HomeMy WebLinkAbout21 Larkspur Laneoy
1% TO THE BUILDING INSPECTOR
of the APPLICATION FOR
PLAN EXAMINATION ANDSiO7't'H W BUILDING PERMIT
zIMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. 0
A AA ®® ZONING
AT (LOCATION) K DISTRICT
LOCATION NO.) STREET)
OF BETWEEN AND
BUILDING CROSS STREET) CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
N
II. TYPE AND COST OF BUILDING — Al! applicants complete Parts A — D v
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M
1 W J_N w building Reside tial Nonresidential
2 Addition(/f residential, enter number 12 FOne family 18 Amusement, recreational
of new housing units added, i/any. 13 Two or more family - EnterinPartD, 13) T f E 19 Church, other religi us
number of units- - - - -i 20 Industrial3 Alteration (See 2 above)
14 Transient hotel, motel, 21 Parkin4 Repair, replacement g garageP P or dormitory - Enter number
5 Wrecking (If multifamily residential, of units ------- - i 22 Service station, repair garag
enter number of units in building in 15 Garage 23 Hospital, institutional
Part D, 13)
16 Carport 24 Office, bank, professional60Moving (relocation)
25 Public utility7 Foundation only
t7 Other - Speci/y Y
26 School, library, other educati nal
B. OWNERSHIP 27 Stores, mercanfiI@
8 Private (individual, corporation, 28 Tanks, towers
nonprofit institution, etc.) 29 Other - Specify
9 Public (Federal, State, or
local g v rnment)
C. COST Omit cents) Nonresidential - Describe in detail proposed use of buildings, .g., food
processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,,, 6 ez) school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. El ctrical......................
b. Plumbing ...................... I-'
c.Heating, air conditioning.........
d. Oth r(elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT
III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part 1, for all others skip to IV.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 Mas my(wall bearing) 40 Public or private company
48. Number of stories................
31 CETW d from 4110 Private (septic tank, etc.)
49• Total square feet of floor area,
all floors, based on exterior
32 Structural steel dimensions .................... C
33 R inforced concrete H. TYRE OF WATER SUPPLY
34 Other - Specify 42 Public or private company
50. Total land area, sq. ft. ...........
43(_] Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL
51. Enclosed .......................
35 r::Gos Will there be central air 52. Outdoors........................
36 Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 237 Ell ctricity 44 Yes 45&NO 53. Number f bedrooms.............
38 coal
39 Other- Specify Will then b on levator?
54. Number f
Full..........
46 Y s 47 No bathrooms
Partial.......
IV. IDENTIFICATION — To b compl ted by all applicants
Name Mailing oddr ss — Number, street, city, and State ZIP cod Tel. No.
1.
Owner or
Lessee
2.
Contractor
3.1'
Architect or
Engineer
The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction.
Signature of applic4nt Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD — For office use
Plans R vi w R quired Check Plan Review Date Plans By Date Plans By NotesFeeStartedApproved
BUILDING
PLUMBING
MECHANICAL
ELECTRICAL
OTHER
V1. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Permit or Approval Check ObDtained Number By Permit or Approval Check ObtDateaned Number By
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USE OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
VII. VALIDATION
Building 3Prmitnumbr
Bui Iding
P rmit issued 3 19
Building
Permit Fee $
Ap oved by 1
c
TITLE
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date July 23 19 85
Fee Paid $. 37 8.0 0 Eat. Value $15'3.,.0 0 0
Permit N° 14563
on the aide of
Lot #48 Larkspur Lane Street
Street No. 21
Owner gpjpan .TanQiins
Applicant Rejean Jacques
CERTIFICATE OF OCCUPANCY ISSUED:
Date
No. 71 4 8
Fee Paid $ 3 .00
CLASSIFICATION
nwe l i i.ng
I
i
i BUIIDING PERMIT
14563
OFFICE OF
THE BUILDING INSPECTOR
of the
I
Town of South Windsor, Conn.
