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DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application'
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
s 644-2511 ext. 230
Date Build Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
o D cidli oo(l
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
Li-c(c5&t Dd o
APPLICANT PHONE#
OV N S OWNER E'i *t
Fq OWNER ADDRESS
14
OWNER PHONE
ow
C ESTIMATED COST$f -
IS THIS A CONTRACT COST? -XYes No
FEE ENCLOSED$ jQ.
f TYPE OF JOB:
OR C New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
J24ESIDENTIAL I BUILDING PERMIT APPLICATION?XYES NO
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 SIZE OF MAIN DRAIN
NO.OF TOILETS 3 STYLE b644QVINO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES
a
NO.OF CONDUCTORS SIZE NO.OF STACKS C;2 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 XYES>(NO
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS S:E!7:!;R SEPTIC TANK
fe
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE 6a fC&1 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 CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
Cob C/
CONTRACTORS LICENSE NO. TYPE STATE
c
SIGNATURE OF APPLIC DATE F ,05