HomeMy WebLinkAbout22 MARILYN RD DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby:
TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
APPRO, 1540 SULLIVAN AVENUE
> 644-2511 ext. 230 Bldg. Permit#
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 FTenant
Street
Over$1,000 a Lot No.
$15.00 per$1,000
or any fraction thereof tion
Apt.No.
APPLICANT i�
APPLICANT ADDRESS
APPLICANT PHONE# - Z Z
a w N S4. OWNERr-1n 1,6- S I i I ---,, �Icl rb
< OWNER ADDRESS ,Z)Q I:4—L] R
OWNER PHONE 52
C ESTIMATED COST$ I�ii[c) ,W
`x �• IS THIS A CONTRACT COST? Yes _No
�r �G FEE ENCLOSED$
4!D)S TYPE OF JOB: -+q q -7
OR-CO _New Installation
Alteration/Addition/Repair
Revised 4/011 002
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILD- IS THIS APPLICATION ASSOCIATED WITH A
ING BUILDING PERMIT APPLICATION? ❑ YES O NO
RESIDENTIAL CURRENT USE AND OCCUPANCY )1 CLOG
❑BUSINESS
Q ASSEMBLY
O MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑STORAGE ADDRESS
❑GARAGE
?.L'.YED 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 0 NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FDCTURES 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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c o h �C C- n n I n
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
I,Q 30 CAq C i
CONTRACTORS LICENSE NO.� TYPE STATE
SIGNATURE OF APPLICANT / (i l DATE
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1400509 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER ELECTRICAL PERMIT
DATE: 12/30/2014
GIS ID: 56700022 FEE: 30.00
MUNIS APPLICATION# 201401823 BUILDING DESCRIPTION:
APPLICANT,: T:; LOCATION
NAME: OLIVA'S ELECTRIC LLC. `' ADDRESS: 22 MARILYN ROAD
ADDRESS: 137 FOX RUN DRIVE,` ;° .,. OWNER: ,,. GOLDFARB LEWIS W&WESLIE K
SOUTHINGTON,CT 06489 22,,MARILYN ROAD
SOUTH WINDSOR,CT 06074
DESCRIPTION OF WORK: REPLACE 100 AMP METER SOCKET AND SERVICE CABLE. EXISTING
PANEL TOREMAIN. '
SPECIAL CONDITIONS: d F
ALL WORK TO BE DONE IN ACCORDANCE.WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT.
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CONSTRUCTION TYPE:
OCCUPANCY GROUP: BUILDING OFFICIAL
12/30/2014 12:34 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE