HomeMy WebLinkAbout102 Bridlewood Road (3) DEPARTMENT DECISION PE
I APPLICATION FOR PLUMBING PERMIT a
#
7Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPRO 1540 SULLIVAN AVENUE ,Z(44 5-L
A6 q? 644-2511 ext.230
Date Building Inspector Application Application must be printed or typed
Location of job
4ricae wdoL I?-C.2 -2
Street No. Street Lot No.
F
FEE SCHEDULE Floor Apt.No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000
OWNER Ltno#,U4
or any fraction thereof ADDRESS ),S— w
r -
OWNERS PHONE#
APPLICANT
ADDRESS L e-Y-
74 V C 7 dc
rjj ESTIMATED COST$k /7,
IS THIS A CONTRACT COST?
YES NO
Air
FEE ENCLOSED
OR 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
t/RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
EDUCAT MERCANILE FUTURE USE AND OCCUPANCY �;�w�
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 NO. OF URINALS — STYLE —
NO. OF BATHTUBS�c _ NO. OF SHOWERS_Z NO. OF LAVATORIES
NO. OF CONDUCTORS SIZE NO. OF STACKS SIZE j `/'
AREA OF ROOF NO. OF CATCH BASINS NO. OF FLOOR DRAINS
NO. OF OTHER FIXTURES 2- KIND 4
ARE TOILET COMPARTMENTS VENTILATED TO OUTE R BY A WI OW */NO
SIZE OF WINDOW X IF NONE C.F.M. OF VENTILATOR
SIZE OF DUCTS SEWER R SEPTIC TANK
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER
TYPE Ot .r eX MANUFACTURE
TANKS SAFETY DEVICES
/ TEMPERATURE
CAPACITY jC) f-r RELIEF VALVE
TEST PRESSURE.)d WORKING PRESSURE16 0 PRESSURE RELIEF VALVE
TYPE MANUFACTURER
DESCRIPTION OF WORK
�e- Y d u 4 eql
L-ZIA a eo ►22kg. , ,
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.
NAME STATE LICENSE NO. TYPE txiGNATWF APPLICANT
PHONE NO. DATE o?l 0 L' g