HomeMy WebLinkAbout132 Pine Knob Drive (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Ap TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.Pem3iit#
Date Building Inspect
Application must be printed or typed
FEE SCHEDULE Location of Job:
-bI"ve.,
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT rs
APPLICANT ADDRESS , i,i d S A
APPLICANT PHONE# 8 e�,-1 1 S
OWN 3 F,q OWNER —L)A,j L,.e V.P S Q
OWNER ADDRESS t 3 -1 'Pi • ' �Gn 1> '7r 15_ (/V
OWNER PHONE "� 3 - Go / l(ID
C � ESTIMATED COST$ a-5,D O
IS THIS A CONTRACT COST? _Yes----- No
�CJ FEE ENCLOSED$ � --
OR COS TYPE OF JOB:
_New Installation
/ A teration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIAT D WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION?, MS ❑NO
❑BUSINESS CURRENT USE AND OCCUPANCY �'eS
❑ASSEMBLY
❑MERCANTILE❑EDUCATIONAL FUTURE USE AND OCCUPANCY
❑INSTITUTIONAL
❑FACTORY :ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD ��ri• Q
SIZE OF SERVICE i O J—I SIZE OF MAIN CONDUCTORS
NUMBER OF METERS 1 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
4An l , ,�,n-, e ro�,ti. ►acr4t4la Arc cg
In .P c C L, r o o, _rfn -4 6n`,Q rn-A-. T y
Y{ ch 4-e ! Jo - � st cue .04 c i
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.
fS366 C— � ,
CONTRACTORS LICENSE NO. /TYPE STATE
SIGNATURE OF APPLICANT 01 DATE 'V-- 2 3 —
Shirley Wilhelm CRS Approval Confirmation: Request No. 424651 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 6/24/05 1:38PM
Subject: CRS Approval Confirmation: Request No.424651
Your approval of the following CRS Request has been successfully
processed.
CRS Work Request M 424651
House No: 2;
Lot No:
Street Name: 061,11 KNO pf
Town Name: SOUTH WINDSOR, CT
Inspector: CHRISTOPHER DOUGAN
Approval Date: Jun 24, 2005
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