HomeMy WebLinkAbout157 Natsisky Farm Road (2) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WIlVDSOR PERMIT#
Application is hereby: al F
BUILDING DEPARTMENT
PRO 1540 SULLIVAN AVENUE
Bldg.Permit#
L 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 [T!e—nant
o. Str t Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Designation Apt.No.
APPLICANT -0 9,/d I n
APPLICANT ADDRESS `l 0
r C+ 6r7
APPLICANT PHONE#
W N S OWNER 1�� � ran
SV-L,
t OWNER
OWNER ADDRESS4 ,
c OWNER PHONE S
C ESTIMATED COST$ �S r '
IS THIS A CONTRACT COST? Yes No
j� t✓ FEE ENCLOSED$ ,
TYPE OF JOB:
O R-C�� 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
*RESIDENTIALBUILDING 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
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
THE UNDERSIUNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRI]BED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
� 1
Gi _
CO R ACTOR9 LICENSE NO. TYPE j STATE
SIGNATURE OF APPLICANT Y'� DATE