HomeMy WebLinkAbout206 WYNDEMERE CT BLDG 2 DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR O p 13Q
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
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644-2511 EXT.230 Bldg.Permit#
(Date (Building Inspecctor)
Application must be printed or typed
FEE SCHEDULE rr Location Job:
2. b \/--,/ �/n I e— C`c`c1 e C
$04I,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
APPLICANT ADDRESS C—
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APPLICANT PHONE# 2-q\— (3 \ \S
OWN SF OWNER S ySC)L `n e- �c W oICU
At '4� OWNER ADDRESS e✓
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C/J 1 OWNER PHONE N U)
Q #•I 0 0
C ESTIMATED COST $ 3 0 O C\
IS THIS A CONTRACT COST? G AYES NO
F
FEE ENCLOSED$ S
0 0
TYPE OF JOB:
0 •COS New Installation
✓Alteration/Addition Repair
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Revised 12/22/11
APPLICATION FOR PLUMBING PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
WIRESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ErNO
13 BUSINESS
O ASSEMBLY CURRENT USE AND OCCUPANCY
O MERCANTILE
O EDUCATIONAL FUTURE USE AND OCCUPANCY
O FACTORY
O STORAGE ENGINEER'S NAME PHONE
O GARAGE
O 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 MANUFACTURER
DESCRIPTION OF WORK
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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.
2--0 > S9,g � - 1 c7v _
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE S