HomeMy WebLinkAbout16 Kelly Road (5)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: 07/o
BUILDING DEPARTMENT
APPRO ,D 1540 SULLIVAN AVENUE Bldg.Permit#
Vte(4
644-2511 ext. 230 j
Building Inspector
Application must be printed or typed
Location of Job:
EE SCHEDULEFFE
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
I
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE# Z?60-
W N S OWNER
O F
OWNER ADDRESSZ&LaOL
0 OWNER PHONE 2 (=
C ESTIMATED COST$
IS THIS A CONTRACT COST? v"'Yes No
FEE ENCLOSED$
TYPE OF JOB:
OR-Co 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? OYES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
Other please specify)
CITY STATE ZIP
TYPE OF INSTALLATION ° ''/'G
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
y
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 64 YES NO
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
of
SIZE OF DUCTS SEWER OR SEPTIC TANK17
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE 1 C r c i ®/f MANUFACTURER li r>
DESCRIPTION OF WORK
C1,
7THEUNDERSI(iNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBE57IM7977'
iiS l/
27A Aez
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
z r/ v(J
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT 111v DATE
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