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HomeMy WebLinkAbout208 Old Farm Road (5)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby:TOWN OF SOUTH WIlVDSOR BUILDING DEPARTMENT I It iC2 APPR 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 3 F7 ate Building Inspector Application must be printed or typed FEE SCHEDULE cation of Job: o Ol 0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= 15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT cry ,ltt t L APPLICANT ADD751sa:;5- 6j` 2!> 6 ®7 Y APPLICANT PHONE# V77 1 e,- O W N S F OWNER OWNER ADDRESS a ©o FAL. e OWNER PHONE G 7 ' 7 C D ESTIMATED COST$ IS THIS A CONTRACT COST? s No FEE ENCLOSED$ S. TYPE OF JOB: OR-C New Installation teration/Addition/Repair Revised 4/01//2002 APPLICATION FOR PLUMBING PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A 5ZSIDENTIAL BUILDING PERMIT APPLICATION? YES NO 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 oo Cf /rp e/&ZE OF MAIN DRAIN r NO.OF TOILETS STYLE NO.URINALS STYLE NO.OF BATHTUBS NO.OF SHOWERS LNO.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 rL SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR SIZE OF DUCTS SEWS R SEPTIC TANK SIZE OF WATER MAIN ZE OF WATER PIPING&RISER WATER HEATER: TYPE Z,4 r!-5 MANUFACTURER DESCRIPTION OF WORK 7z THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS T7 COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. e!: 9e-1 lv 396,3 — .z CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLIC _ DATE