HomeMy WebLinkAbout100 Arnold Way (61) DEPARTMENT DECISION PEFMT W
APPLICATION FOR PLUMBING PERMIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bld Pt#
1540 SULLIVAN AVENUE
APPROVE` 644-2511 ext. 230
Date Building Inspector Application must be printed or typed
7-1p=&—Z�kWARZE Location of job
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Street No. -k Lot No.
FEE SCHEDULE
Floor Apt.No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER 70-9//1/ WIIL11�a01a
or any fraction thereof
ADDRESS
OWNERS PHONE#
APPLICANT //vc-, 3()
OV N g FqADDRESS
L
CIP) # ESTIMATED COST$ -74 3ev,loc
IS THIS A CONTRACT COST?
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............
FEE ENCLOSED $
�OSOR.CO 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
RESIDENTIAL
BUSINESS CURRENT 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 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"lee- 40��: ?-4—*f6r
.F/ anr6-,
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
T / PERFORMANCE OF SUCH WORK
NAME STATE LICENSE NO. TYPE SIG/�► TRE
F AP T
PHONE NO. DATE /%