HomeMy WebLinkAbout125 Ellington Road (7)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: GBUILDINGDEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 e2 F5 73
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
has C l h O ol
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Ve C h Cc,A-7 iC A, (fO n 41-6 C.-kr f,, C—
APPLICANT ADDRESS CP Se-co n d
CGtl Lo ZJH O/OZO
APPLICANT PHONE#3- s Z- S 3 6 O
OW N S OWNER OS T Oct
OWNER ADDRESS
tk OWNER PHONE
VESTIMATED COST$ G S C7 O O
IS THIS A CONTRACT JOST? Yes No
FEE ENCLOSED$ 03
TYPE OF JOB:
SOR-C0v' 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
U BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCY )QrC AOU.1 -fEDUCATIONAL
ACTORYIONAL ENGINEER'S NAME S7"h , o tj C h e PHONE ?3 - 3
STORAGE
GARAGE ADDRESS Z/O 46MIXEDUSE
CITY r' G{ d STATE A n,f Cf ZIP C
Other please specify)
TYPE OF INSTALLATION 1 4 Q /'SIZE OF MAIN DRAIN
NO.OF TOILETS /S;- STYLE / c,t f Aof9,7,j,ICr NO.URINALS 57 STYLE /-X/J-xi e AY-
NO.OF BATHTUBS 0 _ NO.OF SHOWERS O 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 S/I )"
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES EMO
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANKS e 4-1 er
SIZE OF WATER MAIN 7l SIZE OF WATER PIPING&RISER 411 S/Z.C J
WATER HEATER: TYPE
DESCRIPTION OF WORK
Ivew uv 'h n rrm
is
THE UNDERSIGNED HEREBY APPLIES FOR A PERMI Pr TO PERFORM THE WORK DESCRIBED AND 19 T7
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 4-j zl-O 2-