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HomeMy WebLinkAboutBuilding 19 Mill Pond Drive (4)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby:TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT I«4a,")- APP 1540 SULLIVAN AVENUE Bldg.Permit# WW015 644-2511 ext. 230 a 9G a S- Date Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: 963 /Ylj It '?0--w 0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= 15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT D5 oA/ /OYrt/Zo0/-, APPLICANT ADDRESS FV/L .!r7"- w•vt So 12 GT D G o S APPLICANT PHONE# 7/1a - 77` Z OW N S Fq OWNER d 0 Co•vA510441 all/^--f OWNER ADDRESS Z 0.. OWNER PHONE C ESTIMATED COST$ 6©DD• CO O U IS THIS A CONTRACT COST? Yes No FEE ENCLOSED$ 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 ULSIDENTIAL BUILDING PERMIT APPLICATION? YES NO 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 t,J 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 iy,f MANUFACTURER DESCRIPTION OF WORK THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCR ANDIRTO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE PERFORMANCE OF SUCH WORK. p Zo,_ 4/.0 c CONTRACTORS LICENSE NO. TYPE STATE of SIGNATURE OF APPLICANT DATE 7 a k- a-3