HomeMy WebLinkAbout260 Long Hill RoadDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby:TOWN OF SOUTH WINDSOR
PERMIT#
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
WM 3
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
EE SCHEDULE
021
Location of Job:
04 OOL&F$oro
1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
any fraction thereof TenantDesignation Apt.No..
APPLICANT e( 6 L `a:7vN c-
APPLICANT ADDRESS GLr 'eA-,,iei
APPLICANT PHONE,, $ rQ,,14 C;— Q S 1) (
OWN S t. OWNER l Z _
OWNER ADDRESS 0 ti—p dr•
J{ fJSteJ` D(00
M OWNER PHONE S Il o- o7 ' 101
C ESTIMATED COST$ r Ag-o. 0-0
IS THIS A CONTRACT COST? X Yes No
FEE ENCLOSED$30 00
TYPE OF JOB:
OR-0 New Installation
KAlteration/Addition/Repair
Revised 4/01//2002
s
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH
BUILDING PERMIT APPLICATION? YES WNO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCYV A a
ASSEMBLY
MERCANTILE
U EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY ENGINEER'S NAME JN PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD T C" 1 —
SIZE OF SERVICE f SIZE OF MAIN CONDUCTORS 0 L
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS_ REMOTE DISCONNECT REQUIRED? YES KNO
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---I
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
U I r J ` C- e-- Q..Q 0 a VVI
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.
7:4
103 0 rl S-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATEF_—,J 03
Shine Wilhelm -CRS Approval Confirmation: Request No. 262782 Pa e 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 6/23/03 1:33PM
Subject: CkS Approval Confirmation: Request No. 262782
Your approval of the following CRS Request has been successfully processed.
CRS Work Request,,M 262782
House No:260
Lot No:
Street Name: LONG HILL RD
Town Name: SOUTH WINDSOR, CT
Inspector:JOHN COLLINS
Approval Date: Jun 23, 2003