HomeMy WebLinkAbout126 Brook Street (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 (�
Date Building Inspector
Application must be printed or typed
F$0FFEESCHEDULE
Location of Job:
-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANTe—
APPLICANT ADDRESS -�
APPLICANT PHONE# 6-23 ?A r 9
OWN S OWNER Ieo 8&e )C-ItI Mi1(/S fe
OWNER ADDRESS i Z r A IR Ca
So c.E)/,y.D-reR �—
z x:
i0b WN OWNER PHONE P60 - 49
C ESTIMATED COST$
U
' ► �� IS THIS A CONTRACT COST? &'Ies ❑ No
FEE ENCLOSED$
OR�CO� TYPE OF JOB:
❑ New Installation
+X-l-te-ration/Addition/Repair Revised 5/01
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH RESIDENTIAL A�
BUILDING PERMIT APPLICATION? ❑ YES l O
❑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 INSTALLATION/WIRING METHOD
SIZE OF SERVICE le) SIZE OF MAIN CONDUCTORS A�
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
�Gbrg �Sc2�//�' �f����C ,�i20 wl l��/ScS �-y C'�iP C,�/�,(���r9�C-iE'S ►
ides
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.
C-7-
CONTRACTORS LICENSE NO. '1 TYPE STATE
SIGNATURE OF APPLICANT DATE �r`(�'' y
Page 1 of 1
John Collins - CRS Approval Confirmation: Request No. 169753
From: <dPsvc@nu.com>
To: <C0LLIN@S0UTHWINDS0R.0RG>
Date: 7/9/2001 4:15 PM
Subject: CRS Approval Confirmation: Request No. 169753
CRS Work Request#: 169753
House No: 126 '
Lot No:
Street Name:
Inspector: JOHN COLLINS
Approval Date: Jul 09,2001
file://CADocuments and Settings\Administrator\Local Settings\Temp\GWj00001.HTM 7/10/2001