HomeMy WebLinkAbout1279 JOHN FITCH BLVD DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
PERMIT#
TOWN OF SOUTH WINDSOR
Applicatio reby:
BUILDING DEPARTMENT
ROVE 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
Date Building Inspe r
Application must be printed or typed
FEE SCHEDULE c" Location of Job:
12. 7 FTI-I /3 z 00
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT SITF tjSnl'� ) —-
APPLICANT ADDRESS /2- 'T/LOV ![ OA-9 --
,co, �j /Np,5,0/ /t - ! J� 0-7 ( -
APPLICANT PHONE# q-Z 6-- V O �
OWN S F,q OWNER I"l A-S N F_ 7-A P-O J,ti/Z a ti. /?/IA E-N
OWNER ADDRESS 12-7 S' iJ U H N F! � H & *
� � So �✓ �n!p s o11,
.a # OWNER PHONE �Z— �} U
0 _
C = ESTIMATED COST$ 1:20
IS THIS A CONTRACT COST? _Yes No
FEE ENCLOSED$
TYPE OF JOB:
SO R•C0 New Installation
4Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR PLUMBING PERMIT (continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
❑RESIDENTIAL BUILDING PERMIT APPLICATION? ElYES gNO
❑BUSINESS CURRENT USE AND OCCUPANCY lJ 0 51 N F_ 5 5
❑ASSEMBLY
❑MERCANTILE❑ EDUCATIONAL FU.I.UR 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
DESCRIPTION OF WORK
x l.fl J 7,16- 6^-14r s Z—i/V/I 6r +5 Z-- 2 N4 f�i4-s
LA-
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 D 11.)2v 0