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$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT a' r-
APPLICANT ADDRESS C Z
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APPLICANT PHONE# 2 Z- Z 9 2 9
OWNER n
OWNER ADDRESS / Z/
Or
OWNER PHONE
0
C ESTIMATED COST$ . 4�D 0 o"O
U IS THIS A CONTRACT COST? >C Yes No
FEE ENCLOSED$ 6a,
TYPE OF JOB:
OR-COS New Installation
_�S,Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
*RESIDENTIAL BUILDING PERMIT APPLICATION? ❑YES ❑NO
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 V�4SI�c
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW ❑YES ANO
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 3 4 ;Z
WATER HEATER: TYPE h L I-e S 5 MANUFACTURER
DESCRIPTION OF WORK
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THE U ERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND 197M'
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
2
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CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE SIF1 A