HomeMy WebLinkAbout17 Brookfield Street (3)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
Application is hereby:TOWN OF SOUTH WINDSOR
0 3
PERMIT# LU
BUILDING DEPARTMENT
APPROVED
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1540 SULLIVAN AVENUE Bldg.Pernut#
VDate
644-2511 ext. 230
Buil g Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT t C.h Fi PC- I f i 30
APPLICANT ADDRESS Cl? n0 K F.i-e/c-f 3-7—
APPLICANT PHONE# 2 3 eo '.ZN
OWNER
OWNER ADDRESS
s' OWNER PHONE
ESTIMATED COST$ S
IS THIS A CONTRACT COST? 0 Yes G Tqo
FEE ENCLOSED$ 1 3
O TYPE OF JOB:
OR•C
O New Installation
0 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BiJITzD G IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
Q RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY A etj+
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY c)t
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION TU 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
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
SIGNATURE OF APPLICANT YZ DATE 3 TL lZD