HomeMy WebLinkAbout16 Kelly Road (4) Cr2s#, Z 3 9 zy2
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT 1
APPR 1540 SULLIVAN AVENUE Bldg.Permit#
vL 644-2511 ext. 230 A -7�
ate Buil ing Inspector
Application must be printed or typed
FEE SCHEDULE f Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT I'L \krW vc, L+r I C"
APPLICANT ADDRESS 0 4 (!(►' r�,� S S t
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APPLICANT PHONE# �—
O W N S OWNER . ,su G D
q� OWNER ADDRESS A// 1211�
0
OWNER PHONE Oil �7 ZZ ��
C a ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
(� FEE ENCLOSED$ S QO.
TYPE OF J
� iOR'C0� New Installation
Alteration/Addition/Repair
Revised 4/01//2002
i
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑ YES El NO
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 R46 1 At,,n F--{
SIZE OF SERVICE 40 t SIZE OF MAIN CONDUCTORS 4
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS I 36
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES iNO
NUMBER OF LIGHT CIRCUITS �a NUMBER OF POWER CIRCUITS 5
NUMBER OF SWITCHES NUMBER OF OUTLETS YO
NUMBER OF LIGHT FIXTURES 2,4 NUMBER OF HEAT CIRCUITS _
NUMBER OF A/C CIRCUITS I
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
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tj 1
IJ
404
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.
tl 7/� r
CONTRACTORS LICENSE NO. ` TYPE STATE
SIGNATURE OF APPLICANT
DATE �---
Shirley Wilhelm -CRS Approval Confirmation: Request No. 238242 Page 1
From: <cipsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 3/7/03 8:34AM
Subj ct: CRS Approval Confirmation: Request No. 238242
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 238242
House No: 16
Lot No: 2
Street Name: KELLY RD
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Mar 07, 2003