HomeMy WebLinkAbout107 Lefoll Boulevards o
00
i TO THE BUMDING INSPECTOR
3 APPLICATION FOR
PLAN EXAMINATION AND
TOW14 OF C=M BUILDING PERMIT
z
IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX.O
Aw'Ilj ZONING
DISTRICTI• AT (LOCATION) 7 laezl
LOCATION NO.) ST EET)
OF BETWEEN AND
BUILDING
CRO s S EET) CROSS STREET)
LOT
SUBDIVISI LOT BLOCK SIZE v
N
II. TYPE AND COST OF BUILDING — All appli ants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use
1 U6 New building Residential Nonresidential
2 Addition(If residential, enter number 12 T one family 18 Amusement, recreational
of new housing units added, if any,13 Two or more family — Enter 19 Church, other religious
in Part D, 13)
number o/units— — — — -i 20 Industrial
3 Alteration (See 2 above) 14 Transient hotel,motel,21 Parking garage
4 Repair, replacement or dormitory — Enter number
5 Wrecking (If multifamily residential, of units ——————— — -i 22 E:] Service
institutional
station, repair garage
enter number of units in building in 15 Garage 23 Hospital,
Part D, 13) 16 Carport 24 Office, bank, professional
6 Moving (relocation)
p
25 Public utility17 Other — Specify
7 Foundati n only 26 School, library, other educational
B. OWNERSHIP
27 Stores, mercantile
8 M Private (individual, corporation,
28 Tanks, towers
nonprofit institution,etc.)
29 Other — Specify
9 Public(Federal, State, or
local government)
C. COST Omit cents) Nonresidential — Describe in detail proposed use of buildings,e.g.,food
processing plant, machine shop, laundry building at hospital,elementary
10. Cost of improvement,•.............school, secondary school, college, parochial school, parking garag for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical......................
1
b. Plumbing ......................
c.Heating, air conditioning.........
d. Other(elevator, etc.)............
11. TOTAL COST OF IMPROVEMENT $vo
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 Masonry(wall bearing) 40,r Public or private company
48• Number of stories................
49• Total square feet floor area,
31 X1 Wood frame 41 E] Private(septic tank, etc.)all floors, based on exterior
32 Structural steel dimensions .....................
33 Reinforced concrete H. TYPE OF WATER SUPPLY 77,
42 Public or private company
Total land area, sq. ft. ...........
34 Other — Specify p
43 Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
51. Enclosed ......................
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL
35 X Gas Will there be central air 52. Outdoors........................
96 Oil c nditioning? L. RESIDENTIAL BUILDINGS ONLY
37 EI ctricity 44 Yes 45 Z N 53. Number f bedr ms..............
38 C al
39 Oth r— Specify Will there be an el vat r?
54. Number f
Full..........
46 Y s 47[Z N bathrooms
Partial........
NOTES and Data — (For department use)
IV. IDENTIFICATION — To b compi t d by all applicants
Nam Meiling eddress — Number, street, city, and State ZIP c de T I. No.
a
Owner or
Lessee
I
2.
Contractor
3.
Architect or
Engineer
Th own r of this buil ing and the undersigned agree to conform to all applicable laws of this jurisdiction.
Si n ture of plicant Address Applicati date
C
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans R view Re uired Check Plan Review Date Plans B Date Plans B NotesqFeeStartedyApprovedy
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or A roval Check Date
Number B Permit or Approval Check Date Number ByppObtainedyppObtained
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building
Permit number 11199
Bui Iding
Permit issu d Oct. 18 19 79
Bui Iding
Permit Fe $ 378.00
Approv d by.
TLE
ZONING
FRONTDISTRICT
SIDE YARD SIDE YARD
REAR YARD
IX. SITE OR PLOT PLAN ForApplicant
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1
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date nc t_ 1 f3 19 79
Fee Paid $. 37 S..00 Est. Value ,$. .63,000.00
Permit N° 11199
on the side of
Lot #30 LeFoll Blvd. Su
Street No. 107
Owner .JM,1 Construction Co.
