HomeMy WebLinkAboutBuilding 19 Mill Pond Drive (8)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WIIVDSOR
PERMIT#
Application is hereby:BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
o so— 644-2511 ext. 230 Q
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
y -7 pd LJ
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 4S `YN//"'
APPLICANT ADDRESS 19.7 W 07
1y1Ndso,e c 06 OS- 5'
APPLICANT PHONE# V&o ;7m46 — 77G z.
Ow N S OWNER G4VA/A04 4140
q OWNER ADDRESS 1,007 AMC L AdAID oeV
OWNER PHONE
0
ESTIMATED COST$ 6Oa 040
IS THIS A CONTRACT COST? Yes No
r FEE ENCLOSED$
TYPE OF JOB:
FOR'CO VNew 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
R
r
ESIDENTIAL
BUILDING PERMIT APPLICATION? ElYES NO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
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_- 2, 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 G,¢ MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMI FI YO PERFORM THE WORK DESCRIBED AND IS TU'
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 DATE .7' 'o