South Windsor, Conn. July 23 1585
i
94t's is to Tertify, That Re j esn Jacques
is hereby granted permission to Dwe17 i na
I
I
at estimated value of
on the side of Toot _La=:ks=uz—Lane Street on land
I
owned by Wean Jacquas
Said Work to be as described in Application
i
No. 1`A and to conform to specifications and plans filed with said Application, and Building By.
I
Laws of THE TOWN OF SOUTH WINDSOR.
Issued 19850
Building Inspector.I
I
Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers
during the day and by both barriers and colored lights by night.
SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place
or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a
license therefor from the city or borough in which such highway may be situated, he shall pay said city,jtown or borough all coats and damages which it shall sustain, or be compelled to reason therefor."
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Dwelling - Lot #48 Widsh. 4 7/23/85
Re j ean, Jacque s
21 Larkspur Lane
Permit # 14563
Electrician Michael Finnegan #8840
Heating Contr.
Plumbing it 4gxe
Oil Burner
Certificate of Occupancy 7198
Sewer Permit
Plot plan apprd. per Engr.
Permit No. l TOWN OF SOUTH WINDSOR
SOUTH WINDSOR, CONN.
i
Permit NO
l Certificate of Occupancy
TH S TO C R FY+that thei'
I at No(- in the of South Windsor, Connecticut, has
I been er cted and complet in accordance with the Bdildirg Code and Zoning Regulations of
the Town of South Windsor, and is hereby proved o occupa
9A 0 j
ui in n
gwne ui er
I
Fee Paid Date % 19
I
8840
ELECTRICAL APPLICATION
Application No. 10255
on the side of
Lot #4 8 Larkspur Lane Street
Street No. 21
Owner Re j can Jacques
Electrician Michael Finnegan
FILED IN OFFICE OF
The Building Inspector
Aug. 12
19
85
INSPECTION.
m No Electrical Work shall be started until a Per-
mit is granted by the Building Inspector.
In New Buildings no wiring shall be started
until the plumbing and heating pipes. and the Are
stops (if of wood) are installed, without a special
permit from the office of the Building Inspector.
Electrical Permit No. ........_...........................
Master License No. .....f r1. ,?.....7..... ...........
TOWN OF SOUTH WINDSOR Building Permit No.
Date Filed .........=...`/...-:..........
BUILDING DEPARTMENT
Date Final Approval ..........................................._.....
APPLICATION FOR ELECTRICAL WORK
Electrical Inspector
JOBLOCATION. u ........... .' ............................ JOB OWNER. ......... t..............
Sideof .. . ....... ..... ...... .. ...... Between ............ ....................................................... dnd .................................................................................
Nameof Building Owner Address .. ... ...................................... ... ..........................._.......................
Ifwork is for Lessee—Give name ... ..... . • . .......... ............. ..................... ... Address ...................................._........................................ .............
Building now occupied as (unless w) : No. of family units now ................l...............
Building to be occupied as ............... ....- 1..'ti'!.. -1. ....... ........ ...... Number of family units to be ......... ....................
Is this work included is} a Building Permit? Permit Fee .........
If no Building Permit)
Permittee ! .. j'!r j 4 —L Business Address elephone
COST OF INSTALLATION:
TO BE FILLED OUT BY PERMITTEE
TO BE WIRED EXISTING APPLIANCES
Number of light outlets to be installed
Number of convenience outlets to be installed Number of present Appliance Circuits ..................................................
Number of switches to be installed Do these include Range Water Heater Number of appliances to be installed . . . .... ..... .........
as listed below) Dryer Air Conditioner Oil Burner
TYPE RATING NO.
Dish Washer Gas Burner
Range . . • • • • • • Well Pump Elec. Heaters
Range Top . . . . . .
Oven . . . . . . . . REMARKS:
Water Heater
Clothes Washer . . . .
Clothes Dryer . . . . .
Dish Washer . . . . . . C
Air Conditioning Motor .
Oil Burner Motor . . . .
Gas Burner . . . . . .
Circulator Motor . . . .
Attic or Large Fan , . ,
Well Pump . . . . . .
Electric Heat . . . . .
Other . . . . . . .
Number of new Lighting Circuits . . . . ....._..............._.....
Number of new Appliance Circuits . . . ..........._...._...._.....
Number of Heating Circuits . . . . . . ............................
Number of Motor Circuits . . . . . . . ..............
Size of present service ............... . ......._...........................
Size of service to b-e .........................................._..._....................
6782
PLUMBING APPLICATION
Application Na 6553
on the ... side of
Lot 48 Larkspur Lane Strad
Street No. ...._21
Owns s c.c.s'
Plumberr11
Filed in Office of
The BuddingLspecoor
9/18/85 19
II Cl.
4r
No person shall coaservct, add w at alder sty
portion of the drainar system of goy bwl&og
ezoept to repair leafs) umil a Pp is gaoled
by the Building Impamr.
APPLICATION FOR PLUMBING PERMIT (Continued from R vers Side)
TOWN OF SOUTH WINDSOR, CONN.
11. LOCATION OF JOB I
NO STREET FLOOR APT.NO.
GENERAL PLUMBING
12. KIND OF INSTALLATION Ne W 140use. 13. SIZE OF MAIN DRAIN 3 it
14. NO. OF TOILETS STYLE (5ep_6w- 15. NO. OF URINALS STYLE
16. NO.OF BATHTUBS 17.NO.OF LAVATORIES 18. NO.OF SINKS_ 19. NO. OF WASHTUBS
20. NO.OF CONDUCTORS SIZE 21. NO. OF STACKS SIZE
22. AREA OF ROOF 23.NO. OF CATCH BASINS 24. NO. OF FLOOR DRAINS
25. NO. OF OTHER FIXTURES KIND
26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW? )110-5" 27. SIZE OF WINDOW
28. IF NO WINDOW,WHAT KIND OF VENTILATION IS THERE?
29. SIZE OF DUCTS 30. ARE
rr
SEWAGE AND WATER FACILITIES AVAILABLE?
qj A2 c1 c.N Cc)
2jpa-3_-i67
SIGNATURE ADDRESS
LICENSE NO d" 3 ESTIMATED COST 3 TELEPHONE
OWNER ieP ADDRESS l
WATER HEATER
31. TYPE s e-10 GfqCL. Q IDS 32. MANUFACTURER S
TANK SAFETY DEVICES
33. CAPACITY 40 619LL011 37. TEMPERATURE RELIEF VALVE W 10
34. TEST PRESSURE 38. MANUFACTURER_ yiattQ
35. WORKING PRESSURE 1. 1 J-S 39. PRESSURE RELIEF VALVE 5 V
36. TYPE Is 40. MANUFACTURER WaA6
4,
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE OWNER OF THIS PROPERTY
AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE.
CD962 DATE SIGNATURE OF APPLICANT
PERMIT #
Application For 6 614 6224DEPARTMENTDECISION
N Heating Permityo
3 E APPLICATION IS HEREBY:
o DEPARTMENT OF LICENSES AND INSPECTIONSa
N +- KI APPROVED DISAPPROVED
TOWN OF SOUTH WINDSOR
0 Cd 8/21f 85 Thomas P. D'Auria
DATE CHIEF INSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER NE BELOWO
i to p
o v 1. LOCATION OF JOB
O
21 Larkspur Lane
NO. STREETo
v
w 48
O 0 LOT NO. FLOOR AR. NO.
c
Re-jean2. OWNER Jacques
o C ADDRESS 201 Miller Roadbo3
South Windsor 4.PHONE
cc
n S. APPLICANT South Windsor Plumbing
00
PC s. ADDRESS 524 Burnham Street
c South Windsor 7.PHONE 5 2 8-4 413
w
s. LICENSE NO.307190
a
p w 9. EXPIRATION DATE OF LICENSE— 10/1/85
c
10. ESTIMATED COST
r+
11. IS THIS A CONTRACT COST? YES Nobo
a 1:. FEE ENCLOSED s Permit 14563
13. TYPE OF BUILDING:
C blo RESIDENTIAL COMMERCIAL
ai 3 14. TYPE OF JOB: INDUSTRIAL
ORIGINAL ALTERATIONINSTALLATINADDITION
REPAIR
APPLICATION FOR HEATING PERMIT (Continued tr m Reverse Side)
11. LOCATION OF JOB Lot #4 8 Larkspur Lane
NO. STREET FLOOR AFT.NO.