I
Applicant JMJ Cnn S ri j ct i nn (:n_
CERTIFICATE OF OCCUPANCY ISSUED:
I Date
5580
No.
Fee Paid $ 3.00
CLASSIFICATION
Dwelling
BUILDING PERMIT
O 11199
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn.01-r- 18 1979
94is is to (Certify, That TGeastruerzien ro
is hereby granted permission to Lu°+-L -fig,
at estimated value of $&3 t 00
on the side of 7 0j- dk zn IR01 I BlVd. Street on land
owned by IM I I t ian CO
Said IlMfk to be as described in Application
No.11499 and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
Issued 19? .
rA/
Buiding Inspector.
Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers
during the day and by both barriers and colored lights by night.
SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place
or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a
license therefor from the city or borough in which such highway may be situated, he shall pay said city,
town or borough all costs and damages which it shall sustain, or be compelled to reason therefor."
D/Az/ f L- s 8 6
N.44/—EP RT
Permit # Job
1 Footing
2 Foundation — 1
3 Framing lj-,m-2(7
4 Wiring 11JU-174Z)
5 Plumbing
6 Heating
7 Lathing
8 C.o.,.5`6-7O
Permit Na TOWN OF SOUTH WINDSOR
SOUTH WINDSOR, CONN.
C Permit N 55 8 0
i
Certificate of OccupancyP' r7
i n ,.•,
THJS'TO CER T atethe t:1_ - b
at No. f r • '
in the To of South Windsor, Connecticut, hasbeenerectedandcompletedinaccordancewiththeildirgCodeandZoningRegulationsoftheTownofSouthWindsor, and is hereby approved for occupanc
S
Building Inspector
647
wner, Builder
Fee Paid : Date 19 fl
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7009
ELECTRICAL APPLICATION
Application No. 8023
on the side of
Let __0 T eFnl l Blvd. Street
Street No. 107
Owner JMJ Bros. Inc.
Electrician Gilles LaRochelle
FILED IN OFFICE OF
The Building Inspector
Dec. 7 19 79
INSPECTION.
m No Electrical Work shall be started until a Per-
mit is granted by the Building Inspector.
In New Buildings no wiring shall be started
until the plumbing and heating pipes, and the Are
stops (if of wood) are installed, without a special
permit from the office of the Building Inspector.
f
APPLICATION FOR PERMIT TO DO ELECTRICAI. WORK.
No. .....8.....0.23
Permit No. . ..... . .O.Q.9...........
TO THE BUILDING INSPECTOR
of the
TOWN OF SOUTH WINDSOR, CONN.
hereby make application tq perform Electr cal Work according to detailed description below. All
provisions of the Rules for Electrical Installation, Section 48, Building By-Laws, shall be complied with
wheth r specified herein or not.
f
South Windsor, Conn., ,r..--' . 19,/ign here
11r 6
Address 7..
aLocation ..G4
Z..W. ..
Side of
Natureof Building How many stories .............. ......................... .................................. .................
I Building How many families .. Newor old g f1v........... . ..
Kindof Installation .. ...... .. How many Stores ........................................................................................ ......
Owner -.. ... . .. .. ........ ..... . Address
Architect .. ...... ......... .. .. Address . . ............. ....... . ..................................................
Builder Address
y '! ,................. ....... !,„ '............!.. _...
Electrician ... ...Address . . . .... ......... ....
2,
Size of Main Wires ... ..................... ............................
No. of Light Loops .. ...... ....No. of Heat Loops ...... . No. of Power Loops ........................._._..........
No. of Light Outlets ... .. ....... No. of Heat Outlets .... No. of Power Outlets ................................
Noo of Light Circuits ......No. of Heat Circuits ... No. of Power Circuits ... ....... . ....... .....
No. of Sockets No. of Heat Receptacles No. of Motors .............. ... ......... .............
No. of Panels .................................... ......... . . .. Size of Heat Circuit No. of Power Receptacles .. . ...........
No. of Switches .........
f ... ..
