HomeMy WebLinkAbout210 Brook Street (7)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR 0 .7 7 gBUILDINGDEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
I
644-2511 ext. 230 a 7 7 5-.),
Date Building Inspector
Application must be printed or typed
FEESCHEDULE
Location of Job:
a16 Broo k-6-A c-e
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Onl U S A
APPLICANT ADDRESS k- &c--rce'
APPLICANT PHONE#
OWN S OWNER
OWNER ADDRESS 0 7
A
OWNER PHONE q Ll 7 e1
C ESTIMATED COST$
i U
IS THIS A CONTRACT` COST? O Yes O No
FEE ENCLOSED$ C-
pR.CO
TYPE OF JOB:S
13 New Installation
W'ATteration/Addition/Repair Revised 8/99
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION?DES NO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY K+GZ-.-j i`o,y t i
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION -I 7A 1- j' • rc yn SIZE OF MAIN DRAIN 3 fl
NO.OF TOILETS _STYLE NO.URINALS STYLE
NO.OF BATHTUBS t4lA NO.OF SHOWERS 1A 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 YES NO
SIZE OF WINDOW IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
4-,m pow A e--
CONTRACTORS LICENSE NO TYPE STATE
SIGNATURE OF APPLICAN DATE