HomeMy WebLinkAbout176 Oak Street (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: r Y2
BU11,DING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
at Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �j 0 oM-�i f t(A E E[C.+r t c- - K C-V i r1 C A(h O LLn
APPLICANT ADDRESS 3 A I Crq R d g e
Cromwell CT 0(04tlD
APPLICANT PHONE# S(oO — (o 3 a - S-44 9
At OW N S OWNER ROber + GeoF�tly
q� OWNER ADDRESS i `~((o O A K 5 t
" L C��'l� �, SO dz
'= OWNER PHONE f p qL4— gJ940
C
C ESTIMATED COST$ , �d - 00
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IS THIS A CONTRACT COST? B'Yes 0 No
FEE ENCLOSED$ 30.d 0
TYPE OF JOB:
sOR O CO 0 New Installation
B/Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED RESIDENTIAL WITH AA/
BUILDING PERMIT APPLICATION? ❑ YES �40
❑BUSINESS CURRENT USE AND OCCUPANCYL-
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY 2G S fd e,+r'A L
❑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 Z o d A SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS O —
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES ❑NO
NUMBER OF LIGHT CIRCUITS _ NUMBER OF POWER CIRCUITS _
NUMBER OF SWITCHES 1,0 OF OUTLETS
NUMBER OF LIGHT FIXTURES I g NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS j
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
Dy a5 7 .7 9 L/
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 DATE Jr/2/0 3
Shirle` Wilhelm-CRS 8paroyall Confirmation: Re uest No. 257794 r a w . Pale 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 6/12/0311:10AM
Subj ct: CRS Approval Confirmation: Request No. 257794
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 257794
House No: 176
Lot No:
Street Name: OAK ST
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Jun 12, 2003