HomeMy WebLinkAbout17 Brookfield Street (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT / S�
APPROVED 1540 SULLIVAN AVENUE �Y
hDatLe
Bldg.Permit#
Bui ing I ector 644-2511 ext. 230
Application must be printed or typed
FEE SCHEDULE Location of Job: "o
1 7
$0- $1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000 .
or any fraction thereof Tenant Designation Apt.No.
APPLICANT I C
APPLICANT ADDRESS 1 -7 �(,�p t.
C'4- O(DCJ7q
APPLICANT PHONE#
4�O 4 N 8
4. OWNER
OWNER ADDRESS
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OWNER PHONE
ESTIMATED COST$ Q��—
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IS THIS A CONTRACT COST? 13 Yes No
1 :• �� FEE ENCLOSED$ Q
OR-CO TYPE OF JOB:
�A/Original Installation
MOAlrcic`_on/Addition/Repair Revised 8/99
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1
APPLICATION-FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH
RESIDENTIAL
BUILDING PERMIT APPLICATION? ❑ YES ZC
❑BUSINESS CURRENT USE AND OCCUPANCY F'�`��ate`
❑ASSEMBLY T
❑MERCANTILE FUTURE USE AND OCCUPANCY de
❑ EDUCATIONAL
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑ GARAGE
❑MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD 'yt C�-' �� _ I nch
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED 'i tl'
4
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
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.
7 g,Yxeowner- I(q' ( ?o
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 3 r
o n Collins-CRS ApprovalConfirmation: Request No. 169670age
From: <clpsvc@nu.com>
To: <COLLIN@SOUTHWINDSOR.ORG>
Date: 6/7/01 3:44PM
Subject: CRS Approval Confirmation: Request No. 169670
CRS Work Request M 169670
House No: 17
Lot No:
Street Name:
Inspector: JOHN COLLINS
Approval Date: Jun 07, 2001