HomeMy WebLinkAbout116 Bramlebrae (4)DEPARTMENT DECISION PERNUT#APPLICATION FOR PLUMBING PERMIT 16
Application is hereby:TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVE 1540 SULLIVAN AVENUE
4W(4- j 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
111g;Location ofjob
Street No. Street Lot No.
FEE SCHEDULE
0 - $1,000 - $12.00
Floor Apt.No.
Over $1,000
12.00 per$1,000 OWNER
or any fraction thereof
ADDRESS
OWNERS PHONE# 65
APPLICANT
ADDRESS
ESTIMATED COST$
IS THIS A CONTRACT COST?
AWAW YES NO
47
FEE ENCLOSED
OROCO TYPE OF JOB:
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 CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTI USE AND OCCUPANCY
EDUCATIONAL
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 3
AREA OF ROOF NO. OF CATCH BASINS NO. OF FLOOR DRAINS
NO. OF OTHER FIXTURES KIND k1- m
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES/NO
SIZE OF WINDOW --JC IF NONE C.F.M. OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TA ems
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISE —=f
WATER BEATER
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.
6 g;?e g
NAME STATE LICENSE NO. TYPE S ATURE OeAPPOICANT
PHONE N444Z LIr ATE