HomeMy WebLinkAbout16 Kelly Road (4)Cr2s#, Z 3 9 zy2
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: BUILDING DEPARTMENT 1
APPR 1540 SULLIVAN AVENUE Bldg.Permit#
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644-2511 ext. 230 A -7
ate Buil ing Inspector
Application must be printed or typed
FEE SCHEDULE
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Location of Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT I'L \krW vc, L+r I C"
APPLICANT ADDRESS 0 4 (!(' r, S S t
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APPLICANT PHONE#
OW N S OWNER . su G D
q OWNER ADDRESS A// 1211
0
OWNER PHONE Oil 7 ZZ
C a ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ S QO.
TYPE OF J
iOR'C0 New Installation
Alteration/Addition/Repair
Revised 4/01//2002
i
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES El 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 R46 1 At,,n F--{
SIZE OF SERVICE 40 t SIZE OF MAIN CONDUCTORS 4
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS I 36
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES iNO
NUMBER OF LIGHT CIRCUITS a NUMBER OF POWER CIRCUITS 5
NUMBER OF SWITCHES NUMBER OF OUTLETS YO
NUMBER OF LIGHT FIXTURES 2,4 NUMBER OF HEAT CIRCUITS _
NUMBER OF A/C CIRCUITS I
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
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404
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.
tl 7/ r
CONTRACTORS LICENSE NO. `TYPE STATE
SIGNATURE OF APPLICANT DATE
Shirley Wilhelm -CRS Approval Confirmation: Request No. 238242 Page 1
From: cipsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 3/7/03 8:34AM
Subj ct: CRS Approval Confirmation: Request No. 238242
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:238242
House No: 16
Lot No: 2
Street Name: KELLY RD
Town Name:SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Mar 07, 2003