HomeMy WebLinkAbout2163 Ellington RoadDEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
Application is hereb
Iaq7y:TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
PROVE 1540 SULLIVAN AVENUE
Bldg.Permit#
r) Jam_ 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
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 C
APPLICANT ADDRESS Z((o 3 El(I wG T7v%- P-0 v%,o
6 c t(- W t•-JAS IA
APPLICANT PHONE# q 31, —7(a[-
O W N St OWNER
OWNER ADDRESS SSG'
OWNER PHONE
ESTIMATED COST$0 du
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IS THIS A CONTRACT COST? Yes 1.- o
FEE ENCLOSED$I!r
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TYPE OF JOB:
OR-C
New Installation
V 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
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL PHONE
FACTORY ENGINEER'S NAME
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION SIZE OF MAIN DRAIN
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 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
WORKTHEUNDERSIGNEDHEREBYAPPLIESFORAPERMITTOPERFORMTHEWORKDESCRIBEDANDIS11to
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COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
v"y
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT l E''' '` DATE S I