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Home My WebLink About126 JUDY LN DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT ii Application is hereby: TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT qn�,Zn - APPROVED 1540 SULLIVAN AVENUE 644-2511 ext. 230 Bldg.Permit# 6 t c' � -7 Date Building Inspector Application must be printed or typed FEE SCHEDULE Loc tion of Job• $0-$1,000=$15.00 Stree No. t Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. ANT APPLICANT ADDRESS 1 APPLICANT PHONE# � W N S F,q OWNER � � OWNER ADDRESS t of in ,r OWNER PHONE O C ESTIMATED COST$ IS THIS A CONTRACT COST? Yes _No FEE ENCLOSED$ Z 4 TYPE OF JOB: SOR•CO�� N Installatton _Alteration/Addition/Repair Revised 4/01//2002 aoogo k 0 3y APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILD- IS THIS APPLICATION ASSOCIATED WITH A ING BUILDING PERMIT APPLICATION? ❑ YES ❑ NO RESIDENTIAL CURRENT USE AND OCCUPANCY BUSINESS ❑ ASSEMBLY FUTURE USE AND OCCUPANCY ❑MERCANTILE 0 EDUCATIONAL ❑INSTITUTIONAL ENGINEER'S NAME PHONE D FACTORY 0 STORAGE ADDRESS O GARAGE ❑MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES ❑NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTIO OF WORK 1 I 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 PERFORM PC. SUCH WORK. �qz� Cb9TRACtORS LICENSE N E STAT SIGNATURE OF APPLICANT DATE Iq 4/22/22,9:19 AM 7631 D7ED-3FDD-4567-Al04-5256CFF6E066_Fri_Apr_22_2022_09-10-22.jpeg(30204032) https:/Ivpc3uploadedfiles.blob.core.windows.nettvpc3-files/southvindsorct/7631D7ED-3FDD-4567-A104-5256CFF6E066_Fri Apr_22_2022_09-10-22.... 1/1 I II-� e ' ..�►�c�S � 7P b� � l QQLj Pv.•o�Fs 'a�o.C�v 3/24/22,8:28 AM 05B929B4-205A-43B2-93F0-E1048F56C3BF_Wed_Mar_23_2022_11-21-27.jpeg(3024x4032) R DST€ i St6NCp ��: https://vpc3uploadedfiles.blob.core.windows.nettvpc3-files/southwindsorcttO5B929B4-205A-43B2-93FO-E 1048F56C3BF_Wed_Mar_23_2022_11-21-2... 1/1 i �a J�All above, Oro 3'ay�aa, PRIMUS & WELTI ENGINEERS Glastonbury, Conn. l ,L.7'3�4 .Lo>333 4� ,z ors Ira 42' 00 pr. 1 FOUNDATION CNECKEO i DATE 7 � �/ SC AL[ CERTIFIED SUDSTANTIALLY CORRECT SIGNED ! `. ri�Nt4fgr DATE PRIMUS d, WELTI ENGINEERS Glastonbury, Conn. t � r"336 �o1— 23 �� aT�3> ,107�� Ei of o al N! \ i 44 i i � L Xz a I. jV U d id IN *00"m $:met VOW dWd L n N a - now Pinsk FOUNDATION CHECKED ` r DATE 7 �' �" � SCAL W. � � V CERTIFIED SUBSTANTIALLY CORRECT 1 SIGsNED (•/ �l�+v[u' DATE / �! aj/ stONas i CERTIFICATION OF Z�VdGM :.buMg(s).11111108111111Dr stnifto rr • v� 00 Mw(s) to lb M • + w soU* war eb) )o-1 AUG 312009 U South Windsor BUILDING DEPARTMENT Y y��3 �� 1 PRIMUS & WELTI ENGINEERS Glastonbury, Conn. 1 \ IOC 1 a, i v I Q= cj s � FOUNDATION CHECKED ~ DATE $CALF CERTIFIED SUNSTANTIALLV CORRECT SIGNED I / •{ :`;. i��,ItifCCy OATF SIONFO C_5 �i'..f 1'f� a• •P./ c C�II� South Windsor BUILDING DEPARTMENT + r Chan ecru N copies y$in ana �\ rected A tut • proposed b4dva or allcr ationc t, t. �Rgehekrwjth amendments stated in aPPilaotlon riled w8 handn and I- agree to comply with all :ontng t"'Ildln stet,) laws antl issued b each order,) as ,)hair be I this y the 8u110ing ,)apartment du7-� appllcatlon and fMal Pende�Permlt iaauan bulidiny ' r So ad 41C�� :h7a plan Is approved subject to the -- xders and ordlnenee eondlph. than