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RTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
plication is hereby: pBUILDINGDEPARTMENT
AjPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 q
Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
0-$1,000=$15.00 Street No. Street LotNo.
Over$1,000=
15.00 per$1,000
L any fraction thereof Tenant Designation Apt.No.
APPLICANT e k
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APPLICANT ADDRESS
i-I C
APPLICANT PHONE# 2
W N SF OWNER
q OWNER ADDRESS C) c U b 0 "IS— 7
OWNER PHONE2—
Uv
C ESTIMATED COST$ C c N
IS THIS A CONTRACT COST? i/Yes No
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FEE ENCLOSED$ C
TYPE OF JOB:
SOR-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 WITHA
BUILDING PERMIT APPLICATION? YE NO
RESIDENTIAL
USINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
Other please specify)
CITY STATE ZIP
TYPE OF INSTALLATION \ ,, SIZE OF MAIN DRAIN _S
NO.OF TOILETS_STYLE NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS \NO.OF LAVATORIES I
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE Z
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 WIND04' :L3S NO
SIZE OF WINDOW Z >(Z IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER R SEPTIC TANK
SIZE OF WATER MAIN 1` SIZE OF WATER PIPING&RISER S
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
x , /e) c yi) A c x ccyA s c oc t s-Q cry
THE I DERSIUNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCMD AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
o ----: 's K C-- \ C_--,-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE (o S U