HomeMy WebLinkAbout17 Castlewood DriveDEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WIlNDSOR
BUILDING DEPARTMENT
APPR-- 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511-ext. 230 S0-10
Date Building Inspector
Application must be printed or typed
Location ofJob:
FEE SCHEDULE
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS 1-I C.ccS -e,uj by-
APPLICANT PHONE#
O W N S OWNER
4< OWNER ADDRESS
OWNER PHONE
ESTIMATED COST$
U
IS THIS A CONTRACT COST? Yes L-No
FEE ENCLOSED$ ` o
TYPE OF
VowR-Cp Installation
Alt mtion/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATEDXITH A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY S m 4-oym,
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
i1
TYPE OF INSTALLATION SIZE OF MAIN DRAIN
NO.OF TOILETS STYLE NO.URINALS STYLE
NO.OF BATHTUBS l NO.OF SHOWERS IS NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE J
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
i
WATER HEATER: TYPE C- MANUFACTURER
DESCRIPTION OF WORK
rr
In.L a,1 C-t b'v Cc.11 `b—l 5 v, f c
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCR1BED AND iTTT'
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 C_ DATE 2 0