HomeMy WebLinkAbout21 Laurel StreetDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WIl TDSOR
PERMIT#
Ap7APP
cation is h reby: le/'BUILDING DEPARTMENT
OVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
1--2, 3
Date Bui mg Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE 1 a v jZe-, K
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
Mi4 we h , c d r O C/G
APPLICANT PHONE# 17 9 1 a
N S OWNER . ko 4+c,L/ 12
O q OWNER ADDRESS G a r c e,1 J
OWNER PHONE G q
C ESTIMATED COST$
G
i
IS THIS A CONTRACT COST? Yes ZNo
FEE ENCLOSED$
TYPE OF JOB:
sOR-COS New Installation Of j t ale— f
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
AQIDENTIAL
BUILDING PERMIT APPLICATION? O
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
SIZE OF SERVICE6W-SIZE OF MAIN CONDUCTORS
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
up re,d 4"rcri 6a /4-y-K lb a19,
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.
CONTRACTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT DATE
Shirley Wilhelm -CRS Approval Confirmation: Request No. 241633 Pay e 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 2/7/03 4:16PM
Subject: CRS Approval Confirmation: Request No. 241633
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 241633
House No:21
Lot No:
Street Name: LAUREL ST
Town Name:SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Feb 07, 2003