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HomeMy WebLinkAbout1075 Pleasant Valley Road (7)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby:TOWN OF SOUTH WINDSOR 3 QBUILDINGDEPARTMENT APPR 1540 SULLIVAN AVENUE Bldg.Permit# 0361 644-2511 ext. 230 0-y0,2-1 O ate Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: FEE SCHEDULE 1 0-15 l cs4 h`" V`1 o c,4 0-$1,000=$13.00 Street No. Street Lot No. Over$1,000= 13.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT f: V OJ IrED 0 APPLICANT AD PRESS Gh-,A- kid APPLICANT PHONE# C1 86 C Vt N 3 OWNER 12 rr t Mcr o Vb q OWNER ADDRESS 10 V va 034 OWNER PHONE (o 4L+• C46 6 2. C ESTIMATED COST$ G o C) ^ IS THIS A CONTRACT COST? 0 Yes eNo FEE ENCLOSED$ 40 TYPE OF JOB: soR,co Mr*New Installation 0 Alteration/Addition/Repair Revised 8/99 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 INSTITUTIONAL ENGINEER'S NAME PHONE FACTORY STORAGE ADDRESS GARAGE MIXED USE CITY STATE ZIP TYPE OF INSTALLATION ejc,l h o-Q SIZE OF MAIN DRAIN NO.OF TOILETS STYLE alp h NO.URINALS STYLE NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES NO.OF CONDUCTORS SIZE NO.OF STACKS 2 SIZE 2J 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 DYES NO SIZE OF WINDOW 3 IF NONE C.F.M.OF VENTILATOR SIZE OF DUCTS SEWER OR SEPTIC TANK SIZE OF WATER MAIN I SIZE OF WATER PIPING&RISER [4 WATER HEATER: TYPE ©1A MANUFACTURER -AacL DESCRIPTION OF WORK A-In 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. 6a 3 t Gain. CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLIPA TNv\CLLkA-DATE 1 0 - O3