HomeMy WebLinkAbout1370 Main StreetDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT LF6
APPRO —1540 SULLIVAN AVENUE Bldg.Permit#
uffauL Joc— 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Jo
7
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT =7 l
APPLICANT ADDRESS 38 G 41:)
APPLICANT PHONE#7.2
o w N S OWNER . 1 s9 z4'A-)
q OWNER ADDRESS f .y 70
0 OWNER PHONE
ESTIMATED COST$ G d
a
IS THIS A CONTRACT COST? Yes No
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FEE ENCLOSED$
TYPE OF JOB:
soR,Co New Installation
Alteration/Addition/Repair
Revised 4101 H2002
i
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES 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 SIZE OF MAIN CONDUCTORS U
NUMBER OF METERS l 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.
Z-
CONTRACTORS LICENSE NO. T E STATE
DATE
TE
SIGNATURE OF APPLICANT
Shirley Wilhelm -CRS Ap rovahConfirmation: Request No. 239391 Page 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date:1/2/03 4:16PM
Subj ct: CRS Approval Confirmation: Request No. 239391
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:239391
House No:1370
Lot No:
Street Name: MAIN
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Jan 02, 2003