HomeMy WebLinkAbout1655 BASSWOOD AVE; ; SE669483; PermitBUILDING DEPARTMENT
PERMIT OWNER'S
AUTHORIZATION
FOR APPLICANT TO FILL IN
LEGAL DESCRIPTION LOT NO.
LICENSE NO. LICENSE NO.
$200
NO. DESCRIPTION OF WORK FEE! I
HOUSE SEWER CONNECTING TO PUBLIC SEWER
SEPTIC TANK. SEEPAGE PIT OR
OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.,
SIGNED THIS DAY 6F OWNER OR OWNER'S AGENT
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE RCAD THIS
SIGNATURE OF PERMITTE
4 rr h 4 BUILDING ADDRESS
NEAREBT CROSS ST. ' 1 ,, _<
OWNER
MAIL ADDRESS
TE& NO.
CONNECTION DATA
CITY PA* /s lAd
Lateral Charge Computation
30' H., to' V.
Add. Horiz. @ 4" = __ 6* = -
Add. Vert. @ 4" = - 6" = I_
Total Conshidon Cost
@ 4" = __ 6" = - .-
10% Service Charge
Total Lateral Charge
Lat. No.: Lqqed in Ptat:
LINE COST DATA
A. D. & Assmt. No.
LINE COST:
C. C. 8- / dwelling
P. S. @- / dwelling
OTHER
TOTAL
Grand Total, Lstersl, &c.
FOR SEWER LOCATION
st. NORTH
SEWER DER. ENGINEERING
Signed I 1 Signed
/ fls a Sewer PdWhen Properly Filled Out, Signed and Validabd
Issued By -- . - PERMIT VALIDATION
BUILDING DEPARTMENT
2-
3
z
-
1 ( ,
/
'-ICENSE NO. LICENSE NO.
TOILET @ $1.25 7 f u
BATH TUB 0 1.25 s"
WASH BASIN 8 1.25 3 7 i-
KITCHEN SINK @ 1.28 / 21
DISHWASHER Q 1.25 { 21
AUTOMATIC WASHER @ 1.25 tl
SHOWER 8 1.25
LAUNDRY TUB OR TRAY @ 1.25
APPROVALS DATE
/ WATER HEATER L VENT @ 1.50
GAS SYSTEM 1 TO 15 .30 EA. ADD. @ 1.50 l
INSPECTOR'S SIGNATURE
FLOOR DRAIN OR SINK @ 1.25
LAWN SPRINKLER
MISC. WATER PIPING
GARBAGE DISPOSAL
VACUUM BREAKER OR BACK
@ 1.00
FLOW DEVICES 1 TO 5 6%' 2.00
I
I REGULATING PLUMBING.
~6 GRADING PLAN
I ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS
I CERTIFY THAT I AM PROPERLY REGISTERED AND LI-
BUILDING ADDRESS
NEAREST / CROSS ST.
GROUP 1 ZONE
Inspec+ion Record
UNDER FLOOR WORK
ROUGH PLUMBING
GAS PIPING
GAS VENTS
PLUMBING FIXTURES
MISC.
UTILITY CO. NOTIFIED
FINAL
VAL1 DAT I ON perly Filled Out, Signed and validated. ed within 60 days of date of issuance.