Total Wattage ....... ........ ..... . ..... . . .. .. Size of Power Circuit ... ... .... . ... .. .
Total Horsepower . . ... ....... ......
No. of Straight Electric Fixtur No. of Combination Fixtures ...
No. of Receptacles ....... .......: No. of Cord Drops
Remarks: For other kind of Installation ..... ...... ............... ............... ..... ........................ ................. .................... .......................................... ..................
Estimated Cost/.
9-&-e.•.. .L Z....
5532
PLUMBING APPLICATION
No. 6313
on the-------------- aide of
LQ.L—#. Q LeFoll Blvd- s-
Street No. 10
owner ....-JXJ Con str- Co,
Plumber -..S aLh Windsor P & H Co.
Filed in Office of
The Budding Lrpector
v
N v. 29 19-i-9
No pawn AA emsmui, add to cw alter any
portion of the drainage system of my bwld6g
except to repair leaks) until a Permits gcmftd
by the Budding Inq)eaw.
Application No. ......U.1.3................... Permit N . ......5.5.a2...............
TO THE BUILDING INSPECTOR
of the
TOWN OF SOUTH WINDSOR, CONN.
hereby make application to perform plumbing according to detailed description below. All
provisions of the Rules for Sanitation, By-Laws, Sections 33 to 47 inclusive, shall be complied with whether
specified herein or not.
I,
South Windsor. .........r ...,....... .... ...................... ...... ,
4-
19 ....... Sign here ....... .................... . 41.1.4 1) ......................
Address ..(. A'..... A.UZ. .
Location ...... ................. ........... side of ........ ......................................... ......................................... Street
Nature of Building ......... 1...... How many stories tf.........................t .......L " ... .................
Owner .................... .............................. . ............................................... ........ Address.......................................................................................................................
Architect .................................... .......................................................................... Address ....................................................................................................................
7....... ................ ........................................Budder . .......... Address ....................................................................................................
Plumber 0......... .......... . .... r...... .... .............. Address J..... ......I......... r.'... .i'..
DRAINAGE
CESSPOOLS, How many .. ......... ......... .................. ............... . Where located .. ... ...........................................................................................
Are they water tight Of what materials are they built ...................................................
Size of pipe from house to cesspool ................. ...... ............... Kind of pipe .... ..................................................................................
MAIN DRAIN IN CELLAR, Material Diameter .................................................................................................................
Aboveor below cellar bottom
SOILPIPES, Material Diameter ........................................................................................................
WASTEPIPES, Material A,- ................................................. Diameter .....012:1..................................................................................................
TRAPS,Type proposed to use is .. ............................. . . .... .............................................................................................................................................
RAINWATER LEADERS, where do they run to ...................... ...................................................................................................................
REFRIGERATORWASTES, where do they run to ........ ... .................................................................................................... ...............................
TANKOVERFLOWS, where do they run to
FIXTURES
WATER CLOSETS, How many .......S.................................... Where located .... .. .. ....................................................................................
Distance from trap to vertical soil pipe ......................................... Pattern
WASHTRAYS, How many ..... ..................................;............... Where located .. . .......................................................................................
SINKS, How many ...... .......I......V. ......... ......... ..... ......... ................... Where located ...... .........................................................................................
BUTLER'S SINKS, How many ........................................................ Where located.....................................................................................................
REFRIGERATOR SINKS, How many....................................... Where located .....................................................................................................
LAVATORIES, How many ........... ................................................. Where located .....................................................................................................
BATHTUBS, How many..............41........................................................ Where located .....................................................................................................
URINALS, How many ............................................................................. Where located ......... ..........................................................................................
A .
Are water closets and urinals to be local vented If not, is there a window in outer wall
of room where same are to be located ............
3--1 "- --
11 , rEstimatedCost.......
PERMIT #
Application For 6220 5119
DEPARTMENT DECISION
N Heating Permit
3 APPLICATION IS HEREBY:DEPARTMENT OF LICENSES AND INSPECTIONSOw
N IN APPROVED DISAPPROVE
0
TOWN OF SOUTH WINDSOR
1/9/80
00 O DATE IEF INSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER NE BEL W
O
0
107 ,t.E,Coll el-VD1. LOCATION OF JOB
O
Cd 9 NO. STREET
4) 8 Lot #30
LOT NO. FLOOR APT. NO.
