HomeMy WebLinkAbout15 Bancroft Lane (3)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WIlVDSOR
PERMIT#
Application is hereby: I' 7BUILDINGDEPARTMENT
APPROD 1540 SULLIVAN AVENUE Bldg.Permit#
Z AC-,644-2511 ext. 230 a 90 6
Dat Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
LAOQ-
0-$1,000=$15.00 treet No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT R9—
APPLICANTADDRESS
roe T 0 v j 5
APPLICANT PHONE# S.3——7 3 7
OMI N SFq
OWNER
OWNER ADDRESS
0 OWNER PHONE
C' ESTIMATED COST$
U
IS THIS A CONTRACT COST? Yes No
ovFEEENCLOSED$ t S,
TYPE OF JOB:
SOR'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
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
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)
1 ll
TYPE OF INSTALLATION h f.vJ _l S[tnc ju SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE n jM._ NO.URINALS STYLE
NO.OF BATHTUBS a 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 a
WATER HEATER: TYPE MANUFACTURER ji P_ ,j a o Q. GY 1 f e c
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WOMZ DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
ga14 Lk bk CT
CONTRACTORS LICENSE NO. STATE
SIGNATURE OF APPLICANT DATE