HomeMy WebLinkAbout170 Mohegan Trail DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
TOWN OF SOUTH WINDSOR
Application is hereby: BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
IN
J
ate Building Inspector
Application must be printed or typed
Location of Job:
FEESCHEDULE 1-�
/0 �O e a
$0-$1,000= -e1b Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
- I
- -- - -
APPLICANT IXTGIc e Aefa VPnCe
APPLICANT ADDRESS
APPLICANT PHONE#
N Se
OWNER
OW
OWNER ADDRESS 70 092ct / Q I
(4 OWNER PHONE oio
C ESTIMATED COST$
U
flaw IS THIS A CONTRACT COST? Xyes ❑ No
_ FEE ENCLOSED$ �� •
1!Y TYPE OF JOB:
�SOR.Cp1`t
❑ New Installation
Alteration/Addition/Repair Revised 5101
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES A NO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑GARAGE
❑MIXED USE CITY STATE ZIP
TYPE OF INSTALLATIONIWIRING METHOD UNdfe—!qj-&nUj
li
SIZE OF SERVICE c700,0� SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS C�
NUMBER OF PANELS c REMOTE DISCONNECT REQUIRED?
❑YESNO
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
xa N o vO l DD Z�A- A,15 7
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.
J963yb 0z-Y C'T-
CONTRACTORS LICENSE NO. TYPE STAT
SIGNATURE OF APPLICANT DATE O
Shirle Wilhelm -CRS Approval Confirmation: Request No. 228082 Pa e 1
From: <clpsvc@nu.com>
To: <W ILHEL@SOUTHW INDSOR.ORG>
Date: 9/30/02 12:25PM
Subject: CRS Approval Confirmation: Request No. 228082
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 228082
House No: 170
Lot No:
Street Name: MOHEGAN TRL
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Sep 30, 2002