O a regulating building shall be :.m+P11ed with. a( `ondltlonally A Pprovad 7'Aeao flied wtth vt}L�^t Build'ng Igs`pen ro Clark `wta ��r� 1—� No. C!R'TVq „ 1*DN 4F 7^,ok IANCE hjl.. Cr " f ; in ✓al i six ': a�1C+ r� i . ceptjons L � C OAor DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Applicatio emby � TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT ROVED 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 LDICajBui g 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$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT �re sS APPLICANT ADDRESS APPLICANT PHONE# t ' SOW N 8,e. OWNER OWNER ADDRESS OWNER PHONE 0 C ' ESTIMATED COST$ 5 IS THIS A CONTRACT COST? —Yes _No FEE ENCLOSED$ S TYPE OF JOB: -::"-7 353\ G • SOR Co New Installation Alteration/Addition/Repair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A BUILDING PERMIT APPLICATION? ❑ YES ❑NO ❑RESIDENTIAL ❑BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE FUTURE USE AND OCCUPANCY ❑EDUCATIONAL ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE ❑STORAGE ❑GARAGE ADDRESS ❑MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF SERVICE SIZE OF MAIN CONDUCTORS NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES ❑NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. 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. L— CONTRA RS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT ��-- DATE South Windsor Online Property Viewer 5/15/2009 126 Judy JJ6) 3 �.(. r 0 40 feet,. � t`� �i`p �-•�. �,a.�-�� ' .�, a Property Information 'o"r" at.( Property ID Location L try/ i i - '� I +. .-•r% • i`S _,�z r^ MAP FOR REFERENCE ONLY NOT A LEGAL DOCUMENT This data set/ma is for planning purposes only and should v� W 9 purpo Y not be used for larger scale analysis.The Town of South 1 e Windsor shall not be held liable for any use of the data or images shown on this map,nor is any warranty of accuracy <5'r .._w ,.x_.M� •• expressed.All uses of this data set/map are subject to field verification. DEPARTMENT DECISION APPLICATION FOR HVAC PERMIT TOWN OF SOUTH WINDSOR PERMIT# Application is hereby: r BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE 644-2511 ext. 230 Bldg.Perrtut# Dsie 1Building lnspecto Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000=$15.00 F:Tenant :No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof gnation Apt.No. APPLICANT APPLICANT ADDRESS q 3 n�e�,/ h� � C Rec.o t'1 S h 1Tr1Qfi / O (0 0 a'r APPLICANT PHONE# YR 0 Q a s-) S 3 O W N S F,q OWNER OWNER ADDRESS OWNER PHONE C ESTIMATED COST$ J 5 0 0, O0 .� IS THIS A CONTRACT COST? ✓Yes _No � FEE ENCLOSED$ b o � j�OsO O�� TYPE OF JOB: R C New Installation ✓Alteration/Addition/Repair Revised 4/01//2002 APPLICATION FOR HVAC PERMIT (Continued from reverse side) TYPE OF SYSTEM: TYPE OF BUILDING: Uk-HEATING (8'RESIDENTIAL ❑A/C ❑COMMERCIAL ❑VENTILATION ❑INDUSTRIAL HEATING ❑ STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS. ❑HYDRONIC ❑WARM AIR ❑UNIT RADIANT HEATER EXISTING RADIATION ADDITIONAL RADIATION TOTAL RADIATION DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT LOSS(BTUH) °F(HEAT LOSS SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL HEATING EQUIPT�MNT(INCLUDING M KE&MODEL NO.) GROSS HEATING CAPACITY(INPUT-BTUH) NET