HomeMy WebLinkAboutBuilding 19 Mill Pond Drive (6)LDate
RTMENT DECISION APPLICATION FOR PLUMBING PERMIT
plication is hereby:TOWN OF SOUTH WINDSOR
PERMIT#
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 C2
Building Inspector
Application must be printed or typed
FEE SCHEDULE Loc 'on of Job:
f lo bPd"K-4
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Je;St P)V /`lOy ..4A/
APPLICANT ADDRESS AIr 67 9N,yl L— .S7'
4//w0--fog GT 16 a S
APPLICANT PHONE# f6 o 7/6 — 7746 Z
OWNER Sf/1/9W,6iQ1'06& edA/00/40',Di ynIS
10 N SFq OWNER ADDRESS 1345 /1,44 ,o46-JcV Z19
e7—
OWNER PHONE
C ESTIMATED COST
IS THIS A CONTRACT COST? Yes No
r•
f FEE ENCLOSED$
TYPE OF JOB:
SpR.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 jz STYLE NO.URINALS STYLE
NO.OF BATHTUBSA2_ NO.OF SHOWERS NO.OF LAVATORIES Z
NO.OF CONDUCTORS SIZE NO.OF STACKS z 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 6,p Z MANUFACTURER
DESCRIPTION OF WORK
THE UNDERSIUNED 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
r-.0-3SIGNATUREOFAPPLICANTDATE