HomeMy WebLinkAbout1370 Main Street DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT /LF6
APPRO — 1540 SULLIVAN AVENUE
Bldg.Permit#
uffauL Joc— 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Jo
7
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �=✓�7�l
APPLICANT ADDRESS 38 � ���G✓ �� 41:)
APPLICANT PHONE# 7.2
o w N S OWNER . 1�s9�✓ z4'A-)
q� OWNER ADDRESS f .y 70
,
0
OWNER PHONE
ESTIMATED COST$ G d
a
IS THIS A CONTRACT COST? Yes No
_ r FEE ENCLOSED$
TYPE OF JOB:
�soR,Co�
New Installation
Alteration/Addition/Repair
Revised 4101 H2002
i
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑ YES ❑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
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS U
NUMBER OF METERS l 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.
/ �Z-
CONTRACTORS LICENSE NO. T E STATE
DATE
TE
SIGNATURE OF APPLICANT ��
Shirley Wilhelm -CRS Ap rovahConfirmation: Request No. 239391 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 1/2/03 4:16PM
Subj ct: CRS Approval Confirmation: Request No. 239391
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 239391
House No: 1370
Lot No:
Street Name: MAIN
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Jan 02, 2003