HomeMy WebLinkAbout1106 MAIN ST DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Applicat'
TOWN OF SOUTH WINDSOR 1
BUILDING DEPARTMENT
D 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.Permit#
ff
at B i s for
F� I J
Application must be printed or typed
FEE SCHEDULE Location of Job:
m
1 /A/Aj s /
$0-$1,000=$15.00 KFNo. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof n Apt.No.
APPLICANT AJ
APPLICANT ADDRESS /` g �
APPLICANT PHONE#
SOW N 3Fq OWNER N
OWNER ADDRESS I I O Co /Vl S'y O r OWNER PHONE (o — 1I
C ESTIMATED COST$ �v
+� IS THIS A CONTRACT COST? Yea._No
FEE ENCLOSED$ f c
TYPE OF JOB:
s0R 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
O BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
0 MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
U INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
U GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other Please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES U 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.
ITI��Uc�A P�
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
Shirley Wilhelm-CRS Approval_Confirmation: Request No. 343710 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 6/15/0410:15AM
Subject: CRS Approval Confirmation: Request No.343710
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 343710
House No: 11.106 4
Lot No:
Street Name: aMA1N ST- t
Town Name: SOUTH WINDSOR, CT
Inspector: CHRISTOPHER DOUGAN
Approval Date: Jun 15,2004
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