HomeMy WebLinkAbout2281 Ellington Road (2)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Applica'114pBUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230(an(k-
Date Bui Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
4 & E/ 6 e,Cy /yy 41 l a d^J eL
0-$1,000=$15.00 Street N . Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT CA -7-C
APPLICANT ADDRESS 7 7 6 62
46Z e-e taF-x 4 e-4
APPLICANT PHONE# 9 z ?,- 9.S I
W N s OWNER 4,e A e . : 7,
Fq OWNER ADDRESS '2- Z- 9/ c G lry eJ
kuum
OOWNER PHONE C1
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ J,
TYPE OF JOB:
New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED AM A
BUILDING PERMIT APP ATION? S NO
ULSIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY L.C—!/l
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
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 WORK
A Lb l I6 e apse/ t.
e,
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND ISTO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
Z S
CONTRACTORS LI NSE NO. TYPE STATE
SIGNATURE OF APPLICANT A DATE