HomeMy WebLinkAbout124 Brookfield Street (8)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMIT#App a n by:
I oBUILDINGDEPARTMENT
PROVED 1540 SULLIVAN AVENUE
Bldg.Permit#644-2511 ext. 230
Date B it ng or
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$15.00 Street N . Street Lot No.Over$1,000=
15.00 per$1,000 dO,CF C 1 r>n /-/OV Ste'or any fraction thereof Tenant Designation Apt.No.
APPLICANT A-
APPLICANT ADDRESS _ 2 04 ,2 /p
APPLICANT PHONE# 14!5
0 W N S Fq
OWNER I& Z,4/o Zj d O coat 1=
OWNER ADDRESS 1peg'I z n
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0 OWNER PHONE
C a ESTIMATED COST$ Q--
IS THIS A CONTRACT COST? Yes No
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FEE ENCLOSED$ ZO
OR-Co
TYPE OF JOB:
s
4-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
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY C2-T i,UASSEMBLY
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 GG til
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
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES NO
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
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PEIU%IIT TO PERFORM THE WORK DESCRIBED AND IS Tn
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 0. ---
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