HomeMy WebLinkAbout1535 John Fitch Boulevard (17)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
P T#
Application is hereby-: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Blde Permit#
APPROVE 1540 SULLIVAN AVENUE dN-7 0
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location ofjob
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt. No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER E'_
or any fraction thereof
ADDRESS
OWNERS PHONE#
APPLICANT
W N $ ADDRESS ct-
6, 0
ESTIMATED COST$
p40.t
C = IS THIS A CONTRACT COST?
YES NO
k.. C FEE ENCLOSED $
f
f
OR-CO TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
Revised 10/96
APPLICATION FOR PLUMBING PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION YES / NO
RESIDENTIAL
L./'BUSINESS 77ccu-7L
ASSEMBLY
CURRENT USE AND OCCUPANCY
MERCANTILE FUTURE USE AND OCCUPANCY c ck
EDUCATIONAL
INSTITUTION
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION C_ C LSJZE OF MAIN DRAIN
NO. OF TOILETS STYLE L4-k,,L NO.OF URINALS Z STYLE L,
NO. OF BATHTUBS NO. OF SHOWERS NO.OF LAVATORIES
NO. OF CONDUCTORS SIZE NO.OF STACKS SIZE__L-_j -
AREA OF ROOF NO. OF CATCH BASINS 1 NO.OF FLOOR DRAINS__
NO. OF OTHER FIXTURES KIND ivy 1 vt uS
ARE TOILET COMPARTMENTS VENTILATED T UTER AIR BY A WINDOW YES/NO
SIZE OF WINDOW PQXq0 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 MANUFACTURE
TANKS SAFETY DEVICES
TEMPERATURE
CAPACITY RELIEF VALVE
TEST PRESSURE WORKING PRESSURE PRESSURE RELIEF VALVE
TYPE MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILD G CO S IN THE
PERFORMANCE OF SUCH WORK.
C) J
NAME STATE LICENSE NO. TYPE SIGNAT OF APPLICANT
PHONE NO. to 2,, l DATE