HomeMy WebLinkAbout1970 John Fitch Boulevard (4)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APP 1540 SULLIVAN AVENUE Bldg.Permit#
3 l J411— 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FFEESCHEDULE Location of Job:
je/7r,,:
0-$1,000=$15.00 9treet No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Z l'
C 1 r 1491e
APPLICANT ADDRESS tz 0 G
APPLICANT PHONJE# 5,5 d 71 5
W N S OWNEROq< OWNER ADDRESS
OWNER PHONEQ
C ESTMATED COST$ C.
IS THIS A CONTRACT COST? Yes No
Alf 67rCIOFEEENCLOSED$ (5 .
TYPE OF JOB:
OR*C New Installation
ZAlteration/Addition/Repair
Revised 4/01H2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIA WITH A
BUILDING PERMIT APPLICATION? AYES NO
SIDENTIAL
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 l 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
117,
THE UNDERSIUNED HEREBY APPLIES FOR A PERMIT TO PERFORMTHE WORK DESCRIBED AND ISTO
k/
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