RATING(OUTPUT-BTUH) TYPE OF FUEL ❑OIL-GPM OIL TANK LOCATION :❑ INSIDE❑ OUTSIDE CAPACITY ❑ GAS-INPUT LPG TANK CAPACITY ELECTRIC-KW AIR CONDITIONING DESIGN TEMP.OUTSIDE OF INSIDE OF DIFFERENCE OF TOTAL HEAT GAIN(BTU I) (HEAT GAIN SHEET MUST ACCOMPANY APPLICATION) DESCRIBE ALL COOLING EQUIPMENT(INCLUDING MAKE&MODEL NO.) TONNAGE COOLING CAPACITY(BTUH) VENTILATION DESCRIBE ALL AIR HANDLING EQUIPMENT(INCLUDING KITCHEN EXHAUST EQUIPMENT) TOTAL SIZE OF SYSTEM(CFM) FRESH AIR INTAKE(CFM) (PLANS MUST ACCOMPANY APPLICATION) FURTHER 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. )kt ra 03oya5 y- S - S-7 C- CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE J b // Z f T Electric # APPLICATION FOR BUILDING PERMIT Plumbing# 126 Judy Lane HVAC# 9g07 7 Date: —TZ Sprinkler# F Estimated Cost $ FINAL APPROVALS OtT� Permit Fee $ Building COMPLETE RED BOXED AREAS Occupancy Fee $ /d Engineering TYPE OF PRINT ONLY Eng. Insp. Fee $ Affidavit Appr.forCO ON. SIGN ON REVERSE SIDE t -iV Total Fee wb $ TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant Location of Work TQ o. Applicant's Address 7S SP ab Tel # Town kXkj 8r;A&6v� C.! Zip n6a5-4 Lic.# &C 6/72S/ Owner Ad., k". J P ZRSSOb2d-e- Architect 3as y Owner's Address /,2{, 7tr1 4A— Architect's Address v is r Zip 0607 Zip Sq.Ft.New Area: 1 st FI. aS0 2nd FI.1 3rd FI. Total New Area Purpose of this permit 0-rg t /�� City Wateko Well ❑ Septic System rl Sewerx Ins: HO SP Cert. Area Basement Garage Approved by 4C, Date Use Group C.► Construction Type f1"( ot(03 / Revised 1108 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this ` permit is asked,and agree that this building is to be located the proper distance from all street lines, side yard lines,and required distances from all other zones and is located in wbirh this building and its use is allowed. Signed -- I hereby apply for a Certificate of Oc I anc for w d ibed in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS TOWN OF SOUTH WINDSOR AFFIDAVIT OF ACTUAL COSTS PERMIT NO: QO03?7 DATE 5-L,311d The unders' ned,being a duly authorized representative of, Il i kr. e- -C�.c tf�Q� La-S5&1O1-e. do by this statement, certify that the actual costs shown below, of the project referenced by the Permit Number shown above,are true and accurate. This statement is being made pursuant.to the Town of South Windsor Ordinance,Amide II, Section 14-31, (a)thry(e),(see attached). I understand that verification for accuracy of actual costs may be made at any time by the Building Official through an appraisal of the work at the expense of the property owner. hereby certify that the'actual cost of the wait performed under this permit Is: Signature of Permit Holder. Name(Please Print) eA. -Date: ■■aaaaarrararaaaaararaaaaaraaaaraaaaaaaraarararaaaaaaraaraaararaaaaaraaaraa�amass State of Connecticut] ] ss South Windsor Date: County of Hartford] Personally appeared , as aforesaid, Signer and sealer of the foregoing instrument and acknowledged 'the same to be his/her free act and deed, before me. Notary Public Commissioner of the Superior Court My commission expires on INSPECTION•FIELD SHEET 05/13/14 Printed by Peart, Dayshell 11 53 03 INSPECTION: 25754 FOOTING PERMIT: STATUS APPLICATION: 200901034 LOC: 126 JUDY LANE