HomeMy WebLinkAbout12 Kelly Road (5)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: J 01 S3BUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
G
644-2511 ext. 230
Bldg.Permit#
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
1 KF-11v g3>
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT pt 577
APPLICANT ADDRESS GO 4&5,& — w—i2tw
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APPLICANT PHONE# 676 3
W N S F,q
OWNER Co/E
OWNER ADDRESS
A OWNER PHONE0
ESTIMATED COST$ S
IS THIS A CONTRACT COST? Jes No
FEE ENCLOSED$ S•
TYPE OF JOB:
OR*C0 New Installation
Alteration/Addition/Repair
Revised 4/01 H2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
SIDENTIAL
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 8U k&lf,-2
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS GA C 4-
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.
0S-7 9-9 L- .5-- C_+
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
i
tyCO AD TSecurity Sermea Inc
10 Research Parkway
Fire &
Wallingford.CT 06492
Security Tele 203 7414000
Fax 203 294 1514
ADT CTState be # 105 789
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MUNICIPALITY: S- iiv7 sow
JOB NAME:
START DATE:
JOB DESCRIPTION:
JOB COST:
PER PUBLIC ACT 91-95
THIS LETTER AUTHORIZES T*b) Hh9-vj-
TO SIGN PERMIT AS AN AGENT OF ADT SECURITY SERVICESJNC
FOR THE ABOVE MENTIONED JOB AND MUNICIPALITY
APPLICABLE LICENSE:
LICENSE # : 00105789
SIGNED:
Shirley Wilhelm -CRS Approval Confirmation: Request No. 238241 Page 1 a
From: clpsvc@nu.com>
To: W ILHEL@SOUTHW INDSOR.ORG>
Date: 4/16/03 4:02PM
Subj ct: CRS Approval Confirmation: Request No. 238241
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:238241
House No:12
Lot No: 1
Street Name: KELLY RD
Town Name:SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Apr 16, 2003