HomeMy WebLinkAbout10 Wedgewood LaneDEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: o2BUILDINGDEPARTMENT
CROVED 1540 SULLIVAN AVENUE Bldg.Permit#
V JAZI 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE 16 U)ejqe
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT L 61 me/
APPLICANT ADDRESS &l L l/ 5 e'al
APPLICANT PHONE# Y(,16 ' o
W N S OWNER Qlt4 4'40
O
Av- -
q OWNER ADDRESS lo
r OWNER PHONE b
C ESTIMATED COST$ z)-3 dQ
IS THIS A CONTRACT COST? 13 No
FEE ENCLOSED$5
TYPE OF JOB:
soR.Co New Installation
MiTlieration/Addition/Repair Revised 8/99
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED TH A
BUILDING PERMIT APPLICATION? WVES NO
U-16SIDENTIAL
BUSINESS paCURRENTUSEANDOCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
O MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION SIZE OF MAIN DRAIN
t
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 v e
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
16
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.
avoY-c
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE *-?" 0-4—e