HomeMy WebLinkAbout1075 Pleasant Valley Road (5) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Lo5c In ation of Jo
ttn�
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE#
�0 W N S Fq OWNER
OWNER ADDRESS
OWNER PHONE
ESTIMATED COST$
� IS THIS A CONTRACT COST? Yes No
f� C4J FEE ENCLOSED$
TYPE OF JOB:
�SOR.C0� 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
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)
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 UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TT�
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
Facetwin Screen Print for wilhel , from "unix" 5/30/2003 8:39:03 AM
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PERMIT MAINTENANCE
2s, Classification d, Inspections
Permit 120031-1112301-IPI PLUMBING PERMIT Serial No 1 660031
Status 10 1 OPEN Record Type JAI
Permit Date 105/06/20031 C 0 Date 1 I History # 10 1
Street Code 120021 172901 11075 1
Site AddressJ1075 PLEASANT VALLEY ROAD J
Parcel No. 1 16 22 5 1 update by Iwil I
Owner IMAROUSKI AMELIA & I update/Time 105/06/20031/116161
Contractor 15181 UNITED PLB & HTG CO INC Master Permit 120021-1292901-IBI
Applicant JUNITED PLB & HTG CO INC I Struc Type 151 1 PLMB PERMIT
Address 129 BISSELL STREET I Construction INA I DOESN'T APP
I I use Group INAI DOESN'TAPPL
Cty,St zip JEAST HARTFORD J , JCTJ 106108 1 Est value 1 19001
Phone 1 289-95111 Permit Fee 1 40.001
work Description C/O Fee I 0.001
IWASTE VENTS WATER PIPING TO I Final Date J I
IFIXTURES FOR MODULAR HOME 1 Aff Cost 1 01
I I Aff Fee 1 0.001
Eng Fee 1 0.001
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