SOUTH WINDSOR PROPERTY ID: 48600126 OWNER: LASSONDE LAURIE M & MICHAEL A CONTRACTOR: REQUEST BY: PROJ DESC: GARAGE ADDITION KITCHEN REMODEL WORK ORDER: INSPECTOR: ROSE RESULT: PASS REQUESTED: 09/17/09 PRIORITY: SCHEDULED: 09/22/09 AM COMPLETED: 09/22/09 UNPAID FEES 00 Date Time MILEAGE: 00 TIME: TRAVEL ONSITE COMMENTS ALL INSPECTIONS: INSPECTED INSPECTOR RESULT INSP DESCRIPTION 12/21/09 ROSE N/A B002 FOUNDATION 12/21/09 ROSE N/A B003 FRAMING (ROUGH) 12/21/09 ROSE N/A B004 INSULATION 12/21/09 ROSE N/A B005 FIREPLACE / CHIMNEY 12/21/09 ROSE N/A B006 WOOD / GAS STOVE 12/09/09 DOUG FAIL BO10 FINAL 12/18/09 DOUG PASS BO10 FINAL 12/21/09 ROSE N/A E001 ELECTRIC SERVICE 12/21/09 ROSE N/A E002 ELECTRIC UNDERGROUND 10/16/09 DOUG PASS E003 ELECTRIC ROUGH 12/21/09 ROSE N/A P001 WATER HEATER REPLACEMENT 12/21/09 ROSE N/A P002 PLUMBING UNDERGROUND 12/21/09 ROSE N/A P003 PLUMBING ROUGH 12/21/09 ROSE N/A P004 PLUMBING GAS TEST Electric# APPLICATION FOR BUILDING PERMIT Plumbing# 126 Judy Lane Date: HVAC # 800659 — Sprinkler# FINAL APPROVALS - Estimated Cost $ Buildin No g Permit Fee $ g COMPLETE RED BOXED AREAS Occupancy Fee $ Engineering TYPE OR PRINT ONLY Eng. Insp. Fee $ Affidavit Appr. for CO. o SIGN ON REVERSE SIDE Total F- $�r TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant_ 5 Location of Work ��( ��Z,n Lot No. Applicant's Address Ln Tel.# Town S', Zip 0 Lic.# Owner Z--en Lw-t—e e/Y1"a e/ ss Architect Owner's Address Architect's Address Zip Zip Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area_del Purpose of this permit re.C, rc,.n .'n City Water Well❑ Septic System❑ Sewe Ins: HO SP Cert. Area Baseme t Garage Approved by Date Use Gro Construction Type ��j a sod 6102 HIT f T I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required distances from all other zones and is located in which this building and its use is allowed. SignedP I hereby apply for a Certificate of Occupancy for the work described in this application for the permit. Signed DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS INSPECTION FIELD SHEET 05/13/14 Printed by Peart, Dayshell 11 54 54 INSPECTION: 19555 FOOTING PERMIT: STATUS: APPLICATION: 200801797 LOC: 126 JUDY LANE SOUTH WINDSOR PROPERTY ID: 48600126 OWNER: LASSONDE LAURIE M & MICHAEL A CONTRACTOR: REQUEST BY: PROJ DESC: REC ROOM IN BASEMENT WORK ORDER: INSPECTOR: DOUG RESULT: N/A REQUESTED: PRIORITY: SCHEDULED: COMPLETED: 02/26/09 UNPAID FEES 00 Date Time MILEAGE: 00 TIME: TRAVEL ONSITE COMMENTS ALL INSPECTIONS: INSPECTED INSPECTOR RESULT INSP DESCRIPTION 02/26/09 DOUG N/A B002 FOUNDATION 11/19/08 ROSE PASS B003 FRAMING (ROUGH) WALLS INSULATED AT THE TIME OF INSPECTION (SEE TEXT) NEED TO INSULATE BAND JOIST OWNER ADVISED ON THENEED ELECTRICAL PERMIT FOR WIRING DONE 02/26/09 DOUG N/A B004 INSULATION 02/26/09 DOUG N/A B005 FIREPLACE / CHIMNEY 02/26/09 DOUG N/A B006 WOOD / GAS STOVE 12/16/08 ROSE PENDING BO10 FINAL SEE TEXT FOR LIST BALUSTER TO STAIRS TO BE INSTALLED ELECTRIC BASE HEAT NOT IN PLACE QUERY ON PROVISION FOR COMBUSTION PROVIDE FOR BOILER AND WATER HEATER. OWNER TO REPLACE SMOKE DETECTOR REMOVED FOR PAINTING O1/28/09 ROSE PENDING BO10 FINAL LAURIE Q 860-992-3050//SEE TEXT GAVE OWNER INFO. RE:PROVISION FOR COMBUSTION AIR OWNER EXTEND AREA OF ALTERATION TO ENCLOSE WASHER AND DRYER.NEED TO PLACE INFO. ON APPLICATION. .r+ INSPECTION FIELD SHEET 05/13/14 Printed by Peart, Dayshell 11 54 54 COVER EXPOSED KRAFT PAPER TO INSULATION AS PER MANUF. 