HomeMy WebLinkAbout104 Ident Road (3) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR 11859
BUILDING DEPARTMENT
APPRO E 1540 SULLIVAN AVENUE Bldg.Permit#
3�
UL � 644-2511 ext. 2309
ate Building Inspector
Application must be printed or typed
Locati n of Job:
FEE SCHEDULE loll QO+- -
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT go
APPLICANT ADDRESS d0,10
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U
APPLICANT PHONE#
WN S OWNER
'
�q� OWNER ADDRESS
i
OM OWNER PHONE
C ESTIMATED COST$ d
IS THIS A CONTRACT COST? Yes No
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FEE ENCLOSED$ �-
TYPE OB:
TNew
OR•C0 Installation
Alteratio dditio epair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? { YES ❑NO
RESIDENTIAL
❑BUSINESS
❑ASSEMBLY CURRENT USE AND OCCUPANCY -- -
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY _ R'S NAME PHONE
❑STORAGE
r
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATIO G 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
J� v
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 CODE IN THE
PERFORMANCE OF SUCH WORK.
1 D3141l?'
CONTRACTORS LICENSE NO. T E STATE
SIGNATURE OF APPLICANT DATE 0 C
Wilhelm I'm— -CRS"A"p 'o-n-fir,rma-io Shirley p n: R�yest No. 235240
Pap,roval C
From: <clpsvc@nu.com>
To: <WILHEL(§SOUTHWINDSOR.ORG>
Date: 4/14/03 2:27PM
Subject: CRS Approval Confirmation: Request No. 235240
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 235240
House No: 104
Lot No:
Street Name: (DENT RD
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Apr 14, 2003