HomeMy WebLinkAbout21 SHARES LN UNIT 1 I
APPLICATION FOR PLUMBING PERMIT
TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT
1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074(PHONE) 860-644-2511 EXT. 230
DEPARTMENT DECISION PERMIT NUMBER:
APPLICATION IS HEREBY: 'd ocu l � I
APPROVED: BLDG.PERMIT NUMBER:
D �a
DATE INSPECTOR
LOCATION OF WORK:
APPLICANT: OWNER: TYPE OF STRUCTURE:
(� O NEW BUILDING
NAME:�,F-IC.� 1 L�--� NAME: �K�QJ l I"1Q �' 1Q�.I¢ ❑ADDITION
PHONE NUMBER:
tw- -.X�•��gla PHONE NUrM�BER:� LALA �y� EXISTING BUILDING
ADDRESS: e J m�� w 5 ADDRESS:o 1 �rC S
-c Ocoo to `, w t` L<4( .1 Cy TYPE OF USE:
V
RESIDENTIAL 0 COMMERCIAL
PLUMBIING'INFORMATION:` ���/' FURTHER DESCRIPTIION1 OF WOR/K::,�.� �/
TYPE OF INSTALLATION:w( U "C_L-�cf ��`A 1L�•'� a(��,1�p ria Vr w
NO.OF TOILETS: STYLE: NO.OF BATHTUBS: Q `�( C�► L�V
NO.OF SHOWERS: NO.OF LAVATORIES:
NO.OF CATCH BASINS: NO.OF FLOOR DRAINS:
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY WINDOW? tow
�' (�(�
OYES oNO ESTIMATED COST: S `o`�'�
SIZE OF WINDOW: SIZE OF DUCTS: Q
SEWER OR SEPTIC TANK: FEE ENCLOSED:$ , b•00
SIZE OF WATER PIPING AND RISER: a /�
WATER HEATER: TYPE _ MANUFACTURER
FEE SCHEDULE:$18 PER$1,000 OF THE ESTIMATED COST.
ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT IS
$1.00 OVER. (.26 CENT EDUCATIONAL FEE INCLUDED AS PART
OF THE PERMIT FEE)
THE UNDERSIGNED HEARBY 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 PERFOMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO.: TYPE: STATE: ell
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SIGNATURE OF APPLICANT: DATE: �L�I
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