HomeMy WebLinkAbout212 Abbe Road (4)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: c) qs17BUILDINGDEPARTMENT
DROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
bate' Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE# /O tip 'D ?Ty 7
Ow N SF OWNER Sjea< m
q< OWNER ADDRESS a IC) 10156 t a s.
p 3-70 - S161 a OA K.'C 8,4,er - ?g5-oy-15'
OWNER PHONE
ESTIMATED COST$
IS THIS A CONTRACT COST? V Yes D No
f CJ FEE ENCLOSED$
6Z)
O C
TYPE OF JOB:
R-
Q New Installation
I'Alteration/Addition/Repair Revised 8/99
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION fq Aew OQ fIZE OF MAIN DRAIN
NO.OF TOILETS 3 STYLE 1 . (.o 1 Fit.S-!%emu NO.URINALS STYLE
NO. OF BATHTUBS Cry 4ANO.OF SHOWERS_ NO. OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE
I
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 RYES NO
SIZE OF WINDOW 1d 5 IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK S,ep
SIZE OF WATER MAIN W CA SIZE OF WATER PIPING&RISER 3
WATER HEATER: TYPE OS S MANUFACTURER_/I'1ti2Q A CIO C*'h (-
p fL
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 SUCHWORK.
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7 te5 q , r' t L Jrv e larwr C
CONTRACTORS LICENSE NO TYP STATE
SIGNATURE OF APPLICANT DATE