HomeMy WebLinkAbout124 Brookfield Street (5) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVE—� 1540 SULLIVAN AVENUE Bldg.Permit#
1 ` 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
Location of Job:
EE SCHEDULE
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1
E [Tenant
$0-$1,000=$15.00 treet No. Street Lot No.
Over$1,000=$15.00 per$1,000
or any fraction thereof Designation Apt.No.
APPLICANT ADDRESS
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APPLICANT PHONE# �
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'C -4< O*FER ADDRESS
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OWNER PHONE
ESTIMATED COST$ L---I
IS THIS A CONTRACT COST? �C Yes No
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FEE ENCLOSED$ sz�5 -
TYPE OF JOB:
SOR•C New Installation
Alteration/Addition/Repair
Revised 4/01H2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
❑RESIDENTIAL BUILDING PERMIT APPLICATION? ,DES ❑ NO
?NRUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE 6CX—)Pr-*, 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 @0 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
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
SIGNATURE OF APPLICANT �® —�� DATE O
Shirley Wilhelm - CRS Approval Confirmation: Request No. 213374 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 6/12/02 12:24PM
Subject: CRS Approval Confirmation: Request No. 213374
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 213374
House No: 124
Lot No:
Street Name: BROOKFIELD ST
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Jun 12, 2002