HomeMy WebLinkAbout110 Pine Tree LaneDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
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0-$1,000=$15.00 Street No. Street ELot .Over$1,000$
15.00 per$1,000
or any fraction thereof TenantDesignation Apt.
APPLICANT I
APPLICANT ADDRESS ,7 9O Q` L.d Y1 P
To 11 and
APPLICANT PHONE# $? 0 — 7
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OWN 3 F,q
OWNER i F1 an A
OWNER ADDRESS e. Lr.in
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q 4'7-
914LI
0 OWNER PHONE C)
C ESTIMATED COST$
IS THIS A CONTRACT COST? _4Yes No
FEE ENCLOSED$ /,-OO o
TYPE OF JOB:
OR-C0 New Installation
Alteration/Addition/Repair
Revised 4/01//2002
I
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH
BUILDING PERMIT APPLICATION? YES X NO
RESIDENTIAL
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 9, SIZE OF MAIN CONDUCTORS 1
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
S4e r
1 1
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.
1 5
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT . DATE 2 `J
Shirley Wilhelm -CRS Approval Confirmation: Request No. 234447 Page 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 4/15/03 2:27PM
Subject: CRS Approval Confirmation: Request No. 234447
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:234447
House No:110
Lot No:
Street Name: PINE TREE LN
Town Name:SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Apr 15, 2003
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