HomeMy WebLinkAbout2719 Ellington RoadDEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT fo
APPRO 1540 SULLIVAN AVENUE
Bldg.Permit#
J GZ j/&-,644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Loc tion of Job-
7
0-$1,000=$15.00 Street No. Street Lot No.Over$1,0()0=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT ..3wbQ At ORD
APPLICANT ADDRESS
APPLICANT PHONE#
ONO N SF OWNER
OWNER ADDRESS
rES
1 3Nf
OWNER PHONE X0 0 4-- }3
UESTIMATED COST$ YSd,
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
1
SOR,C011 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 WITH A
BUILDING PERMIT APPLICATION? YES NO
A RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL PHONE
FACTORY ENGINEER'S NAME
STORAGE
GARAGE ADDRESS
MIXED USE
Cry STATE ZIP
Other please specify)
r
TYPE OF INSTALLATION SIZE OF MAIN DRAIN a
l
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
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.
a39 4l CT
CONTRACTORS LICENSE NO.TYPE STATE
APPLICANT DATE /d/SIGNATURE OF