HomeMy WebLinkAboutElectrical Permit-160 Maskel Road DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby:
TOWN OF SOUTH WINDSOR PERMIT#BUILDING DEPARTMENT �?.2-(L/S>
APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
675 JA-- 644-2511 ext. 230
a Building Inspector
Application must be printed or typed
Fo
EE SCHEDULE Location of Job:
(coo
-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
ny fraction thereof Tenant Designation Apt.No.
APPLICANT 01--
APPLICANT ADDRESS 6 - l
APPLICANT PHONE#
OWN S OWNER _
OWNER ADDRESS
0
OWNER PHONE L29 LI
ESTIMATED COST$ r ��
U
IS THIS A CONTRACT COST? K0 Yes ❑ No
FEE ENCLOSED$ S 6 0
�SOR.COS TYPE OF JOB:
97t-New Installation
Alteration/Addition/Repair Revised 5101
1
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
SIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES (;&NO
BUSINESS CURRENT USE AND OCCUPANCY �-
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY _r
❑ EDUCATIONAL
❑INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑GARAGE
❑MIXED USE CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
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
( C_ GarK-0 i4�i c4`%C)i4M 10
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.
CONTRACTORS LICENSE NO. TYPE STATE
DATE
SIGNATURE OF APPLICANT o�
S�6�He-111 11.11, 11-141-11-1-11 1 1". 41 1 1 11 111.1 A--x�.1 11 .1111,�el�I 0—��"-
Y
Wilhelm -CRS Approvals Confirmation: Re.. Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 5/1/03 2:08PM
Subject: CRS Approval Confirmation: Request No. 257035
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 257035
House No: 160
Lot No:
Street Name: MASKELL RD
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: May 01, 2003