HomeMy WebLinkAboutBuilding 19 Mill Pond Drive (2)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WIlVDSOR
PERMIT#
Application is hereby:BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 C2-
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Loca1on of Job:
v / eQL
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT TSzpw /`7 DyA//f1'y
APPLICANT ADDRESS 3 AoaealL ST
4ZI /10.1rag CT 0609S
APPLICANT PHONE#d G 0 7749 Z
OW N OWNER STi j1uJ 2/D`E Lc DoI!/iG
q OWNER ADDRESS AdNo
i1r OWNER PHONE
C ESTIMATED COST$ 4e0, oa
IS THIS A CONTRACT COST? /Yes No
FEE ENCLOSED$
f11r TYPE OF JOB:
dSOR-C0 V 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? Z ES NO
Rd RESIDENTIAL
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 7 STYLE NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS I 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 yy SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE SAS MANUFACTURER
DESCRIPTION OF WORK
THE UNDMIGNED TMREBY APPLIES FOR A PERMIT To PERFORM THE WORK DESCRIBED AND 19 To
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
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CONTRACTORS LICENSE NO. TYPE STATE
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DATESIGNATUREOFAPPLICANT 7'