HomeMy WebLinkAbout201 Strawberry Lane (2)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#644-2511 ext. 230 n7 N 9
Date Bujoing Inspector
Application must be printed or typed
FEE SCHEDULEI s4-,wc.A36e4,r-y )A r
Location of Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Y
APPLICANT ADDRESS 0-.e.,m e4t T R
APPLICANT PHONE#
O W N 8 F,q
OWNER
OWNER ADDRESS
J j
OWNER PHONE
OESTIMATED COST$
low IS THIS A CONTRACT COST? Yes No
CIO FEE ENCLOSED$ 9 0
TYPE OF JOB:
OR-Co ew Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED A
BUILDING PERMIT APPLICATION? N0 NO
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 L)&J SIZE OF MAIN DRAIN q
NO.OF TOILETS 3 _STYLE 7C-ty 911 NO.URINALS STYLE
NO.OF BATHTUBS 3 NO.OF SHOWERS NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS f SIZE
AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS
NO.OF OTHER FIXTURES KIND G I /—r41AF/At4
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES NO
SIZE OF WINDOW 3 O X Y 3 IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS `{EWE R SEPTIC TANK
SIZE OF WATER MAINS/ SIZE OF WATER PIPING&RISER
1,
WATER HEATER: TYPE 3(C41:,cf MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND 1977'
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
7 Y5-23 P-/
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE S'