HomeMy WebLinkAbout2 Jeffrey Drive (2)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT#
Application i eby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date u g Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT lCrICIV e a Q
APPLICANT ADDRESS
APPLICANT PHONE# 3 R7
W N S OWNER L
4< OWNER ADDRESS
OOWNER PHONE 2_
C ESTIMATED COST$ 1, y
IS THIS A CONTRACT CO'1T? es No
r'1 0 C
f FEE ENCLOSED$
TYPE OF JOB:
u O R-C 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
RESIDENTIAL I BUILDING PERMIT APPLICATION? YES INO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
ITY
Other please specify)
C STATE ZIP
TYPE OF INSTALLATION l Ldle^(1 S SIZE OF MAIN DRAIN 2
NO.OF TOILETS STYLE NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE 2 NO.OF STACKS 1 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
3
t t_ V%
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND 19"M
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
C_7
CONTRACTOR LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT Cis it,n DATE