HomeMy WebLinkAbout121 Maskel Road (4)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 02 7ytl0
Efate Building Inspector
Application must be printed or typed
FEE SCHEDULE Loc n of Jo
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0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
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APPLICANT 7:pco 1
APPLICANT ADDRESS O r&N o a,
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APPLICANT PHONE#
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OWNER . 4
q< OWNER ADDRESS
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OWNER PHONE 7
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OESTIMATED COST$
vt IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ S•O`7
TYPE OF JOB:
S01R.CQ New Installation
c-'Alteration/Ad n/Repair
Revised 4/01//2002
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APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? BYES El NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY e
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY l+0 ell tf
EDUCATIONAL
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 90D 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
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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.
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CONTRACTORS LICENSE NO. TYPE STATE
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DATE c3/0 3
SIGNATURE OF APPLICANT
Wilhelm Approval--Confirmation:--ke, 248758-,--Shirley
From: cipsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 5/13/03 2:42PM
Subj ct: CRS Approval Confirmation: Request No. 248758
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:248758
House No:
Lot No:
Street Name: V44ASKELL RI?
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: May 13, 2003