02/25/09 ROSE PASS BO10 FINAL 02/26/09 DOUG N/A E001 ELECTRIC SERVICE 02/26/09 DOUG N/A E002 ELECTRIC UNDERGROUND 11/19/08 ROSE PENDING E003 ELECTRIC ROUGH NEED ELECTRICAL PERMIT APPLICATION 02/26/09 DOUG N/A P001 WATER HEATER REPLACEMENT 02/26/09 DOUG N/A P002 PLUMBING UNDERGROUND 02/26/09 DOUG N/A P003 PLUMBING ROUGH 02/26/09 DOUG N/A P004 PLUMBING GAS TEST Electric# APPLICATION FOR BUILDING PERMIT Plumbing# 126 Judy Lane Date: S- 3 — o-S— HVAC # Sprinkler# 31657 NAL Estimated Cost '$.� G O O FI R Building?(� ®5 — COMPLETE RED BOXED AREAS Permit Fee $ 0 — Enginee 'n ; TYPE OR PRINT ONLY Occupancy Fee $ /<�, � Eng. Insp. Fee Affidavi $ Appr. for Co SIGN ON REVERSE SIDE Total Fee $ �5, 611 \\ TO THE I DI G DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ The undersigned hereby applies to do work according to the following: Applicant M i cha e_l 4 L,4 s so A_.>c1LE location of Work!a Co 7,ct.4 L,,?N Lot No. Applicant's Address / :I (a Tocam. L^N -Tel.# :�(0-a90-IS-L/L-/ Town So c)T'H i.y i •)cl s o r- F C_T Zip 0 c0 0 7 Y Lic.# Owner M i c-kq e_( N L.-s5'0,0&,& Architect Owner's Address 1, -(o i A-d Architect's Address SoJ-9� Ct Zip OHO>y Zip Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area Purpose of this permits l oTQ_4_ r-��s S�erQ- I D� n l fo City Water❑ Well❑ Septic System El Sewer❑ Ins: HO_ SP Cert. Area Basement Garage Approved by Date Use Group Construction Type Revised 6/02 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or sp ifications of the Building for which this permit is asked,and agree that this building is to be located the roper distance fr II street lines,side yard lines,and required distances from all other zones and is located in which thi buil g and its se i II Signed I hereby apply for a Certificate of Occupancy f r the k describ in thi lication for the permit, 1 Signe DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR cn-L BUILDING DEPARTMENT — APPROVE 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 01 Date Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: $0-$l,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT ,,AP. C APPLICANT ADDRESS Q t% `� V.,e,� Q. 4 C� o rosy 3`1 APPLICANT PHONE# S26,O cpa 5-1 5 3 014 N St OWNER OWNER ADDRESS a. �. OWNER PHONE C ESTIMATED COST$ ) O 0. O� .� IS THIS A CONTRACT COST? Yes _No �G (� FEE ENCLOSED$ `� ✓ 1 TYPE OF JOB: SCR C New Installation��" ration/Addition/Repair APPLICATION FOR PLUMBING PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED^ITH A BUILDING PERMIT APPLICATION? El YES El NO RESIDENTIAL ❑BUSINESS CURRENT USE AND OCCUPANCY Q,� ❑ASSEMBLY ❑MERCANTILE❑ EDUCATIONAL FUTURE USE AND OCCUPANCY ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE ❑ STORAGE ❑GARAGE ADDRESS ❑MIXED USE (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 ❑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 MANUFACTURER DESCRIPTIcON OF WORK � I� C et t 'e. �`�L�,e n 1►Yl 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. 4\..rn a037y a P L Ct CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE O h 4 la 9