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DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby:
TOWN OF SOUTH WINDSOR -7 77/-
PERMIT#
_ BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS f'�� &2N
V,�F-AnkxkJ G7- - 06G%
APPLICANT PHONE# V 7a jq
N S OWNER E,4L 7r�`
W _ ®
OWNER ADDRESS L,, r✓G�`�l N
OWNER PHONE
0
x ESTIMATED COST$ -
r� V
!�:► ��' IS THIS A CONTRACT COST? XYes ❑ No
j, FEE ENCLOSED$ . 00
y(
OR.CO TYPE OF JOB:
xNew Installation
11 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? ❑YESA NO
SIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY O,EA�
❑EDUCATIONAL
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑STORAGE ADDRESS
❑GARAGE
❑MIXED USE CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE (�OO SIZE OF MAIN CONDUCTORS O P L
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS -d00,"/n
NUMBER.OF PANELS=` ��. � 4RE TE DISCONNECT RE, U kED? t]YES d,40
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES c� NUMBER OF OUTLETS O
NUMBER OF LIGHT FIXTURES �� NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS I
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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT /G'l/ ��"yJ DATE
Shirley Wilhelm- CRS Approval Confirmation: Request No. 211053 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
'r Date: 6/12/02 12:09PM
Subject: CRS Approval Confirmation: Request No. 211053
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 211053
House No:
Lot No:
Street Name: fS CASTLEWOOD DR
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Jun 12, 2002
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