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DEPARTMENT DEc1s1oN APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMTT#
BUILDING DEPARTMENT g00237
QePROV1540 SULLIVAN AVENUE� Bldg Pert 644-251I ext.230
Date ildmg Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
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$0.-$1,000—$15.00 Street No. Stroet Lot No.
Over$1,000
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt,No,
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o APPLICANT 1 y
a APPLICANT ADDRESS
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N APPLICANT PHONE# Cl L
v �0w N SFq OWNER begf^T ►!1
OWNER ADDRESS u h} ri VIC
OWNER PHONE /
y ;r ESTIMATED COST$
o •� �'� IS THIS A CONTRACT COST? _Yea ,,-,,,No
�G FEE ENCLOSED
TYPE OF JOB:
New Installation
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-+ -_Alteration/Addition/Rq)alr
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08/11/2009 TUB 10:56 FAX 210 349 2464 ERCC OFFICE 10 001/0016
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APPLICATION FOR PLUMING-PERMIT(continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WftVNO
C7 RR ESIDENTIAL BUILDING PERMIT APPLICATIONS1.:13
❑BUSINESS I CURRENT USE AND OCCUPANCY -
U ASSEMBLY
O MERCANTILE❑EDUCATIONAL FUTURE USE AND OCCUPANCY
Cl INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
LO STORAGE
❑GARAGE ADDRESS
CI MIXED USE
CITY STATE ZIP
(Other please specify)
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 ❑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: T YPF,� �tt��/ MANUFACTURER L(
DESCRIPTION OF WORK f
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T=UNDERSIGNED HEREBY APPLIES FOR
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COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK
CONTRACTORS LIC NO. TVE STATE
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SIGNATURE OF _ ffgANr DATE