HomeMy WebLinkAbout20 Baker Lane (13)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROV-E--1P> 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 c 5UkYQ
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE 1 l Q p I#N e
0-$1,000=$13.00 F O
Street Lot No.
Over$1,000= 84$13.00 per$1,000
or any fraction thereof esignation Apt.No.
APPLICANT Q NN S /u r b J ry z-1 l v
APPLICANT ADDRESS t
e( j //a.44rd i c-r- oto l(>e-cam o..1
APPLICANT PHONE# (96-0 6f 17-3 YJ l
040111,11,1111111111111111
N S OWNER Te" lP Ge A h le l
00, 0V I:
q OWNER ADDRESS Oa/ F - 7t x P'U iec)( G3
X0v ASOr ' 1 06 G7
OWNER PHONE Ck G 6 7
ESTIMATED COST$ ao 0
IS THIS A CONTRACT COST? M es 0 No
FEE ENCLOSED$
TYPE OF JOB:
OR-C ew Installation
0 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? Q-11ES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
UASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME ICE`fit f ^ PHONE(yI c)
FACTORY
STORAGE ADDRESS /S (T+c'n-Sid=iwc t lfE'y o
GARAGE
MIXED USE CITY ON,V r Jy}i I S STATE ML ZIP oTV
Other please specify)
6TYPEOFINSTALLATIONcry Eti SIZE OF MAIN DRAIN
NO.OF TOILETS 0 STYLE NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES
it
NO.OF CONDUCTORS y SIZE NO.OF STACKS a SIZE
AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS
NO.OF OTHER FIXTURES a KIND J nf 4-
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES 3<O
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
SIZE OF WATER MAIN v'
Y
SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE MANUFACTURER 0. l r' t h
DESCRIPTION OF WORK
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THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
T
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT L .-a2' DATE /O /