HomeMy WebLinkAbout17 Brookfield Street (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby:TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT SAPPROVED1540SULLIVANAVENUE YhDatLeBldg.Permit#
Bui ing I ector
644-2511 ext. 230
Application must be printed or typed
FEE SCHEDULE Location of Job: o
1 7
0- $1,000=$13.00 Street No. Street Lot No.Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT I C
APPLICANT ADDRESS 1 -7 p t.
C'4- O(DCJ7q
APPLICANT PHONE#
4 O 4 N 8 4. OWNER
OWNER ADDRESS
r
OWNER PHONE
ESTIMATED COST$ Q—V
IS THIS A CONTRACT COST? 13 Yes No
1 FEE ENCLOSED$ Q
OR-CO TYPE OF JOB:
A/Original Installation
MOAlrcic`_on/Addition/Repair Revised 8/99
i
E1
APPLICATION-FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH
RESIDENTIAL
BUILDING PERMIT APPLICATION? YES ZC
BUSINESS CURRENT USE AND OCCUPANCY F'`ate`
ASSEMBLY T
MERCANTILE FUTURE USE AND OCCUPANCY de
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD ytC-' I nch
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED i tl'4
NUMBER OF METERS 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.
7g,Yxeowner- I(q' ( ?o
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 3 r
o n Collins-CRS ApprovalConfirmation: Request No. 169670age
From: clpsvc@nu.com>
To: COLLIN@SOUTHWINDSOR.ORG>
Date: 6/7/01 3:44PM
Subject: CRS Approval Confirmation: Request No. 169670
CRS Work Request M 169670
House No: 17
Lot No:
Street Name:
Inspector:JOHN COLLINS
Approval Date: Jun 07, 2001