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HomeMy WebLinkAbout1075 Pleasant Valley Road (7) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR �' 3 Q BUILDING DEPARTMENT APPR 1540 SULLIVAN AVENUE Bldg.Permit# 0361 644-2511 ext. 230 0-y0,2-1 O ate Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: FEE SCHEDULE 1 0-15 �l�cs4 h`�" V�`1 �o c,4 $0-$1,000=$13.00 Street No. Street Lot No. Over$1,000= $13.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT �� ° ' `�`� f: V OJ IrED 0 APPLICANT AD PRESS Gh-,A- kid APPLICANT PHONE# C1 86 C � Vt N 3� OWNER 12�rr t Mcr o V b�� q� OWNER ADDRESS 10 V va �� 034 OWNER PHONE (o 4L+• C4 6 6 2. C ] ESTIMATED COST$ G o C) �^ _ IS THIS A CONTRACT COST? 0 Yes eNo FEE ENCLOSED$ 40 TYPE OF JOB: �soR,co� Mr*New Installation 0 Alteration/Addition/Repair Revised 8/99 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 ENGINEER'S NAME PHONE ❑FACTORY ❑ STORAGE ADDRESS ❑ GARAGE ❑MIXED USE CITY STATE ZIP TYPE OF INSTALLATION �ejc,l h o-Q SIZE OF MAIN DRAIN NO.OF TOILETS _STYLE alp h NO.URINALS STYLE NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES NO.OF CONDUCTORS SIZE NO.OF STACKS 2 SIZE 2J 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 DYES ❑NO SIZE OF WINDOW 3 IF NONE C.F.M.OF VENTILATOR SIZE OF DUCTS SEWER OR SEPTIC TANK SIZE OF WATER MAIN I SIZE OF WATER PIPING&RISER [4 WATER HEATER: TYPE ©1A MANUFACTURER -AacL DESCRIPTION OF WORK A-In THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. ,�;6a 3�� ? t � Gain. CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLIPA 'TNv\CLLkA- DATE 1 0 - O3