HomeMy WebLinkAbout16 Green Lane (7)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT
OVE-- D 1540 SULLIVAN AVENUE Bldg.Permit#
U S
644-2511 ext. 230 A305
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
I b T 9zA/L n2 I
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
APPLICANT ADDRESS I C Q•
g23
APPLICANT PHONE# ` U
OW N 3 OWNER . l o,'r e-r M w
OWNER ADDRESS
W l; v
0 M OWNER PHONE LILI-a Ip -q
C ESTIMATED COST$0V
IS THIS A CONTRACT COST? Yes X No
FEE ENCLOSED$ r 5 00
TYPE OF JOB:
soR, New 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
j RESIDENTIAL
BUILDING PERMIT APPLICATION? J4 YES 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 k(18 Q N; Ho U se—
SIZEOFSERVICE L1 U 0 hM P SIZE OF MAIN CONDUCTORS SZ,S 'I!b L
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS L L fjir l
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES Ed 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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT ....,,,I ,, R a DATEJ ,AXr
Shirley Wilhelm -CRS Ap roval Confirmation: Re uest No. 2455542
From: clpsvc@nu.com>
To: WlLHEL@S0UTHWlNDS0R.0RG>
Date: 3/20/03 2:30PM
Subj ct: CRS Approval Confirmation: Request No. 245554
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:245554
House No:16
Lot No: 12
Street Name: GREEN LN
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Mar 20, 2003