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HomeMy WebLinkAbout14 Bancroft Lane (4) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WIlVDSOR BUILDING DEPARTMENT APPR 1540 SULLIVAN AVENUE Bldg.Permit# U 644-2511 ext. 230 TO 3A '15ate Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: ga-nou Z'n. $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT Ln!�A APPLICANT ADDRESS 75- C l,� 4'L'� Alad G7"' ©6 off/ APPLICANT PHONE# e?6-0 6 71 �O W N S�� OWNER , OWNER ADDRESS OWNER PHONE C ESTIMATED COST$ /SOD IS THIS A CONTRACT COST? Yes ✓No f� FEE ENCLOSED$ 3� TYPE OF JOB: �SOR-Cps ✓New Installation Alteration/Addition/Repair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A RESIDENTIAL BUILDING PERMIT APPLICATION?KYES ❑NO ❑BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE FUTURE USE AND OCCUPANCY ❑EDUCATIONAL ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE ❑ STORAGE ❑GARAGE ADDRESS ❑MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD Gt SIZE OF SERVICE A-d SIZE OF MAIN CONDUCTORS NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS_Z ,f NUMBER OF PANELS_� REMOTE DISCONNECT REQUIRED? KYES LINO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK 0 J4 (ar - r—(e C R-7�— 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. 7"- CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE Shirle Wilhelm -CRS Approval Confirmation: Request No. 224502 Pa a 1 From: <clpsvc@nu.com> To: <WILHEL@SOUTHWINDSOR.ORG> Date: 9/25/02 2:35PM Subject: CRS Approval Confirmation: Request No. 224502 Your approval of the following CRS Request has been successfully processed. CRS Work Request M 224502 House No: 14 Lot No: 38 Street Name: BANCROFT LN Town Name: SOUTH WINDSOR, CT Inspector: JOHN COLLINS Approval Date: Sep 25, 2002