HomeMy WebLinkAbout163 RIVERVIEW DR DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
PRO Ems, 1540 SULLIVAN AVENUE Bldg.Permit#
F5 3 (-s4-J 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
F
af-=T im'/a C$0-$1,000=$15.00 Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof gnation Apt.No.
APPLICANT Poti1,9,L1
APPLICANT ADDRESS 2!9 �'�z L�`+�' R-D
o C- fin Cam- 060c9el'
APPLICANT PHONE#
O W N 3 F,q OWNER Z�Ifyloe -
OWNER ADDRESS 9- 4 •-��
C.7 _
OWNER PHONE
C = ESTIMATED COST$
�.� IS THIS A CONTRACT COST? _Yes ----No
FEE ENCLOSED$
f�d TYPE OF JOB:
SO R C 0 New Installation
_ZAlteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH,A�
UIRESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES d1vO
❑BUSINESS CURRENT USE AND OCCUPANCY
0 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
SIZE OF SERVICE /a C, SIZE OF MAIN CONDUCTORS_ 2�3
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.
CONTRACTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT DATE �20-$3
Shirley Wilhelm -CRS Approval Confirmation: Re uest No.283972 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 9/11/03 8:32AM
Subject: CRS Approval Confirmation: Request No.283972
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 283972
House No: 163
Lot No:
Street Name: ROBERT DR
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Sep 11, 2003