HomeMy WebLinkAbout170 Mohegan TrailDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
TOWN OF SOUTH WINDSOR
Application is hereby: BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
IN J
ate Building Inspector
Application must be printed or typed
Location of Job:
FEESCHEDULE 1-0 O e a
0-$1,000= -e1b Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
I
APPLICANT IXTGIc e Aefa VPnCe
APPLICANT ADDRESS
APPLICANT PHONE#
N Se
OWNER
OW OWNER ADDRESS 70 092ct / Q I
4 OWNER PHONE oio
C ESTIMATED COST$
U
flaw IS THIS A CONTRACT COST? Xyes No
FEE ENCLOSED$
1!
Y TYPE OF JOB:
SOR.Cp1`t
New Installation
Alteration/Addition/Repair Revised 5101
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? YES A NO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
TYPE OF INSTALLATIONIWIRING METHOD UNdfe—!qj-&nUj
li
SIZE OF SERVICE c700,0 SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS C
NUMBER OF PANELS c REMOTE DISCONNECT REQUIRED?YESNO
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
xa N o vO l DD Z A- A,15
7
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.
J963yb 0z-Y C'T-
CONTRACTORS LICENSE NO. TYPE STAT
SIGNATURE OF APPLICANT DATE O
Shirle Wilhelm -CRS Approval Confirmation: Request No. 228082 Pa e 1
From: clpsvc@nu.com>
To: W ILHEL@SOUTHW INDSOR.ORG>
Date: 9/30/02 12:25PM
Subject: CRS Approval Confirmation: Request No. 228082
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 228082
House No:170
Lot No:
Street Name: MOHEGAN TRL
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Sep 30, 2002