HomeMy WebLinkAbout15 Bancroft Lane (3) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WIlVDSOR PERMIT#
Application is hereby: I' 7
BUILDING DEPARTMENT
APPRO D 1540 SULLIVAN AVENUE Bldg.Permit#
Z AC-, 644-2511 ext. 230 a 90 6
Dat Building Inspector
Application must be printed or typed
FEE SCHEDULE �� Location of Job:
LAOQ-
$0-$1,000=$15.00 treet No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT R9—
APPLICANTADDRESS
roe T &0 v j 5�
APPLICANT PHONE# S.3——7�3 7
�OMI N S Fq OWNER
OWNER ADDRESS
0
OWNER PHONE
C' ESTIMATED COST$
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IS THIS A CONTRACT COST? Yes No
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FEE ENCLOSED$ t S,
TYPE OF JOB:
�SOR'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
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)
1 ll
TYPE OF INSTALLATION h f.vJ _�l�S[�tnc j u SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE n jM._ NO.URINALS STYLE
NO.OF BATHTUBS a 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 `►- a
WATER HEATER: TYPE .. MANUFACTURER ji��P_ �,j a�o►Q. GY 1 f e c�
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WOMZ DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
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CONTRACTORS LICENSE NO. STATE
SIGNATURE OF APPLICANT DATE