HomeMy WebLinkAbout132 Pine Knob Drive (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Ap TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.Pem3iit#
Date Building Inspect
Application must be printed or typed
FEE SCHEDULE Location of Job:
bI"ve.,0-$1,000=$15.00 Street No. Street Lot No.Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT rs
APPLICANT ADDRESS , i,i d S A
APPLICANT PHONE#8 e,-1 1 S
OWN 3 F,q
OWNER —L)A,j L,.e V.P S Q
OWNER ADDRESS t 3 -1 'Pi • ' Gn 1> '7r 15_ (/V
OWNER PHONE 3 - Go / l(ID
C ESTIMATED COST$ a-5,D O
IS THIS A CONTRACT COST? _Yes----- No
CJ FEE ENCLOSED$ --
OR COS TYPE OF JOB:
New Installation
A teration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIAT D WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION?, MS NO
BUSINESS CURRENT USE AND OCCUPANCY 'eSASSEMBLY
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
Other please specify)
CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD ri• Q
SIZE OF SERVICE iO J—I SIZE OF MAIN CONDUCTORS
NUMBER OF METERS 1 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
4An l , ,,n-, e ro,ti. acr4t4la Arc cg
In .P c CL, r o o, _rfn -4 6n`,Q rn-A-. T y
Y{ ch 4-e ! Jo st cue .04 c i
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.
fS366 C—
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT 01 DATE 'V-- 2 3 —
Shirley Wilhelm CRS Approval Confirmation: Request No. 424651 Page 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 6/24/05 1:38PM
Subject: CRS Approval Confirmation: Request No.424651
Your approval of the following CRS Request has been successfully
processed.
CRS Work Request M 424651
House No: 2;
Lot No:
Street Name: 061,11 KNO pf
Town Name: SOUTH WINDSOR, CT
Inspector: CHRISTOPHER DOUGAN
Approval Date: Jun 24, 2005
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