HomeMy WebLinkAbout162 Cornerstone Drive (6)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WIlVDSOR
PERMIT#
Application is hereby: o2 5 2BUILDINGDEPARTMENT
APPRO D 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 2`5-/14(/0 3
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
RoZ Ccv nab straw aDr.
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT tJ1
APPLICANT ADDRESS
S OL -V-\
APPLICANT PHONE# _ O V' 4 )2—
M1 N S OWNER S+`vW'-
4 OWNER ADDRESS
a
i OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
r1 r TYPE OF JOB:
SOR.CO New Installation
CAItcration/Additio epair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
SIDENTIAL
BUILDING PERMIT APPLICATION? YES NO
U BUSINESS
ASSEMBLY
CURRENT USE AND OCCUPANCY
MERCANTILE
FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE 3-kZ d a Vd NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES 1
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 WTO
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER SEPTIC TANK
SIZE OF WATER MAIN 4i j176A SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
U` 1 a ' C CYf k Ct 'K -
r
THE UNDER IGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND ISTO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
H-C,Kr()w A er-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE J—