HomeMy WebLinkAbout26 Chandler Drive (5)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDII I'G DEPARTMENT Q 5_01:G
APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#644-2511 ext. 230
a
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE ovation of Job:
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000 .
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 5. ff-
APPLICANT ADDRESS X4 h
Cl L%27
APPLICANT PHONE# LW 0
O W N 8,0 OWNER hip
OWNER ADDRESS
0i !OWNER PHONE c,MQ
C ESTIMATED COST$
IS THIS A CONTRACT COST? 13 Yes ,0"'No
FEE ENCLOSED$1(w 0
9 6b
OR-00 TYPE OF JOB:
M New Installation
13 Alteration/Addicon/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
El ASSEMBLY
CURRENT USE AND OCCUPANCY
MERCANTILE FUTURE USE AND OCCUPANCY f
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 G/
NO.OF TOILETS STYLE NO.URINALS ---' STYLE
NO. OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES • S
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE
AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS
NO.OF OTHER FIXTURES KIND Ll S i S v
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
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.
CONTRACTORS LICENSE NO. TYPE STATE
G-4 i,'SIGNATURE OF APPLICANT DATE Ll' j}