12. TYPE OF INSTALLATION; OIL BURNER ELECTRIC VENTILATION SPRINKLER
GAS BURNER STACK INCINERATOR to MISCELLANEOUS
IDENTIFY
SIZE LOCATION SIZE SIZE
13. OF TANK OF TANK OF FILL OF VENT
ta. B.T.U. EQUIP. AT REGISTER FURNACE MAKE AND NO. AT BONNET FIRING RATE
BOILER OR FURNACE MAKE AND NO. 0&64i B.T.U. OR SQ. FT. NET - off, B.T.U. OR SO. FT. GROSS FIRING RATE
FLOORS TO BE HEATED 19ZO NEW OR OLD BUILDING INSULATED - YES OR NO ,Y f
TYPE OF WALL WOP-0 rl I INSULATION ROOF OR CEILING c' T INSULATION, "C"frr
AVG. SYSTEM WATER TEMP. Z qG B.T.U./SQ. FT./HR. EMISSION '-
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE 2r/yCl`' FAHRENHEIT
MAKE OF RADIATION(ASEBOARDCOPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ.
FT. OR B.T.U.-
DESCRIPTION OF WORK L"";4 fJ7 P 0-- If G&lC At ss r is. TO BE DONE;
is. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS);
NDOWSROOMSIZEANDDOORS AREA - SQUARE FEET VOLUME
e.r.u. e.T.u.DISTRIBUTION INSTALLED
TOTAL TOTAL N
ROOM NO'GROSS GLASS NET WALL CEILING FLOOR CU.FT. AT 70•IVCORRECTED J j IL
LL
REGISTER
INFILTLWNANDC TEMP. TO <F TYPE AND SIZE RAD. OR LEADER
SIZE < WALL
f'Lt0 DIFF. F m a SO. FT. FREE AREA
TOTALS
A. HEAT LOSS FROM BUILDING B.T.U./HR.
B. DOMESTIC HOT WATER DEMAND k-o e1A k f B.T.U./HR.
C. PIPING. OTHER THAN NORMAL B.T.U./HR.
ALLOWANCE FOR HEAT VALVE OF FUEL ((A B C) FACTOR
17. ELECTRICAL WORK BY; '/c /l c w]L1 zz"iL d"-,-
NAME ADDRESS
SUBCONTRACTORS AND
t13. THEIR TRADES
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILL
BE DONE IN STRICT ACCORDANCE WITH THE BUILDING/CODE.
APPLICATION TO BE COMPLETELY FILLED IN. 2
DATE NAT1J E F A L PANT
r
CAIt
CHtMINEY S1ZE
4VRUCTf0#1. WALL
WINDOWS—A-1a .'ce- j" ROOF OR CItlult'a
BASEMENT HEIGHT: ABOVE GRADE BELOW/ GRADE VWSIGN WATER TEMPERATURE DES143N TEMP. RIFF
1 Z 3 4 5 6 i 8 9 t0 11 tZ 13 14 15 f6 17 t8
ROOM SIZE wiNoow AREA•SRO. FT. Fuo" VO ILUb# DA Es ARDsNDDooru. TOTAL TOTAL
St_l s* t ET WALL CE1LIi
1sE1R iyoTtt Co"9CTC0 ACCESSORIESpAtT$F YVATEE LRNGTH000mNUMBEROROS* f i Q T6111. TO TEMP OF.L W H ow AREA WALL ENCLOSURESIZE00.17 alFr. _ SoF
N L ItS LC MISC.
f l 1 0 f o TEMP. Dirr. FT.
