HomeMy WebLinkAbout100 Farmstead Drive (2)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT 1116
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 s ty
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
do r H. ek c tom ,
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT i ho P114 w L L
APPLICANT ADDRESS G ra In Q eW•
S - t.;v s o Cam`
APPLICANT PHONE# YY
0W N S F
OWNER a4b 14f w
4 OWNER ADDRESS 34
3 f
W OWNER PHONE
C ESTIMATED COST$ 3,.SV O.e 6
IS THIS A CONTRACT COST? Yes No
f FEE ENCLOSED$ ,
TYPE OF JOB:
OR-CO New Installation
Q lteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
oMRESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION t cJ G Q i 4 ba SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE I k k NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS i NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE _11r 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 7e IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
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SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER /Z
WATER BEATER: TYPE I MANUFACTURER
DESCRIPTION OF WORK
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THE UNDER IGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCIUBED AND TTT7'
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
zo It!3T I?l C;i-----
CONTRACTORS LICENSE NO. TYPE STATE
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SIGNATURE OF APPLICANT DATE f /J