HomeMy WebLinkAbout105 WYNDEMERE CT BLDG 1 DEPARTIENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR Z
BUILDING DEPARTMENT 1p00 3
APPRO 1540 SULLIVAN AVENUE Bldg Permit#
10 S- �� 644-2511 EXT.230
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(Date) (Building Inspect
Application must be printed or typed
FEE SCHEDULE Location of Job:
FStremet
$0-$1,000=$15.00 Street Lot No.
Over$1,000-
$15.00 per$1,000
or any.fraction thereof Tenant Designation Apt.No.
APPLICANT ' I tYF'I 1A W P P(I T K61 P 0C�
APPLICANT ADDRESS 30 7 D Y
APPLICANT PHONE# SfCl C'"y3lD"!l c�a2
OW N SF OWNER -r)eJl1Cr' �r-1�(1C11lJ
OWNER ADDRESS _�2]f i
O # OWNER PHONE W 0-5
C ESTIMATED COST $
IS THIS A CONTRACT COST? X YES NO
x FEE ENCLOSED$ 7
CJ
�f S14' TYPE OF JOB: p O
SO •COS New Installation
_,�L Alteration/Addition Repair
Revised 12/22/11
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
[I RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑ NO
0 BUSINESS CURRENT USE AND OCCUPANCY
0 ASSEMBLY
0 MERCANTILE FUTURE USE AND OCCUPANCY
0 EDUCATIONAL
0 FACTORY
0 STORAGE ENGINEER'S NAME PHONE
O GARAGE
0 MIXED USE ADDRESS
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION 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 O YES O 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 G i I MANUFACTURER ,BOG L_
DESCRIPTION OF WORK
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THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED 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