HomeMy WebLinkAbout105 Edgewood DriveDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WIlVDSOR
PERMIT#
Application is hereby: 7 /OBUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
Q L
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE
eJ odd./
Location of Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS sr
X U
APPLICANT PHONE#
OW N S 4t
OWNER
OWNER
t
I
i j YS
OWNER PHONE
C ESTIMATED COST$ 1 4 O() _C)O
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED
6b
e
TYPE OF JOB:
OR-C New Installation
1.2Alteration/Addition/Repair
Revised 4/01//2002 1
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
5,d'RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL PHONE
FACTORY ENGINEER'S NAME
STORAGE
O 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
ProLoQ C)
r
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.
ISV13C0 1 0 T.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OR APPLICANT C•A DATE oZ
Shirley Wilhelm - CRS Approval Confirmation: Request No. 219704 Page 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 8/2/02 4:04PM
Subject: CRS Approval Confirmation: Request No. 219704
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 219704
House No: 105
Lot No:
Street Name: EDGEWOOD DR
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Aug 02, 2002