HomeMy WebLinkAbout135 Spinners Run (4) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT#
Application is hereby: TOWN OF SOUTH WIl�TDSOR �����
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
� � 644-2511 ext. 230
lCo UAc
ate Building Inspector
Application`must be printed or typed
Location of Job:
F� FEE SCHEDULE ! t.._
$0-$1,000=$15.00 Street N,6.
Street Lot No.
Over$1,000= ''
$15.00 per$1,000 �-
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 21 P149 C-L Li
APPLICANT ADDRESS
APPLICANT PHONE#
W N S OWNER
Fq 3 j s
< OWNER ADDRESS
�. C�
0 OWNER PHONE
ESTIMATED COST$
IS THIS A CONTRACT COST? Yes _X No
FEE ENCLOSED$ �,
TYPE OF JOB:
�`S�R•C�� New Installation
�teration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
XRESIDENTIAL 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
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION „l a y a 7�i'0$A SIZE OF MAIN DRAIN .�
NO.OF TOILETS_ STYLE -Te,,L NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS I NO.OF LAVATORIES Z
NO.OF CONDUCTORS SIZE 3 NO.OF STACKS SIZE 3
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 ;pUnS ❑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 1 y f L
WATER HEATER: TYPEf:2�r'-,-
MANUFACTURER
DESCRIPTION OF WORK
r`p d
iL14 od"4
w -Gv'�. 64cr
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFURR TH WORK DESCRIBED AND ITT7'
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 01
DATE �D
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