HomeMy WebLinkAboutBuilding 19 Mill Pond Drive (13)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR 3 p
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
05 jItc
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE j P ol q
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000= f `, 134
15.00 per$1,000 C
or any fraction thereof Tenant Designation Apt.No.
APPLICANT E:
APPLICANT ADDRESS /" f
V/
APPLICANT PHONE#
N $OWNER et r, 0 Wn Pf'S S 4
OW e,4 OWNER ADDRESS
0OWNER PHONE
0
C ESTIMATED COST$
U IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB:
sOR-CO New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYP Z OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? YES NO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
L3 EDUCATIONALTURE USE AND OCCUPANCY S
INSTITUTIONAL
UFACTORY ENGINEER'S NAME 7 SG'•r 1 I=mod PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY Fev' !l fO*" STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE lov, 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
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.
a 2
f-1
CONTRACTORS LICENSE NO. TYPE STAT
SIGNATURE OF APPLICANT DATE 7
Shirle Wilhelm -CE§,,8pproval Confirmation: Reguest No. 262532 Pa e 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 5/30/0312:50PM
Subject: CRS Approval Confirmation: Request No. 262532
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:262532
House No:19
Lot No:
Street Name: MILL POND DR
Town Name:SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: May 30, 2003