HomeMy WebLinkAbout163 Northview DriveDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR I.3 1 1
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
V644-2511 ext. 230
Ll
Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE FTenwat0-$1,000=$15.00 o. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereofesignation Apt.No.
APPLICANT
APPLICANT ADDRESS CIE, T ' eQ`
APPLICANT PHONE#7 7 Z
O N OWNER ecl- v"
q OWNER ADDRESS5
f
k OWNER PHONE
r
ESTIMATED COST$ V-7L
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ f ?'D
ICJ TYPE OF JOB:
SOR• New Installation
t Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERNUT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH
14 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
AIIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WERING METHOD Ihkna e
SIZE OF SERVICE 'C) ro SIZE OF MAIN CONDUCTORS
NUMBER OF METERS r NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES "0
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.
C` 7 4
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT K- a DATE
Shirle Wilhelm -CRS Ap royal Confirmation: Request No. 260107 Pa e 1
From: cipsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 6/10/03 9:04AM
Subj ct: CRS Approval Confirmation: Request No. 260107
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 260107
House No:163
Lot No:
Street Name: NORTHVIEW DR
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Jun 10, 2003