HomeMy WebLinkAbout210 Avery Street (4)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
T
PERMIT#
OWN OF SOUTH WINDSORApplication' C/pBUILDINGDEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 2 ?e2?3
Date Bui ng Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
G Af
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS '? 7 :Poo/
APPLICANT PHONE#
let
C1S%S
W N S OWNER
q OWNER ADDRESS
a
O k OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB:
XNew Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
SIDENTIALNUBSINESS 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 SIZE OF MAIN DRAIN Y
NO.OF TOILETS — STYLE NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.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 XYES NO
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK '-5z /"
SIZE OF WATER MAIN ( ( SIZE OF WATER PIPING&RISER
WATER HEATER: TYPED MANUFACTURER 'S
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY 7MPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND is TT'
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT 4 DATE Sf/ /