HomeMy WebLinkAbout143 ROBERT DR DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
p 1540 SULLIVAN AVENUE Bldg.Permit#
3/�2— 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE F
Location of Job:
$0-$1,000=$15.00 Street Lot No.
Over$1,000=
$15.00 per$1,000or any fraction thereof gnation Apt.No.
APPLICANT J - 0 ad r r C- ev,
APPLICANT ADDRESS /`
Op t u
APPLICANT PHONE# y,
OWN SF
OWNER J O
q< OWNER ADDRESS
cod s OWNER PHONE rR G I cl C
C = ESTIMATED COST$ ,�`(�(� OU
} IS THIS A CONTRACT COST? es _No
�r. FEE ENCLOSED$
TYPE OF JOB:
SO R-C� _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
BUILDING PERMIT APPLICATION? ❑ YES ❑NO
❑RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE F U'I'URE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑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 ❑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
JJDESCRIPTION OF WORKTHE UNDERSIGNED HEREBY APPLIES FOR A PERMI F I I 1 40 PERFORM I HE WORK DESCRIBED AND IS I
/
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
P- i C-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT J DATE "� �U