HomeMy WebLinkAbout100 Arnold Way (52) DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PE
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPRO 1540 SULLIVAN AVENUE
-7 7644-2511 ext. 230
4
Date Building Inspector
Application must be printed or typed
Location of job
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt. No.
$0 - $1,000 - $12.00
Over $1,000 O 7A, I 1,F,0u'� ,05 sckfooL
$12.00 per$1,000 OWNER. �rj' 0 cr 7/L 14111-VS-44 S C II 611•S'
or any fraction thereof
ADDRESS )J 3 1g ,7
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OWNERS PHONE# 02 q/
APPLICANT T^ 10J—v44,6 IvC CO 14-
ow N gF ADDRESS 9-9 CAIUAeA s 7
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ESTIMATED COST$
s
C = IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $
OR CO TYPE OF JOB:
�,Original n
teratio /Additio /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
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
l/ EDUCATIONAL
INSTITUTION
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE I 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 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 MANUFACTURE
TANKS SAFETY DEVICES
TEMPERATURE
CAPACITY RELIEF VALVE
TEST PRESSURE WORKING PRESSURE PRESSURE RELIEF VALVE
TYPE MANUFACTURER
DESCRIPTION OF WORK
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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.
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NAME STATE LICENSE NO. TYPEq c� OF APPLICANT
PHONE NO. g�-�6�/ t ATE 7 2 AT