O O3lV
C
p 2. OWNERCe00S. ADDRESS Ellington Road
be 3
4.PHONE
00 Cc y/ //l
S. APPLICANT n. A 'll r rl
w a. ADDRESS Cq,o lo
7.PHONEy
w 'C
G
S. LICENSE NO.
a
o .+', S. EXPIRATION DATE OF LICENSE
c c'w an
0 G 10. ESTIMATED COST S G, V
11. IS THIS A CONTRACT COST?YES Altosb0
12. FEE ENCLOSED :Permit 11199
13. TYPE OF BUILDING:
W bo RESIDENTIAL COMMERCIAL
3 14. TYPE OF JOB: INDUSTRIAL
ORIGINAL ALTERATI
IINSTALLATI N ADDIT ONON
REPAIR
APPLICATION FOR HEATING PERMIT (Continued from Reverse Side)
11. LOCATION OF JOB C y O G/J// l/G`
NO. STREET FLOOR APT.NO.
12. TYPE OF INSTALLATION: OIL BURNER Cl ELECTRIC VENTILATION SPRINKLER
pa GAS BURNER STACK INCINERATOR MISCELLANEOUS
IDENTIFY
SIZE LOCATION SIZE SIZE
13. OF TANK OF TANK OF FILL OF VENT
14. B.T.U. EQUIP. AT REGISTE FURNACE MAKE AND NO. AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND
1
NOL,inA Alftk B.T.U. OR SQ. FT. NET 3 izv B.T.U. OR SO. FT. GROSS 1V0P`PlRING RATE
FLOORS TO BE HEATED_ C. NEW OR OLD BUILDING /VegA, INSULATED — YES OR NO Ye j
TYPE OF WALL wd+/1 /'i*.c INSULATION'1 ROOF OR CEILING 6 i INSULATION
AVG. SYSTEM WATER TEMP. /RO c B.T.U./SQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE 0:262 t D FAHRENHEIT
MAKE OF RADIATION: BASEBOARD. COPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ.
FT. OR B.T.U.
DESCRIPTION OF WORK
15. TO BE DONE:
16. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS):
wooM slzE AND DOORS AREA - SQUARE FEET
VOLUME
B.T.U. e.T.u. i o DISTRIBUTION INSTALLED
TOTAL TOTAL q
ROOM NO.GROSS GLASS HET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED J j U.
LL
REGISTER
L W H AND
orWALLtINFILT.) TEMP. {TO • F f . TYPE AND SIZE wAD' OR LEADER
SIZE IF DIFF. v U F I-m N SO. FT. FREE AREA
O 8 IF,,
00 00 a
Li
ri o 0 v
1
o Ak o c 9 Ya V
S r so w yov d
8 n d 3na l3
700 0 d oov toon
A lb o V-0 3
bo 8`yo l b
3w f kg 30e 10,2 D
o 6°c'
o 0
TOTALS 0000
s'o
A. HEAT LOSS FROM BUILDING B.TU.%HR.
B. DOMESTIC HOT WATER DEMAND U Oro ke &Z, */ T lI HR.
C. PIPING, OTHER THAN NORMAL B.T.U./HR.
ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR
17. ELECTRICAL WORK BY:
NAME ADDRESS
SUBCONTRACTORS AND
1e. THEIR TRADES
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILL
BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE.
APPLICATION TO BE COMPLETELY FILLED IN.
DATE SIGNATIJR APPLICANT
Building
SPECTIONS:
APPLICATION FOR BUILDING PERMIT
Plumbing a
HVAC Date:
Sprinkler 107 LE FOLL BLVD.
2
EI ctri c Estimated Cost $ J 6v
Zonrrfg Permit Fee$3a
Affidavit NO. 17 5 7 8 Occupancy Fee $ q
Eng. Dept.
