HomeMy WebLinkAbout15 Bancroft Lane (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 Q a
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
o 7.a
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT )/"/cif &,eeAaA=d
APPLICANT ADDRESS Q(Uj1
APPLICANT PHONE# At 0 a2J- cle 711
W N St OWNER O C( it n PP l
OWNER ADDRESS
t-4
M.OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes <o
FEE ENCLOSED$ 3o
TYPE OF JOB:
SOR VNew 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
RESIDENTIAL
BUILDING PERMIT APPLICATION? AYES 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 Gc
SIZE OF SERVICE g7V 0 A SIZE OF MAIN CONDUCTORS
NUMBER OF METERS ` NUMBER OF DISCONNECTS AND RATINGS 00,
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
C4 e r _ 'e
C/._
C_
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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 9
Shirley Wilhelm -CRS A roval Confirmation: Request No. 224498 PaOe 1
From: clpsvc@nu.com>
To: W ILHEL@SOUTHW INDSOR.ORG>
Date:11/1/02 8:34AM
Subj ct: CRS Approval Confirmation: Request No. 224498
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:224498
House No: 15
Lot No: 2
Street Name: BANCROFT LN
Town Name:SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Nov 01, 2002