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Home My WebLink About109 Bridlewood Road (5) DEPARTMENT DECISION jaT# APPLICATION FOR PLUMBING PERMIT Application is hereby: TOWN of SOUTH WINDSOR BUILDING DEPARTMENT Bldg Permit# :APPROVED 1540 SULLIVAN AVENUE:P ql 3Q 644-2511 ext. 230 lv Date Building Inspector Application must be printed or typed Location of job SAJ—No.' Street Lot No. FEE SCHEDULE I I Floor Apt.No. $0 - $1,000 - $12.00 Over $1,000 1 1 $12.00 per$1,000 OWNER JAJ�Z-�- /�/� c�W��Wly or any fraction thereof ADDRESS F2 Sr ,5 If- ZifeA16 w1,4,1j),56A c� OF OWNERS PHONE# 3 6 ,57, APPLICANT /2JL/YA4 0 ADDRESS 6/zf_C e)Z633 ESTMATED COST$ IS THIS A CONTRACT COST? "'� ` ` YES NO AV FEE ENCLOSED OR 0 /4 P.E OF JOB: 0 ginal 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 V'-RESIDENTIAL BUSINESS CURRENT USE AND OCCUPANCY ASSEMBLY MERCANTILE FUTURE USE AND OCCUPANCY 2-Y �GtI EDUCATIONAL INSTITUTION FACTORY ENGINEER'S NAME PHONE STORAGE GARAGE ADDRESS MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION C IA I— SIZE OF MAIN DRAIN NO. OF TOILETS STYLE�� OF URINALS STYLE NO. OF BATHTUBS NO. OF SHOWERS_� NO. OF LEA_VATOE S -S 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 SIZEOF DUCTS SEWER OR SEPTIC TANK SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER 0/�1/ WATER BEATER TYPE D j L- F t,Q f,.Q MANUFACTURE `�© G f� TANKS SAFETY DEVICES TEMPERATURE CAPACITY RELIEF VALVE �O TEST PRESSURO#0D WORKING PRESSURE`,5'0 PRESSURE RELIEF VALVE TYPE MANUFACTURER DESCRIPTION OF WORK 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 IGN OF APPLICANT PHONE NO. 951 DATE