TUlE
131
A00 o 009400
L i t goq 26SS
av 8 v2?00 1 00 3Yoo Soo 8 570
A 3f
I WA 3000 /SOO 6000 /0.500 -C2000 02
qj 6 vZ oSOO
rA„
9 130 s o0 15300 17600D
Ise 6 1 ao oo Boo 3Vo s900 47yo
R -- o 150
i y 5 ;o 1700 500 Soo 500 1 6 0 0 51 yo
c 0 1
00 goo 3oo 600 d o o l 6 D o.
34
f
S o pr 5 i0 g 300 p® 3 DD j 0 1 a
o i
i i b
348 3 3 3 ,l r 5 - a.5 0
5 a q 0 0 o oo » yo o 13 0 30 2 y
13S.,
I 00(a 0D 8o0 000 q5?0 8
NOTE: r R C NCRETE FLOOR ON KOUNO OR FILL AT ARADE LEVEL,USE LINEAR FEET F EXPOSED EDGE. TOTALSFRALLOTHERFLOOR$USE SQUARE FEET OF AREA. Q 0 I /
PERMIT #
Application For 6632 6242
x DEPARTMENT DECISION PermitHeatinger
O
3 APPLICATION IS HEREBY:
o
DEPARTMENT OF LICENSES AND INSPECTIONS
N +' Cit APPROVED DISAPPROVED
TOWN OF SOUTH WINDSORc
o p Thanas P. D'Auria
00 ATE CHIEF INSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BEL W
O W
C 1. LOCATION OF JOB
1.4 0
21
Cd r, NO. STREET
O
C v
O L7
LOT NO. FLOOR AFT. N
0 O
CV
QO
2. OWNER '+tEALJ ReaAE
O wwx0
0 S. ADDRESS
3
ai a 4,
s. APPLICANT Ifft!Kli
0 ors 6. ADDRESS /a7.7 Z v A4 z 7-k'T 2F Z&y
03 4 7.PHONE 07YO ,C
rv, B. LICENSE NO. ,dL1 7 v
1a
E , S. EXPIRATION DATE OF LICENSE 93ZO
a c 10. ESTIMATED COST s
i
1 I. IS THIS A CONTRACT COST? YES NO
b0
41. 0
12. FEE ENCLOSED S Pe]Znit 14563
y ai 13. TYP F BUILDING:
RESIDENTIAL COMMERCIALb0
1
14. TYPE OF JOB: INDUSTRIAL
ORIGINAL ALTERATI
3
IINSTALLATI N ADDITIONON +
REPAIR
APPLIC TION FOR HEATING PERMIT (Continued it m Rev roe side)
11. LOCATION OF JOB—2T Aa-Ak 3 jgz,&,,r SQ
NO. STREET FL OR AFT.NO.
12. TYPE OF INSTALLATION: OIL BURNER ElELECTRIC VENTILATION SPRINKLER
GAS BURNER STACK INCINERATOR MISCELLANEOUS 6C4 A0 i
ENTIFV
SIZE LOCATION SIZE SIZE
13. OF TANK OF TANK OF FILL OF VENT
14. B.T.U. EQUIP. AT REGISTER URN C MAKE AND NO. AT BONNET FIRING RATE
BOILER OR FURNACE MAKE ND NO. B.T.U. OR SQ. FT. NET// X B.T.U. OR SO. FT. G FIRING RATE
FLOORS TO BE HEATED NEW OR OLD BUILDING l SULATED YE OR NO
TYPE OF WALL AV INSULATION d ROOF OR CEILING INSULATION
AVG. SYSTEM WATER TEMP._1606AI B.T.U./SQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE FAHRENHEIT
MAKE OF RADIATIO ' BA BOARD. COPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ.
FT. OR B.T.U.
