HomeMy WebLinkAbout105 Edgewood Drive DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WIlVDSOR PERMIT#
Application is hereby: 7 �/O
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
Q L 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE eJ odd./ Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS sr
(X�U�
APPLICANT PHONE#
O W N S 4t OWNER
OWNER
t
_I i j YS
OWNER PHONE
C ESTIMATED COST$ 1�4 O() _C)O
,� �'�► IS THIS A CONTRACT COST? Yes �No
FEE ENCLOSED 6b e
TYPE OF JOB:
OR-C New Installation
-1.2Alteration/Addition/Repair
Revised 4/01//2002
1
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
/ BUILDING PERMIT APPLICATION? ❑YES ❑NO
5,d'RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL PHONE
❑FACTORY ENGINEER'S NAME
❑ STORAGE
O 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
-ProLoQ C)
r
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.
ISV13C0 �- 1 0 T.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OR APPLICANT C�• A
DATE
� — oZ
Shirley Wilhelm - CRS Approval Confirmation: Request No. 219704 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 8/2/02 4:04PM
Subject: CRS Approval Confirmation: Request No. 219704
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 219704
House No: 105
Lot No:
Street Name: EDGEWOOD DR
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Aug 02, 2002