HomeMy WebLinkAbout2249 Ellington Road (2)DEPARTMENT DECISION PE'
sUT#APPLICATION FOR PLUMBING PERMIT 1
Application is hereby-: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
PRO 1540 SULLIVAN AVENUE 9,123
2 V
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location ofjob
Street No. Wreet Lot No.
FEE SCHEDULE
Floor Apt. No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER__ CCL+1 IUDoranyfractionthereof
ADDRESS 2o
S B u i- \/\ J Lead s 6 0 r7 l
OWNERS PHONE#
APPLICANTSeer,6cet,,, l IJ C
W N S ADDRESS rl L n(AI Pr
ESTIMATED COST$ Od
IS THIS A CONTRACT COST?
YES NO
C.FEE ENCLOSED $
OR.C0 TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
Revised 10/96
APPLICATION FOR PLUMBING PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED TH A
BUILDING PERMIT APPLICATION(nSy NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY 77s i peN c'e.1
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY SCc/'Y1 —
EDUCATIONAL
INSTITUTION
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION ADO 8,414 TZ(V\ SIZE OF MAIN DRAIN
NO. OF TOILETS_STYLE NO. OF URINALS STYLE
NO. OF BATHTUBS NO. OF SHOWERS I _ NO. OF LAVATORIES _
NO. OF CONDUCTORS SIZE NO. OF STACKS SIZE 211
AREA OF ROOF NO. OF CATCH BASINS NO. OF FLOOR DRAINS
NO. OF OTHER FIXTURES_Z KIND K /100 6hw
ARE TOILET COMPARTMENTS VENTILATED TO OUTER A R BY A WINDO NO
SIZE OF WINDOW
E
IF NONE C.F.M. OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER 9 j
WATER HEATER
TYPE t 031f)IV G' MANUFACTURE
TANKS "fiqt?,k le55 CO SAFETY DEVICES
TEMPERATURE
CAPACITY 3•Gr P RELIEF VALVE
TEST PRESSURE WORKING PRESSURE PRESSURE RELIEF VALVE
TYPE MANUFACTURER
DESCRIPTION OF WORK
PlIzIn 6
of,
46
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
0?o*"1y0 6 P-/11 Aljzyr2 d vng-
NAME STATE LICENSE NO. TYPE I NATURE OF APPLICANT
PHONE NO. 9d? DATE 11,3111