HomeMy WebLinkAbout157 Natsisky Farm Road DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WIlVDSOR
_ BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
3 ��1 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of lob:
$0-$1,000=$15.00 Street No. S et Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
�*-W L11,1h--
APPLICANT ADDRESS
C6a!V
APPLICANT PHONE# `I �
OWN S OWNER . A4& - -
�4� OWNER ADDRESS ZCQ
J•'Y
OWNER PHONE
ESTIMATED COST$ �
* IS THIS A CONTRACT COST? Yes No
f� FEE ENCLOSED$ 6 �—
f1`r TYPE OF JOB:
�sOR- � New Ration
teration/Addition/Repair
Revised 4/01//2002 j
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑YES ❑NO
SIDENTIAL
❑BUSINESS El ASSEMBLY CURRENT USE AND OCCUPANCY
❑MERCANTILE
U EDUCATIONAL FUTURE USE AND OCCUPANCY
❑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
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
f
to
MCI
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. f �►--�
CONTRACTORS ISCIENSE NO. STATE
SIGNATURE OF APPLIC DATE
ShirleY Wilhelm -CRS Approval Confirmation: Request No.x249658 Pa e 1
. ,
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 4/3/0312:33PM
Subj ct: CRS Approval Confirmation: Request No. 249658
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 249658
House No: 157
Lot No:
Street Name: NATSISKY FARM RD
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Apr 03, 2003