DESCRIPTION OF WORK% T
15. TO BE DONE:
m HEAT LOSS SCHEDULE. (TO-BE INCLUDED FOR ALL JOBS);
ROOM size ANo 000Rs AREA - SQUARE FEET
VOLUME
B.T.U. B.T.U.o DISTRIBUTION INSTALLED
TOTAL TOTAL y
ROOM W GROSS GLASS NET WALL CEILING FLOOR CU.FT. AT 70•F CORRECTED J j LL
LL
REGISTER
WALL t0 INFILT.) TEMP. TO 6.f TYPE AND SIZE RAD.L W N AM OR LEADER
SIZE IF"C" DIFF. F O dim SO. FT. FREE AREA
TOTALS
A. HEAT LOSS FROM BUILDING B.T.U./HR.
B. DOMESTIC HOT WATER DEMAND B.T.U./HR.
C. PIPING, OTHER THAN NORMAL B.T.U./HR.
ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR
17. ELECTRICAL WORK BY:
NAME ADDRESS
SUBCONTRACTORS AND
18. THEIR TRADES
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILL
BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE.
APPLICATION TO BE COMPLETELY FILLED IN.
DATE SIGN R[ OF APPLICANT
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South Windsor
Plumbing & Heating, Inc.
524 Burnham Street, South Windsor, Connecticut 06074
f
Phone (203) 528-4413
September 9 , 1985
Mr. Pat DiCiancia
Building Department
Town of South Windsor
1540 Sullivan Avenue
South Windsor, CT 06074
Dear Pat :
Re : Lot #48 Larkspur Lane
This letter will confirm that we are releasing the permit we
hold on the above lot .
Should there be anything further , please contact me.
Sincerely,
Carlton L. Pttlemoyer
President
CLZ/11
6758
PLUMBING APPLICATION
ppplir tion No. 6529
on the...si&of
Lot 14 8_Larkspur Lane sy I
Street 140. 21
Owner _ Re 'can Jacques
plumber S o. Windsor P & H
Filed in Office of
The Bui Inrpoctor
Aug. 22 19 85
II BPSCION.
No person AA aommuct, add to or aiaar my
portion of the drainage sy = of any bmlW6g
eaoept to repair leala) uo& a Pkrmit is gemmed
by the Building Impactor.
APPLICATION FOR PLUMBING PERMIT (Continued from Reverse Side)
TOWN OF SOUTH WINDSOR, CONN.
11. LOCATION OF JOB Lot #4 8 Larkspur Lane
NO. STREET FLOOR APT.NO.
GENERAL PLUMBING
12. KIND OF INSTALLATION residential 13. SIZE OF MAIN DRAIN 4"
14. NO. OF TOILETS STYLE %'V t/ L - 15. NO. OF URINALS STYLE
TT
16. NO.OF BATHTUBS 17.NO.OF LAVATORIES 18. NO.OF SINKS 19. NO. OF WASHTUBS _
20. NO.OF CONDUCTORS SIZE 21. NO. OF STACKS SIZE
22. AREA OF ROOF 23.NO. OF CATCH BASINS 24. NO. OF FLOOR DRAINS
25. NO. OF OTHER FIXTURES KIND l"
26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW? r f 27. SIZE OF WINDOW
28. IF NO WINDOW, WHAT KIND OF VENTILATION IS THERE? rIze/Z. c LAC,r L
29. SIZE OF DUCTS
r
30. ARE SEWAGE AND WATER FACILITIES AVAILABLE? f 1
SIGNATURE ADDRESS 524 Burnham St - Smith Wi ndgnr
LICENSE NO. 203068 ESTIMATED COST c CU 0, 0 C TELEPHONE 528-4411
OWNER Rei can Jacques ADDRESS 2.01 Miller Road Smith Wi nl-isnr
WATER HEATER
31. TYPE 1741 it l 32. MANUFACTURER
TANK SAFETY DEVICES
33. CAPACITY_ 'T4) l_/C: 37. TEMPERATURE RELIEF VALVE o
34. TEST PRESSURE_ /AU/ a 38. MANUFACTURER
35. WORKING PRESSURE o%& 39. PRESSURE RELIEF VALVE
36. TYPE 40. MANUFACTURER
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE OWNER OF THIS PROPERTY
AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE.
8/16/8 5
CD962 DATE Al(GN OF APPLIC T