HomeMy WebLinkAbout10 Carman Road (2)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT 112,02
PERMIT#
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPRO 1540 SULLIVAN AVENUE N
644-2511 ext.230
Date Building Inspector
Application must be orprinted typedP
Location ofjob
F jNo. Street
AptNo.
FEE SCHEDULE
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER 4'1I tIC- 2 6W 60oranyfractionthereof
ADDRESS 10
OWNERS PHONE# ` 1 lr7
APPLICANT -Z vl l S Gel C
0* N S 4.4
ADDRESS
cf tog
J'
EST34ATM COST$
0
C IS THIS A CONTRACT COST?
YES NO
Y.
FEE ENCLOSED $
DSO . .O TYPE OF JOB:R C
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
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
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
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 GNATURE PLICANT
PHONE NO. DATE Chi