HomeMy WebLinkAbout151 Berle Road (14) 1-
DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PPE
RMIT#
/0676
Application is hereby-: TOWN�of SOUTH WINDSOR
BUILI?ING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE 7
644-2511 ext. 230
i
Date Bui1 ng Inspector
tpplication must be printed or typed
Location of job
S l D beak e, f;�C�
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt. No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER
or any fraction thereof
ADDRESS 8 eNzL C--,
OWNERS PHONE#
APPLICANT wl s!u P SAC)*
W S ADDRESS
a l.+•t Pt e o 4
Q
01D ESTIMATED COST$
IS THIS A CONTRACT COST?
YES NO
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r= ` C► FEE ENCLOSED $ Z3, op
OR CO TYPE OF JOB:
�
Original Installation
Alteration/Addition/Repair
Revised 10/96
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 �� , cI a ►+-�1'L rQ �.
ASSEMBLY
MERCANTILE EDUCATIONAL FUTURE USE AND OCCUPANCY S/a 1�'d �.►
INSTITUTION
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 S:3t:-.,-r NO. OF URINALS STYLE
NO. OF BATHTUBS NO. OF SHOWERS NO. OF LAVATORIES
NO. OF CONDUCTORS /_SIZE_8)=" NO. OF STACKS SIZE
AREA OF ROOF NO. OF CATCH BASINS NO. OF FLOOR DRAINS
NO. OF OTHER FIXTURES O KIND
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES/NO
SIZE OF WINDOW NU IF NONE C.F.M. OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK Sp w
1.
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER
TYPE MANUFACTURE
TANKS SAFETY DEVICES
TEMPERATURE
CAPACITY RELIEF VALVE
TEST PRESSURE WORKING PRESSURE PRESSURE RELIEF VALVE
TYPE MANUFACTURER
DESCRIPTION OF WORK
/ /? b
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
d 6) 011-oq_ 11
NAME STATE LICENSE NO. TYPE SIG TURE OF APPLICANT
PHONE NO. �d T"'/Ve- DATE ll` -7 `e-'4'