COMPLETE RED BOXED AREAS.Fire Dept.TYPE OR PRINT ONLY
Total Fee $ 33
Health Dept.
Approved for CO: D t1 SIGN ON REVERSE SIDE.Additional Cost) $
TO BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT
The undersigned, hereby applies to do work according to the following specifications:
Job Location o Lot No. Side of Street Zone tfaD
Applicant or Tel. #
Address if Icalt Ail! Zip ZtLic.#
sllufj CITY STAT
Owner cSp" r Address
Architect Address l
Size New Area: Ft. Front Overall Ft. Deep Overall Total Area Garages
Lavatories
No. of Families No. of Stories Construction Bathrooms Rooms 1st 2nd 3rd
Size of Lot Dist. from Street Line Dist. from Side Street Line,
Purpose of this Permit fi / JLIC ibax6vft 74 414ac a46ar &V d!nz
City W ter Well Septic Sewer
Approved by Date*-S'g BD1A 11/88
I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor
and to notify the Building Inspector of any alt ration in th plans or sp cifications of th Building for which this p rmit is ask d,and agree
that this building is to be located the proper distance from all street lines,side yard lines and required distances from all other zones and is
located in a zone in which this building and its use is allowed.
c
Signed 4 Z ZI
I hereby apply for a Certificate of Occupancy for the work described in this application for permit.
Signed
DO NOT WRITE BELOW THIS LINE—
INSPECTION RECORD 41 24FootingFraming
Foundation Fireplace/Chimney Insulation
Plumbing Permit# d e Inspections:
HVAC Permit# Inspections:
Electrical Permit# Inspections:
7 Ze e,-
Sprinkler Permit# Inspections:
s3fe lll.—,,.-r^iw.efl5 4'F',r.fa4'il.e'n'a.S .„, Ik.,.,'R/ 1!".nnt+Ra4..v 6'`• .';MRI:`.'u",v r;5-n''"'^ e,nar^. -r.s. ..... ,..... ..._ .,,y
BUILDING INSPECTION DEPARTMENT
SOUTH WINDSOR, CONNECTICUT
FEE PAID: $3.00
CERTIFICATE OF OCCUPANCY
ZONE:DATED 9/7 19 90
This is to certify that 107 Le Poll AI VA
Al tared under permit No. 1 757A conforms substantially to the requirements of the building ordinances and the
zoning regulations of the Town of South Windsor and is hereby approved for occupancy as indicated below.
Approved for Occupancy— *Residential alteration -- f inished basement
Use Group: R4
C nstr. Type: 5B
Building Official
Notice:ff this certificate is lost or destroyed, a duplicate should be obtained immediately from the Building Department.
Any change or extension of the use herein appn wed requires a new certificate of occupancy.
PERMITI #
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby :
TOWN OF SOUTH WINDSOR
APPROVED D
APPs
BUILDING INSPECTION DEPT.
644-2511 Ext . 230
8 Application must be printed or typed .
Date Building Insp r
1 . LOCATION OF JOB
C z r--eW 131d
FEE SCHEDULE No . Street
0 - $19000 - 10. 00 Floor Apt . No.
Over $1 ,000 - 10 .00 r !
