HomeMy WebLinkAbout117 Bridlewood Road (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT —Z Y0 Y
IRrrzeerra�
"""'^�� 1540 SULLIVAN AVENUE Bldg.Permit#
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A/w
L _ 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE //7 `-BRJba0 O 0 3 A-b-
$0-$1,000= Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 16/0tD #y F!E C•b E C?-A-/ C
APPLICANT ADDRESS 3
d CQ Cf (40
APPLICANT PHONE# tea d
OWN S OWNER ; -CJ� B C�-/l�
q� OWNER ADDRESS �• y^�� -�'�- S• '�y �4-e `�C
OWNER PHONE 7Sr 5 - a c
C ESTIMATED COST$ 7�ado
IS THIS A CONTRACT COST? des 0 No
CJ FEE ENCLOSED$ l0
TYPE OF JOB:
dsOR.Cps
w Installation
13 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
V, BUILDING PERMIT APPLICATION?RYES El NO
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❑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
SIZE OF SERVICE 7 oo 4"'t SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES M(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
�.c)�/l.<� .,lam � ��•�— � 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.
/ate k/ �F,-/ C-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE �8 6�
[ShirleyWilhelm -CRS Approval Confirmation: Re uest No.232113
From: <cipsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 12/20/02 4:07PM
Subject: CRS Approval Confirmation: Request No. 232113
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 232113
House No: 117
Lot No: 17
Street Name: BRIDLEWOOD RD
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Dec 20, 2002