HomeMy WebLinkAbout17 THOMAS ST DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
MIT#
Applica ' uis#ter TOWN OF SOUTH WINDSOR PER
#
BUILDING DEPARTMENT
APP 1540 SULLIVAN AVENUE
WR 644-2511 ext. 230 Bldg.Permit#
Date uilding spector
Application must be printed or typed
FEE SCHEDULE �] Location of Job:
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT c Y1 1 C�c��f�•� R�;e a•,t
APPLICANT ADDRESS �
NJC rhoyl L- -r
APPLICANT PHONE# 2�'.r7`
7
SOW N Sfq OWNER ( 5e JG ✓G 1{�
OWNER ADDRESS nl-,� j -5 _
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OWNER PHONE Q ---o q t4 - se f
C ESTIMATED COST$
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"f. IS THIS A CONTRACT COST? I'Yes C No
f ° i`I' �G FEE ENCLOSED$
� 0R.CO11� TYPE OF JOB:
0 New Installation
0 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
JRESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES,;�NO
BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUSE USE AND OCCUPANCY
❑EDUCATIONAL
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
❑ FACTORY
❑ STORAGE ADDRESS
❑GARAGE
❑MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD SC- Z V.0(% Ct, pi '4, 1(V l(1 C c
��SIZE OF SERVICE /U J _ 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
JOU,".j r6t &e C-I-Q 4"jk�-3 71! Pt
iI6 F.�L /C.
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 NA TYPE STATE
,r
SIGNATURE OF APPLIC 6� DATE % " d S
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Shirley Wilhelm-CRS Approval Confirmation: Request No.419910 Pagel
From: <cipsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 4/21/0511:02AM
Subject: CRS Approval Confirmation: Request No.419910
Your approval of the following CRS Request has been successfully
processed.
CRS Work Request#: 419910
House No: 17
Lot No:
Street Name: THOMAS ST
Town Name: SOUTH WINDSOR, CT
Inspector: CHRISTOPHER DOUGAN
Approval Date: Apr 21, 2005
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