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HomeMy WebLinkAbout120 Bridlewood Road (5) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WIlNDSOR [-MN BUILDING DEPARTMENT PROVED 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 a Date Bu g Inspector Application must be printed or typed FEE SCHEDULE Location of Job: Ar $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT A aC APPLICANT ADDRESS�fU �,� C ©off APPLICANT PHONE# O N S OWNER / '4� OWNER ADDRESS 1-31) Oi0 _ OWNER PHONE ESTIMATED COST$ �- u IS THIS A CONTRACT COST? es No f� FEE ENCLOSED$ TYPE OF �New OR-C� 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 , RE"�SIDENTIAL BUILDING PERMIT APPLICATION? S ❑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 i� 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 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. I / 6-7- CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT v� DATE e�p—6 �� Shirley Wilhelm -CRS A royal Confirmation: Request No.232772 Page 1 From: <clpsvc@nu.com> To: <WILHEL@SOUTHWINDSOR.ORG> Date: 10/29/02 2:19PM Subj ct: CRS Approval Confirmation: Request No. 232772 Your approval of the following CRS Request has been successfully processed. CRS Work Request#: 232772 House No: 120 Lot No: 18 Street Name: BRIDLEWOOD RD Town Name: SOUTH WINDSOR, CT Inspector: JOHN COLLINS Approval Date: Oct 29, 2002