per $1 , 000 or 2 . OWNER IVILf6 Ci
fraction thereof
3. ADDRESS
so U T"
4 . APPLICANT
5 . ADDRESS
6 . ESTIMATED COST $ 570 0. DD
7 . IS THIS A CONTRACT COST
Yes No
8 . FEE ENCLOSED $Ztz
9 . TYPE OF BUILDING:
RESIDENTIAL COMMERCIAL
10. TYPE OF JOB :
Original Installation
lel Alteration/Addition/Repair
BD 3A 11/88
APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side)
11. LOCATION OF JOB
NO. STREET APT. NO,
12 . TYPE OF INSTALLATION
13. SIZE OF MAIN FEEDER
14. NO. OF LIGHT LOOPS 15 . NO. OF HEAT LOOPS
16. NO. OF POWER LOOPS 17 . NO . OF LIGHT OUTLETS
18 . NO. OF HEAT CIRCUITS 19 . NO . OF POWER OUTLETS
20. NO. OF CONVENIENCE OUTLETS 21 . NO . OF HEAT CIRCUITS
22 . NO,, OF POWER CIRCUITS 23 . NO. OF LIGHT CIRCUITS
24. SIZE OF HEAT CIRCUITS 25 . NO. OF MOTORS
26 . NO. OF PANELS 27 . TOTAL WATTAGE
28 . NO. OF POWER FEEDERS 29 . NO. OF SWITCHES
30. A/C LOAD 31 . SIZE OF POWER FEEDERS
32 . NO. OF FIXTURES 33 . TOTAL HORSEPOWER
34 . NAME OF SUBCONTRACTORS AND THEIR TRADES
35 . REMARKS AND FURTHER DETAILS :
LICENSE NO. SIGNATURE OF APPLICANT DATE
PHONE NUMBER:
Cxr' 4vD INr V#io 04
BUILT`
tRo35 v l1yp
O"K e7 44yi
Z'7
I
r f
B N C H
op77
L e.ct't 'r c49f
pR u
South Windsor
BUILDING DEPARTMENT
l,57,k'
PERMIT NO.
AR
DEPARTMENT DECISION
APPLI CAT I O N FOR
APPLICATION IS HEREBY:
PLUMBING PERMIT
APPROVED DISAPPROVED TOWM OF SOUTH WINDSOR
BUILDING INSPECTION DEPT.
644-2511 Ext. 230
DATE PLUMBING INSPECTOR Application must be printed or typed.
1. LOCATION OF JOB:
o e, blv
2. OWNER:Q Qf J`yjCCt,
3. ADDRESS: A Fo f t 61 d
FEE SCHEDULE 1lGt W 1 C! S 6!-
0 - $19000 - $10.00 4. APPLICANT:
Over $1,000 - $10.00 5. ADDRESS: ez.,
per $1,000 or
Fraction Thereof
6. EST. COST: $ Q d i lft)
7. IS THIS A CONTRACT COST? YES LNO
8. FEE ENCLOSED: $ 00 a/ti344
9. TYPE OF BUILDING: 176'78
RESIDENTIAL COMMERCIAL
10. TYPE OF JOB:
ORIGINAL ALTERATION
INSTALLATION ADDITION
REPAIR
BD 2A 11/88
APPLICATION FOR PLUMBING PERMIT (Cont. from Reverse Side)
11. LOCATION OF JOB: Q 7 L.E / D/I 13 L rD
GENERAL PLUMBING
12. KIND OF INSTALLATION: 13. SIZE OF MAIN DRAIN
14. NO. OF TOILETS STYLE 15. NO. OF URINALS STYLE
16. NO. OF BATHTUBS 16A. NO. OF SHOWERS 17. NO. OF LAVATORIES
18. NO. OF SINKS 19. DISPOSAL 19A. DISWASHER
20. NO. OF CONDUCTORS SIZE 21. NO. OF STACKS SIZE
22. AREA OF ROOF 23. NO. OF CATCH BASINS 24. NO. OF FLOOR DRAINS
25. NO. OF OTHER FIXTURES KIND
26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW?
27. SIZE OF WINDOW
28. IF NO WINDOW, WHAT KIND OF VENTILATION IS THERE?
29. SIZE OF DUCTS 30. SEWER OR SEPTIC TANK?
31. SIZE OF WATER MAIN 31A. SIZES OF WATER PIPING & RISERS
32. REMARKS AND FURTHER DETAILS
WATER HEATER
33. TYPE 34. MANUFACTURER
TANKS SAFETY DEVICES
TEMPERATURE
35. CAPACITY 39. RELIEF VALVE
36. TEST PRESSURE LBS. 40. MANUFACTURER
37. WORKING PRESSURE LBS. 41. PRESSURE RELIEF VALVE
38. TYPE 42. MANUFACTURER
01
S/?)4-- a
LICENSE NO. DATE SIGNATURE OF APPLICANT
PHONE No. S/