HomeMy WebLinkAbout108 Birch Hill DriveFDERTMENT
DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
plication is hereby: lQBUa,DING DEPARTMENT
APPR 1540 SULLIVAN AVENUE Bldg.Pernrit#644-2511 ext. 230W16k-2
Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT d.- 'S
APPLICANT ADDRESS
APPLICANT PHONE#
OWN S OWNER
4 OWNER ADDRESS
OWNER PHONE O
ESTIMATED COST
IS THIS A CONTRACT COST? Yes o
G FEE ENCLOSED$ICJ
TYPE OF JOB:
SCR CO New Installation
ation/Addition/Repair
Revised 4/01//2002 j
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i
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BMDING IS THIS APPLICATION ASSOCIATED WITH A
SIDENTIAL
BUILDING PERMIT APPLICATION? YES NO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
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
L/&, zr-
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. T STATE
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SIGNATURE OF APPLICANT DATE
Shirley Wilhelm -CRS Approval Confirmation: Request,No
11.
238038 Page 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date:1/24/03 8:56AM
Subject: CRS Approval Confirmation: Request No. 238038
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:238038
House No: 108
Lot No:
Street Name: BIRCH HILL DR
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Jan 24, 2003