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HomeMy WebLinkAbout171 Beelzebub Road (4) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR M3RO BUILDING DEPARTMENT APPRO 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 ate Building Inspector Application must be printed or typed L tati n ofJb: FEESCHEDULE nl �e� _ev $0-$1,000=$13.00 Street No. Street Lot No. Over$1,000= $13.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT ao Pal j APPLICANT ADDRESS ©N APPLICANT PHONE# ��{$ �0 90 W N S OWNER ' r�$ A O 101 OWNER ADDRESS a �v��w► OWNER PHONE 3 I ESTIMATED COST$ LOAD .O 0 IS THIS A CONTRACT COST? 0 Yes L4-N6�- FEE ENCLOSED TYPE OF JOB: OR CO LfNew Installation 13 Alteration/Addition/Repair Revised 8/99 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED A BUILDING PERMIT APPLICATION? S ❑NO SIDENTIAL ❑BUSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE FUTURE USE AND OCCUPANCY ❑EDUCATIONAL ❑INSTITUTIONAL ENGINEER'S NAME PHONE ❑FACTORY ❑ STORAGE ADDRESS ❑GARAGE ❑MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD -2m SIZE OF SERVICE L SIZE OF MAIN CONDUCTORS 6 NUMBER OF METERS ( NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS_� REMOTE DISCONNECT REQUIRED? ❑ YES ❑NO 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 ote :s 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. )"� 9-7B5 1 CONTRACTORS LICENSE NO. STATE SIGNATURE OF APPLICANT DATE 9—2 1 Shirley Wilhelm--CRS Approval onfirmation: Request No. 181513 Page 1 From: <clpsvc@nu.com> To: <WILHEL@SOUTHWINDSOR.ORG> Date: 10/10/01 2:13PM Subj ct: CRS Approval Confirmation: Request No. 181513 CRS Work Request M 181513 House No: VP (V e-Be,e 1 Z e 6 Lot No: 2 Street Name: Inspector: JOHN COLLINS Approval Date: Oct 10,2001