HomeMy WebLinkAbout17 Brookfield Street (12) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
Application is hereby: TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT U 3
APPROVED 1540 SULLIVAN AVENUE
' 644-2511 ext. 230 Bldg.Permit#
Date Buil ng Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
7 Pao r-,_e_IC�/ -f-
$0-$1,000=$13.00 Street No. Street
Over$1,000= Lot No.
$13.00 per$1,000
or any fraction thereof Tenant Designation
Apt.No.
APPLICANT I c.h Fi PJ G
APPLICANT ADDRESS 1 R Q n0 K l e
APPLICANT PHONE# �2
OWN S F,q OWNER
OWNER ADDRESS
" #• OWNER PHONE
ESTIMATED COST$ S�
V
� �
IS THIS A CONTRACT COST? 0 Yes o
FEE ENCLOSED$ * 13
�SOR-C0� TYPE OF JOB:
13 New Installation
D Alteration/Addition/Repair Revised 8/99
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
�� BUILDING PERMIT APPLICATION? ❑ YES ❑NO
Q RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY 1 A L
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY 7'
❑EDUCATIONAL
❑INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑STORAGE ADDRESS
❑GARAGE
❑MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION 76 SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE NO.URINALS STYLE
NO.OF BATHTUBS 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
WATER HEATER: 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 CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT �Z� DATE