HomeMy WebLinkAbout20 Birch Road (3)DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT 11133
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
o
APPLICANT i 4 P114 a--t C—.—
APPLICANT ADDRESS
APPLICANT PHONE#
OW N S OWNER
q< OWNER ADDRESS
5 V'j
OWNER PHONE
C 7 ESTIMATED COST$
IS THIS A CONTRACT COST? _ Yes No
FEE ENCLOSED$ '7
1 TYPE OF JOB:
SOR.Cp11 New Installation
teration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
gPRESIDENTIAL I ILBUDING PERMIT APPLICATION? DES ElNO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
Cry STATE ZIP
Other please specify)
TYPE OF INSTALLATION / cv-3 u lk d .r SIZE OF MAIN DRAIN
i
NO.OF TOILETS STYLE .Ta, L NO.URINALS STYLE
NO.OF BATHTUBS NO.OF SHOWERS NO.OF LAVATORIES /
i
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 )CVES NO
SIZE OF WINDOW 3 IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
SIZE OF WATER MAIN SIZE OF WATER PIPING&RISER
Lfe-/WATER HEATER: TYPE t-04v-w v MANUFACTURER
DESCRIPTION OF WORK
D 0 Z-/o zz
THE UNDERSIGNED HEREBY APPLIES FOR A PERAIIT TO PERFORM THE WORK DESCRIBED AND IS FIto
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
3 P/ C
CONTRACTORS LICENSE NO. TYPE STATE
DATESIGNATUREOFAPPLICANT