HomeMy WebLinkAbout21 POPLAR DR DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN OF SOUTH WINDSOR PERMIT#3�� �
BUILDING DEPARTMENT
APPR VE 1540 SULLIVAN AVENUE� Bldg.Permit#� 644-2511 ext. 230
Date Building Insp or
Application must be printed or typed
FEE SCHEDULE Location of Job:
FF—enantDesignation
b r1 V-e
$0-$1,000=$15.00 Street Lot No.
Over$1,000$15.00 per$1,000
or any fraction thereof Apt. No.
APPLICANT &L00 --1 <! E C rn i C
APPLICANT ADDRESS /,°� 1.4-fi�0 !� r
&-//M-fa(, B u r y G T .
APPLICANT PHONE# O - y 3 O -
O W N S Fq OWNER
f� OWNER ADDRESS Z / Po "o/CL. yr�'^-e
OWNER PHONE CQO - C� YY — 2)�
O
C ESTIMATED COST$ �
+ IS THIS A CONTRACT COST? vYes No
FEE ENCLOSED$
TYPE OF JOB: -* 5(t-} (
�SOR CON New Installation
'�Alteration/Addition/Repair 26 t 36 r 2
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
I�RESIDENTIAL BUILDING PERMIT APPLICATION? 0 YES QrKO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
El MERCANTILE FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL
0 INSTITUTIONAL
0 FACTORY ENGINEER'S NAME PHONE
OSTORAGE
❑GARAGE ADDRESS
Cl MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE DU SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑ YES 0 NO
NUMBER OF LIGHT CIRCUITS -3 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
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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. TYPE STATE
SIGNATURE OF APPLICANT DATE
a
.:-ate • =�
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POPLAR ROAO -
SOUTH NIN090R, CCNM
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I 87 74
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To 1HE aaaV!NG D:?T.
This certified that thlc rlin and
flit
copies of the propcsad budJlnY to be
erected at
n•
together with "'t ing
filed with plIn Ar.d er t be
Building and st)tc 1 ws a i ic)
!$sued by the TtiAing ding
of this apPlic-twn and final
Permit.
Signed -
This Plan it per v d that
orders amid r_t n.: s r Kai ••
compir.d I
ih sr I -th
Clark
Building in>peetor
LCT # 39
POPLAR QOAD
SOUTH WlfqDSC)Rt CONK
19 7 74
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PCPLAR ROAD
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HAVII!,i ANO INVVf"S 'VE)ADS
OOM# 00CALr jULY
�,.64s 0#Nr Cot, .56 1'. ;,rvflbt:c
k k 1 HEREBY CERTIFY
THIS PLAN TO BE
ENGINEERING AND LAND SURVEYING
��y. ,, SUBSTANTIALLY
CORRECT; 740 NO. MAIN STREET, CROSSROADS PLAZA
p4o. 3732 WEST HARTFORD 7. CONNECTICUT
to
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S!QALE R k;VIS.ED DATI: QRWQ
-
1300378 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER ELECTRICAL PERMIT
DATE: 09/04/2013
GIS ID:73800021 - FEE: 30.00
MUNIS APPLICATION# 201301242 ,BUILDING DESCRIPTION:
APPLICANT.4' Yam. ,:' LOCATION
NAME: BLOOMFIELD ELECTRIC'COMPANY ADDRESS: 21•POPLAR DRIVE
ADDRESS: 3 ALCAP RIDGE - .. OWNER:=•• DAUGHERTY CLIFFORD B&MARLYS M
"
CROMWELL,CT 06416:� 21, POPLAR DRIVE
'I �� �;� SOUTH WINDSOR,CT 06074
DESCRIPTION OF WORK: 100 ANIP,SERVICE CHANGE TO INLCUDE SERVICE CABLE,METER
SOCKETi PANEL;AND NEW GROUNDING: y* `
SPECIAL CONDITIONS: `
ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT.
CONSTRUCTION TYPE: �.
OCCUPANCY GROUP: - BUILDING OFFICIAL
9/4/2013 12:52 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE