HomeMy WebLinkAbout109 Benedict Drive CRS # 232843
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN O SOUTH WINDSOR PERMIT#
Applicatio 963
BUILD G DEPARTMENT l
APPROVED 1540 SU� LIVAN AVENUE
b 2 � 64 Bldg.Permit#-2511 ext. 230
Date Bui ng Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
109 Benedict Drive
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
I
APPLICANT Joseph Dumas
APPLICANT ADDRESS 55 Winter St.
Manchester Conn.
APPLICANT PHONE# 646-5 2 5 3
OW N Se OWNER John Dougenik
;k q< OWNER ADDRESS 109 Benedict Drive South Windsor Conn.
der' A.# E,, OWNERPHONE 044-4343
ESTIMATED COST$ 5 0 0.0 0
�~ IS THIS A CONTRACT COST? ❑Yes ❑ No
FEE ENCLOSED$ 1
�SOR. � TYPE OF JOB:
IM New Installation
0 Alteration/Addition/Repair Revised 5101
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑ YES ❑ NO
❑RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITLJTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑GARAGE
❑MIXED USE CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD Temporary Service
SIZE OF SERVICE 10 0 a SIZE OF MAIN CONDUCTORS # 2 a 1
NUMBER OF METERS 1 NUMBER OF DISCONNECTS AND RATINGS 1-10 Oa
NUMBER OF PANELS 1 REMOTE DISCONNECT REQUIRED? ❑YES LJ'NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS 2—gf i
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
Install temporary service while house addition is
being completed.
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.
E-102888 E-1 Conn.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE October 2 3, 0 2
Shirley Wilhelm -CRSApjproval Confirmation: Request No. 232843 F Pa e 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 10/29/02 2:18PM
Subject: CRS Approval Confirmation: Request No. 232843
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 232843
House No: 109
Lot No:
Street Name: BENEDICT DR
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Oct 29, 2002