HomeMy WebLinkAbout12 Kelly Road (5) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: J�01 S3
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
G �� 644-2511 ext. 230 Bldg.Permit#
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
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$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT pt�577
APPLICANT ADDRESS GO 4&5,& — w—i2tw
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APPLICANT PHONE# 676 3
W N S F,q OWNER Co/E
OWNER ADDRESS
A OWNER PHONE
0
ESTIMATED COST$ S
IS THIS A CONTRACT COST? Jes No
_ FEE ENCLOSED$ S•
TYPE OF JOB:
OR*C0 New Installation
Alteration/Addition/Repair
Revised 4/01 H2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑YES ❑NO
SIDENTIAL
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 8U k&lf,-2
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS GA C 4-
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
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.
0S-7 9-9 L- .5-- C_+
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
• i
tyCO AD T Security Sermea Inc
10 Research Parkway
Fire &
Wallingford.CT 06492
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Security Tele 203 7414000
Fax 203 294 1514
ADT CT State be # 105 789
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MUNICIPALITY: S- i iv7�sow
JOB NAME:
START DATE:
JOB DESCRIPTION:
JOB COST:
PER PUBLIC ACT 91-95
THIS LETTER AUTHORIZES T*b) Hh9-vj-
TO SIGN PERMIT AS AN AGENT OF ADT SECURITY SERVICESJNC
FOR THE ABOVE MENTIONED JOB AND MUNICIPALITY
APPLICABLE LICENSE:
LICENSE # : 00105789
SIGNED: `
Shirley Wilhelm -CRS Approval Confirmation: Request No. 238241 Page 1 a
From: <clpsvc@nu.com>
To: <W ILHEL@SOUTHW INDSOR.ORG>
Date: 4/16/03 4:02PM
Subj ct: CRS Approval Confirmation: Request No. 238241
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 238241
House No: 12
Lot No: 1
Street Name: KELLY RD
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Apr 16, 2003