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Home My WebLink About2759 ELLINGTON RD r DEPARTMENT DECISION APPLICATION FOR PLUMBING PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT __ao oaf APPRO D 1540 SULLIVAN AVENUE - Bldg.Permit# 644-2511 ext. 230 Date Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: FTenantDesignation $0-$1,000=$15.00 Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Apt.No. APPLICANT Q nA o a", APPLICANT ADDRESS 516 n�:S� ah Cx.. 0j��\z Cz APPLICANT PHONE# 6Cc3) 'W- a` '-I5 o W N S F,q OWNER Qa�ocs4 W,l do r OWNER ADDRESS D151 O .o OWNER PHONE C ESTIMATED COST$ '115 IS THIS A CONTRACT COST? _Yes _No FEE ENCLOSED$ t S SO O�� TYPE OF JOB: 4:pco yz R C New Installation Alteration/Addition/Repair zvl2oa9� ( Revised 4/01H2002 • APPLICATION FOR PLUMBING PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A UJ 1 RESIDENTIAL BUILDING PERMIT APPLICATION? ❑YES ❑NO ❑BUSINESS CURRENT USE AND OCCUPANCY ❑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 DESCRIPTION OF WORK R4a. ,L Sy:�C i rr� 6� `/� &U S�rl� •CA��r�� ,n�o -I I HE=ERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND is TT— 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 A6— Db1 1 MWOUg-11411 -1 M � PLUBING&PIP Uij?#:� *Q�N1bR ,n. sco Vito ��B( p # 7-1431 ' 'LM.0277688-P1 v 'U� +` 10/31/2012 SIGNED Licensed Contractor/Agent Authorization Form Connecticut General Statutes Sec 2-338b. Building permits applications. Who may sign? Any Licensed contractor, as defined in section 20-330,who seeks to obtain a permit from a building official, may sign the permit application personally,or such licensed contractor may delegate the signing of the building permit application to an employee,subcontractor or other agent if the agents submits to the building official a dated letter on the licensed contractor's letterhead,signed by licensed contractor,stating that the bearer of the letter is authorized to sign the copy or a facsimile,but shall be an original letter bearing the original signature of the licensed contractor. The letter shall also include: (1) the name of the municipality where the work is to performed (2) the job name or description of the job (3) the starting date of the job (4) the name of the licensed contractor(5) the name of the licensed contractor's agent; and (6) the license number of All contractors who shall be involved in the work. Roto-Rooter Services Company 576 Christian Lane Berlin, CT 06037 (860) 356-2545 Date: I,Scott Coutant authorize: � yC- a`C.P (agent) To sign the building permit application as my agent to perform work at: Address: job name or description: R1V\r(`(-k- ` 0� L`} t�L� vim[a 1Co.�evv.inh�, Starting Date: 65 License type and number P-10277688 Agent signature: Licensed Contractor Signature: ,� -- 1200278 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER PLUMBING PERMIT DATE: 07/31/12 GIS ID: 30302759 FEE: 15.00 MUNIS APPLICATION# 201200971 BUILDING DESCRIPTION: APPLICANT ' LOCATION NAME: ROTO ROOTER ADDRESS: 2759 ELLINGTON ROAD ADDRESS: 576 CHRISTIAN LANE OWNER: WILDER ROBERT E JR BERLIN,CT 06037 2759-ELLINGTON ROAD SOUTH WINDSOR,CT 06074 DESCRIPTION OF WORK: REPLACE SECTION OF 1/2 COLD WATER LINE FROM KITCHEN SINK CABINET INTO BASEMENT. SPECIAL CONDITIONS: ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 7/31/2012 12:39 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE