HomeMy WebLinkAbout2289 Ellington Road (2)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR 11o26 3BUILDINGDEPARTMENT
jR:0 1540 SULLIVAN AVENUE Bldg.Permit#
21) 03 1,3 419 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
o a,n
0-$17000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 6—jIn
APPLICANT ADDRESS Yy i CL
APPLICANT PHONE# Q Q — 2k.4)
W N S F
OWNER Z.-.r7C?
O 4 OWNER ADDRESS
a
OWNER PHONE 6"'YOP1=
d0CESTIMATEDCOST$ 3 DO
IS THIS A CONTRACT COST? 0 Yes P(No
17JFEEENCLOSED$7
TYPE OF JOB:
S0R*C O
0 New Installation
kAlteration/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?)q YES NO
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 /I/'6 SIZE OF MAIN DRAIN
i/
NO.OF TOILETS_STYLE avti NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS I NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE 12-
AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS
NO.OF OTHER FIXTURES KINDL (zelinya L-
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 Se 4(/i=
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE rkIS MANUFACTURER
DESCRIPTION OF WORK
lVe-
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.
COTSITRACTORS LICENSE NO TYPE STATE
SIGNATURE OF APPLICANT L DATE D