HomeMy WebLinkAbout112 Bridlewood Road (3) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT IPERMIT
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Application is hereby-: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPRO D 1540 SULLIVAN AVENUE GCS
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
pt j r 7. Location of job
(2)�dsl 1.4-19
Street No. Street Lot o.
FEE SCHEDULE
Floor Apt. No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER (),pg,�
or any fraction thereof
ADDRESS_ 2
lam.
OWNERS PHONE# 6`6,3
APPLICANT 9o„ PJc.c
O W p S t4 ADDRESS
ESTIMATED COST$ //,'O O C
C a IS THIS A CONTRACT COST?
� S O
.v.:r C► FEE ENCLOSED $ �3� o✓
f
OR-CO � TYPE OF JOB:
t/Original Installation
Alteration/Addition/Repair
y� Revised 10/96
APPLICATION FOR PLUMBING PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL S
BUILDING PERMIT APPLICATION YE NO
BUSINESS GENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
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 3 STYLt NO. OF URINALS — STYLE
NO. OF BATHTUBS 2, NO. OF OWERS Z NO. OF LAVATORIES 6✓
NO. OF CONDUCTORS SIZE NO. OF STACKS f SIZE 3
AREA OF ROOF NO. OF CATCH BASINS NO. OF FLOOR DRAINS
NO. OF OTHER FIXTURES 2 KIND r # `--�-
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES/ O
SIZE OF WINDOW `—' IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS el (SEWS R SEPTIC TANK
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER 3/
WATER HEATER
TYPE Gi( �i y��Q MANUFACTURE I e-rk G /�/CC3
TANKS SAFETY DEVICES
/ TEMPERATURE
CAPACITY �"b ail RELIEF VALVE r/
TEST PRESSURE, WORKING PRESSURE 15b PRESSURE RELIEF VALVE J
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 C$IGNAT'OE OF APPLICANT
PHONE NO. 6-t% 0 )3 DATE