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HomeMy WebLinkAbout120 Bridlewood Road (5)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby:TOWN OF SOUTH WIlNDSOR MNBUILDINGDEPARTMENT PROVED 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 a Date Bu g Inspector Application must be printed or typed FEE SCHEDULE Location of Job: Ar 0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= 15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT A aC APPLICANT ADDRESS fU C ©off APPLICANT PHONE# O N S OWNER 4 OWNER ADDRESS 1-31) Oi0 OWNER PHONE ESTIMATED COST$ u IS THIS A CONTRACT COST? es No f FEE ENCLOSED$ TYPE OF NewOR-C 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 RE"SIDENTIAL BUILDING PERMIT APPLICATION? S 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 i 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. I / 6-7- CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT v DATE ep—6 Shirley Wilhelm -CRS A royal Confirmation: Request No.232772 Page 1 From: clpsvc@nu.com> To: WILHEL@SOUTHWINDSOR.ORG> Date:10/29/02 2:19PM Subj ct: CRS Approval Confirmation: Request No. 232772 Your approval of the following CRS Request has been successfully processed. CRS Work Request#:232772 House No:120 Lot No: 18 Street Name: BRIDLEWOOD RD Town Name:SOUTH WINDSOR, CT Inspector: JOHN COLLINS Approval Date: Oct 29, 2002