HomeMy WebLinkAbout100 Farmstead DriveDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERNIIT#
Application is hereby: gQ QBUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
U Z J 644-2511 ext. 230 c2 7k
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
00 4,;r"rIq/,=q C l in 1
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
0
APPLICANT
APPLICANT ADDRESS v
SS42 a Gf
APPLICANT PHONE#
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N S OWNER U Ccr r o
q OWNER ADDRESS Dd d-nl r cc3 .d rye
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R OWNER PHONE
ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB:
OR-Co w Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? S NO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
DUCAT ONE FUTURE USE AND OCCUPANCY ah
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
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SIZE OF SERVICE D 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
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.
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CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
Shirley Wilhelm -CRS Approval Confirmation: Request No. 230753 Page 1
From: clpsvc@nu.com>
To: W ILHEL@SOUTHW INDSOR.ORG>
Date:10/17/02 4:11 PM
Subj ct: CRS Approval Confirmation: Request No. 230753
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:230753
House No: 100
Lot No:
Street Name: FARMSTEAD DR
Town Name:SOUTH W INDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Oct 17, 2002