HomeMy WebLinkAbout15 WOODSIDE DR DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
P:iw] 644-2511 ext. 230 Bldg. Permit#
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
Wo64,76 i a� /JYi ve
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT P " 1.O1J I C
APPLICANT ADDRESS & ' ,V j( Ve
Pp TT L � 4
APPLICANT PHONE# �D L(Z` C�5v AGO-G 5U`l l ly CI.
SOW N SF�9 OWNER �l/J�JC �����
OWNER ADDRESS I SI/J e rU�
C-0( w.N sv _ s 1163/u(
OWNER PHONE Wpo — zqc) �waq
C ESTIMATED COST$ 12O0,Cr)
IS THIS A CONTRACT COST? y Yes _No
FEE ENCLOSED$ '
SOR•CONS TYPE OF JOB: J�
New Installation
Alteration/Addition/Repair
Revised 4/01//2002 AP
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? ❑ YES ElNO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD / Vl + Sejp,ce, C�OI�J
SIZE OF SERVICE I C d A'YIP SIZE OF MAIN CONDUCTORS JE
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS_t REMOTE DISCONNECT REQUIRED? Ll YES 0 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
X1$r/e�
SCN+�i (nine, 152d :7�e gnaC AVn /N ISAQ
5 pe
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.
lU q 15,6
CONTRACTORS LICENSE NO. guo;
TYPE STATESIGNATURE OF APPLICANT DATE �(J
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-36
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PROPEnTY OF
NO . WOODSIDE DRIVE SOUTH 4INDSOR, CONN .
:icing Lot No. 2 on map entitled "Mfap of WOODSIDE Pleasant Valley
Road South Windsor, Conn . Property of James ?1i14cie Scale 1 " _ 401
September 8, 1962 Hayden L. Griswold C . E."
HAYDT.:N' L. GZISttiOLD C .E.
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PROPERTY OF
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-SOUTH li.I N.
13 e i n g -'Lot tio . 2 on ra-a p entitled a p. of WOODSIDE Pleasant V-a 11 e y
'toad South Windsor, Conn-. Property of James Milkie Scale I " = 401
September 8, 1962 Hayden L. Griswold C .F.."
A'�' -, - --
Scale 1 " 401
11A.YDEN L. (IT11 iWOLD C r.,
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00
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FOR gu1LD1�0 i . _.
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PROPERTY OF
NO. WOODSIDE DRIVE SOUTH WINDSOR, CONN .
Being Lot No . 2 on map entitled "Mar of WOODSIDE Pleasant Valley
Road South Windsor, Conn . Property of James Milkie Scale 1 " = 40 '
September 8, 1962 Hayden L. Griswold C.E . "
Scale 111 = 40 '
HAYDEN L. GRISWOLD C .E.