HomeMy WebLinkAbout176 Margaret Drive (3) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR /�O�-
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
v�
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of 1
0
/7!�
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT CoAj S 7.4-,4/7 R)6,ve1z-
APPLICANT ADDRESS SQ S gcfF-F G <�
ll��r 6-7. 060P-�-1
APPLICANT PHONE# F?
ow N s F OWNER
q� OWNER ADDRESS 11(o �4i"g 4✓L�' vet
M OWNER PHONE
C ESTIMATED COST$ 3 0 0 O. — j
V
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ q:� �--
TYPE OF JOB:
SOR-CO New Installation
Alt eration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED.. ' A
BUILDING PERMIT APPLICATION? U 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 2�Uv� SIZE OF MAIN CONDUCTORS �� c
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS / REMOTE DISCONNECT REQUIRED? ❑YES ❑'1q—O'
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES 16 NUMBER OF OUTLETS 5 e)
NUMBER OF LIGHT FIXTURES 4:5' NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS -�--
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
12- tf lea o--1 rIA
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 G z,6 �=/ C47
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT
DATE ff—Z 2'_—d
Shirley Wilhelm -CIRS Approval Confirmation: Request No. 238545 Page,1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 1/10/0311:54AM
Subj ct: CRS Approval Confirmation: Request No. 238545
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 238545
House No: 176
Lot No:
Street Name: MARGARET DR
Town Name: SOUTH W INDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Jan 10, 2003