HomeMy WebLinkAbout1535 John Fitch Boulevard (20)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT P#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
v
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
812100 644-2511 ext. 230
cl? ?Q 3
ate ding Inspector
Application must be printed or typed
FEE SCHEDULE
1
r
Location of Job:
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT c: o
APPLICANT ADDRESS 6
J ,19-- f lam— 696 CS'4
APPLICANT PHONE# 2z
11000OWN S OWNER S
4 OWNER ADDRESS
y.s y
it OWNER PHONE
C ESTIMATED COST$ Zoe,-C .
IS THIS A CONTRACT COST? 0 Yes WNo
CJ FEE ENCLOSED$ ?
CO
TYPE OF JOB:
XrgSpR.ew Installation
0 Alteration/Addition/Repair Revised 8/99
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 Z:FG YN
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME 'r a K lG C b'v4•JG ,PHONE
FACTORY
STORAGE
GARAGE
ADDRESS ZLC 7 ld 41 4 r', file
MIXED USE CITY STATE i1
ZIP 06--
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
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
J
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.
CONTRACTORS LICENSE NO. TYPE STATE
IN
SIGNATURE OF APPLICANT DATE ^2 c