HomeMy WebLinkAboutBuilding 19 Mill Pond Drive (7)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WIl TDSOR
PERMIT#
Application is hereby: 10 9 SBUILDINGDEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
7 ``fU3 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
120(c /0 j // 0-h J
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT o Y/y AJ
APPLICANT ADDRESS 4 001G s 7—
1 A-4,0 0/L GT 0602,5
APPLICANT PHONE# 9A O 71 eo " 77` Z
O N OWNER 7'/?4w 49jeIV 646 G e.yd D A4/JO/UAtS
q OWNER ADDRESS
f Tffl l jfcJOsD/e L1'
0 i1 tat OWNER PHONE
C I;) ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
f FEE ENCLOSED$
f1V • ' TYPE OF J B:
OR-Co 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
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
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_Z JV 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 4,,t-f MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIUNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TU
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE STATE
r
SIGNATURE OF APPLICANT DATE