HomeMy WebLinkAbout121 Maskel Road (4) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230 02 7ytl0
Efate Building Inspector
Application must be printed or typed
FEE SCHEDULE Loc n of Jo
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$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
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APPLICANT 7:pco 1
APPLICANT ADDRESS O '��r&N o a,
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APPLICANT PHONE# �
O W N S t OWNER . 4
q< OWNER ADDRESS
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OWNER PHONE 7
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OESTIMATED COST$
vt � IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ S•O`7
TYPE OF JOB:
�S01R.CQ� New Installation
c-'Al teration/Ad n/Repair
Revised 4/01//2002
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APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? BYES El NO
RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY e
❑ASSEMBLY /
❑MERCANTILE FUTURE USE AND OCCUPANCY l+0 ell tf
❑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 90D SIZE OF MAIN CONDUCTORS
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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
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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.
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CONTRACTORS LICENSE NO. TYPE STATE
a DATE c3��/�0 3
SIGNATURE OF APPLICANT
Wilhelm Approval--Confirmation:--ke, 248758-,--
Shirley
From: <cipsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 5/13/03 2:42PM
Subj ct: CRS Approval Confirmation: Request No. 248758
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 248758
House No:
Lot No:
Street Name: V44ASKELL RI?
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: May 13, 2003