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HomeMy WebLinkAbout1739 Ellington Road (35) r (A1 (er DEPARTMENT DECISION APPLICATION FOR PERMIT PERNHT# 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 Location of Job: FEE SCHEDULE $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000 $15.00 per$1,000 or any fraction thereof T Designation Apt.No. APPLICANT 4 APPLICANT ADDRESS f2 — C130 APPLICANT PHONE# o�� v2-��✓ �p �W N S�� OWNER At < OWNER ADDRESS OWNER PHONE ESTIMATED COST$ C - U IS THIS A CONTRACT COST? ✓Yes No as C FEE ENCLOSED$ 30- �1 TYPE OF JOB: SOR•CO ✓New Installation Alteration/Addition/Repair Revised 4/01//2002 Sr7m k (e APPLICATION FOR PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED A BUILDING PERMIT APPLICATION? © NO C3 jESEDENTIAL 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 DESCRY ON OF WORK ///,7j"-z, THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND 1977' w { 1 COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. ;r�- �300 2-2- Z-: CONTRACTORS LICENSE NO. STATE SIGNATURE OF APPLICANT DATE �-