HomeMy WebLinkAbout121 Maskel Road (5)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: 5-6BUDDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
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644-2511 ext. 230 a I/M
bate7 Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
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0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT a' r-
APPLICANT ADDRESS C Z
S c nclso,r C._T OC O y
APPLICANT PHONE# 2 Z- Z 9 2 9
OWNER n
OWNER ADDRESS Z/
Or
OWNER PHONE0
C ESTIMATED COST$ . 4 D 0 o"O
U
IS THIS A CONTRACT COST? >C Yes No
FEE ENCLOSED$ 6a,
TYPE OF JOB:
OR-COS New Installation
S,Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? YES 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 / STYLE NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE
AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS
NO.OF OTHER FIXTURES KIND V 4SI c
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES ANO
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER 3 4 ;Z
WATER HEATER: TYPE h L I-eS 5 MANUFACTURER
DESCRIPTION OF WORK
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Czt j 14 J' w FRS w
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THE U ERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND 197M'
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
2 L--0 7
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE SIF1 A