HomeMy WebLinkAboutBuilding 19 Mill Pond Drive (3)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
711 o
644-2511 ext. 230
Z
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE L tion of Job:
0,2 IY II
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT c oS"11 "'Ve YN/f7i9.J
APPLICANT ADDRESS 6 j i;FA.14 11- s`r'
AlIA1,0SAe Cr- d 6 0l'S
APPLICANT PHONE#7/6 774 Z
0W N S.
q
OWNER S'Ti i w Gw/ La 00/i 0 y/isZs
t s OWNER ADDRESS Z l''1/t..L RA/b l7
OOWNER PHONE
C ESTIMATED COST$Opl3, 60
IS THIS A CONTRACT COST? Yes No
f
r
FEE ENCLOSED$ q0 f
f1'r TYPE OF JOB:
R-Cod V 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
J BUILDING PERMIT APPLICATION? I YES NO
cif 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 Y Ne, NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES
NO.OF CONDUCTORS SIZE NO.OF STACKS SIZE .3
AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS
NO.OF OTHER FIXTURES KIND
ARE TOILET COrApARTMENTS 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 Y SIZE OF WATER PIPING&RISER
WATER HEATER: TYPE t.4,_ 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
SIGNATURE OF APPLICANT DATE 7-