HomeMy WebLinkAbout15 Jean Lane (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 c,2�3 15�
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �US7.��v7 4L✓
APPLICANT ADDRESS SCa S OFF
APPLICANT PHONE# -7 '3 v 2 S
N S OWNER . /Y'L �AQ 3 lrl oz-
£4 OWNER ADDRESS 15
OWNER PHONE -
0
C ESTIMATED COST$ 3U 0
IS THIS A CONTRACT COST? Yes <
f� FEE ENCLOSED$
TYPE OF JOB:
�SOR-C�� New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? U-YV-S ❑NO
N RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS V16 ,4 r
NUMBER OF METERS / NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES U'T TO
NUMBER OF LIGHT CIRCUITS Z— NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES !0 NUMBER OF OUTLETS �—' d
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
edo 4C 'I J� I
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.
IF3 6 Z16 C-- / C7
CONTRACTORS LICENSE NO. TYPE STATE
- --- DATE S U
SIGNATURE OF APPLICANT � G�
Shirley Wilhelm -CRS Approval Confirmation. Request No. 249783
Pa a 1`
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 4/1/03 4:11 PM
Subj ct: CRS Approval Confirmation: Request No. 249783
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 249783
House No: 15
Lot No: 139
Street Name: JEAN LN
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Apr 01, 2003