HomeMy WebLinkAbout108 Birch Hill Drive FDERTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
plication is hereby: l Q
BUa,DING DEPARTMENT
APPR 1540 SULLIVAN AVENUE Bldg.Pernrit#
644-2511 ext. 230
W16 k-2
Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT /✓d�����.- 'S
APPLICANT ADDRESS
APPLICANT PHONE#
OWN S� OWNER ,
4� OWNER ADDRESS
OWNER PHONE /- O
ESTIMATED COST
�, '�► IS THIS A CONTRACT COST? Yes o
�G FEE ENCLOSED$ ICJ
TYPE OF JOB:
SCR CO New Installation
' ation/Addition/Repair
Revised 4/01//2002 j
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APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BMDING IS THIS APPLICATION ASSOCIATED WITH A
SIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑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
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
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
L/&, zr-
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.
CONTRACTORS LICENSE NO. T STATE
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SIGNATURE OF APPLICANT � '�` DATE
=Shirley Wilhelm -CRS Approval Confirmation: Request,No 11. 238038 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 1/24/03 8:56AM
Subject: CRS Approval Confirmation: Request No. 238038
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 238038
House No: 108
Lot No:
Street Name: BIRCH HILL DR
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Jan 24, 2003