HomeMy WebLinkAbout17 Brookfield Street (11)DECISION
APPLICATION FORx - ELECTRICAL PERMITTOWNOFSOUTHWINDSR PERMIT#u
BUILDING DEPARTMENT r
1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.Permit#
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Application must be Printed or typedr
Location ofJob:17
Street No.
Street Lot No.
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Tenant Designationgnation
err,Apt.No.
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APPLICANT
uF,7' 9r,'T APPLICANTADDRESS 11 -r
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APPLIC.AW PHONE#
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OWNER
OWNERADDRESS
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OWNER PHONE
ESTIMATED COST
r 'IS THIS A CONTRACT COST? 13 Yes No
FEE ENCLOSED S I 60
x
n TYPE OF JOB:
13 Original Installation
Aitelz!ion/Addition/Repair
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Revised 8/99
APPLICATION-FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH
BUILDING PERMIT APPLICATION? YES d 0
RESIDENTIAL n
BUSINESS CURRENT USE AND OCCUPANCY F'f a0`
ASSEMBLY n
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD ut e.9-, n(h PVC.,
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED 4 0 _
NUMBER OF METERS I 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 SUBNUTTED.
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.
yg7m Pawner
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
o n o ins- pprova oOM ation: eques o. age
From: clpsvc@nu.com>
To: COLLIN@SOUTHWINDSOR.ORG>
Date: 6/7/01 3:44PM
Subj ct: CRS Approval Confirmation: Request No. 169670
CRS Work Request M 169670
House No: 17 ftkCr '`
Lot No:
Street Name:
Inspector:JOHN COLLINS
Approval Date: Jun 07,2001