HomeMy WebLinkAbout26 Brewster Road (14)ti
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APPLICATION FOR PLUMBING PERMITPERMIT#
y:TOWN OF SOUTH WINDSORBUILDINGDEPARTMENT
1540 SULLIVAN AVENUE Bldg.Pe 't#
644-2511 ext. 230
Inspector
Application must be printed or typed
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SCHEDULE Location of Job:
B w 5 2
1
1,000=$13.00 Street No. Street Lot No.
Over$1,0003.00 per$1,000
any fraction thereof Tenant Designation Apt.No.
APPLICANT 5 It &3 ' BC /V
APPLICANT ADDRESS 4'3 C f2E S:t j3n L C(q G- V e
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APPLICANT PHONE#
oellIllIlIllillIlIllillillill OWNER KLa Cl0001'C OWN S
OWNER ADDRESS C
S (Oct Ceti Ic C O
E., OWNER PHONE C Cf— 29 5'9
C ESTIMATED COST$
IS THIS A CONTRACT COST? ffeYes 0 No
CJ FEE ENCLOSED$
TYPE OF JOB:
SOR.CO E New Installation
0 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 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 zfOQ S MANUFACTURER A Q mil l#-
DESCRIPTION OF WORK
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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.
g r C'O ti A-2
CO CTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE