HomeMy WebLinkAbout110 VALLEY VIEW DR DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PER MIT#
Application is h
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE
Bldg.Permit#
M AJ 644-2511 ext. 230
I'�1 �q!''r r Irk
a Building In r
Application must be printed or typed
FEE SCHEDULE Location of Job:
\4&m I�P (0 d r—
$0-$1,000=$15.00 Street No. StreeT Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
\'L% APPLICANT
APPLICANT ADDRE S
APPLICANT PH O #
O W N 3 F,q OWNER
� OWNER ADDRESS �
COD e OWNER PHONE — a
C ESTIMATED COST$ r/OZ�
b
�.� IS THIS A CONTRACT COST? Yes _No
�G FEE ENCLOSED$ '3 D
TYPE OF JOB:
SpR Co _New Installation
�Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑YES ❑NO
❑RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MDCrD USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD l
SIZE OF SERVICE � 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
�0 -�(30q m JL
WU
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 STATE
SIGNATURE OF APPLIC DATE ''
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s�tlA1 ,1, Fti� a FOR BUILDING vLnevotftl* J 11
r�r "''`�'" � PROPERTY OF �
No . VALLEY VIEW DRIVE SOUTH WINDSOR, CONN .
Being Lot No. 61 on map entitled "Map of VALLEY VIEW FARMS Ellington
Road South Windsor, Conn . Property of Emma Palmer & Kenneth Palmer
Scale 1 " = 80 ' Nov. 1 , 1960 Hayden L. Griswold C.E."
Scale 1 " = 50 '
HAYDEN L. GRISWOLD CE . ,
Shirley Wilhelm -CRS Approval Confirmation: Re uest No. 340523 Page 1
From: <cipsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 5/25/04 2:05PM
Subject: CRS Approval Confirmation: Request No. 340523
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 340523
House No: 110
Lot No:
Street Name: VALLEY VIEW DR
Town Name: SOUTH WINDSOR, CT
Inspector: CHRISTOPHER DOUGAN
Approval Date: May 25, 2004
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