HomeMy WebLinkAbout22 PINEKNOB DR APPLICATION FOR ELECTRICAL•PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR Pam#
Application is hereby: BUILDING DEPARTMENT l(v Dct
APPR VB 1540 SULLIVAN AVENUE
.
►� 644-2511.ext. 230 Bldg.Permit#
Da Building Inspector ,
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 ?2 ��\�U� le. io e 0i
Over$1,000= Street No. Street Lot No.
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT /q} �l<< (Y)� LLB
APPLICANT ADDRESS
APPLICANT'S PH NE# '�O —� 6-7
SOW N Sf OWNER tf 10 'fir Het /L'C Vclex
OWNER ADDRESS � Z I V R- j f
O OWNER PHONE 99 6 - 3 f? I - � Z 12
C ESTIMATED COST$ G
*� � IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED,$.
j TYPE OF JOB: [b 7y
OR C N�Installation
:;?Alteration/Addition/Repair
i60
Revised 03/05/10
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDIN IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑ YES ❑ NO
M RESIDENTIAL CURRENT USE AND OCCUPANCY
❑ BUSINESS
❑. ASSEMBLY FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL;
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
❑ FACTORY
0 STORAGE ADDRESS
❑ GARAGE
❑ MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE
SIZE OF MAIN CONDUCTORS
NUMBERS OF METERS NUMBERS OF DISCONNECTS AND RATINGS
NUMBERS OF PANELS NUMBERS OF DISCONNECTS REQUIRED? ❑ YES ❑ NO
NUMBERS 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 SUBMTMD.
DESCRIPTION OF WORK
RZ'0 az�le- . Jef Vt r- e o- -4. vs,
THE UNDERSIGNED HEARBY 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 PERFOR-
MANCE OF SUCH WORK
2 6)
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE —7 — 2 7
CRS# 281433
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMTT#
Application is hereby:
_ BUILDING DEPARTMENT
APPRO D, 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
F—Tenant
Pine Knob Circle
$0-$1,000=$15.00 Street Lot No.
Over$1,000=
$15.00 per$1,000 _or any fraction thereof gnation :;A�pt. o.
APPLICANT Joseph Luma s
APPLICANT ADDRESS 55 Winter St.
Nianchester Conn.
APPLICANT PHONE# 64 6-5 2 5 3
OW N SF OWNER . Robert Nadeau
4� OWNER ADDRESS 22 Pine Knob Circle
South Windsor Conn.
O ♦ OWNER PHONE 644-0003
C ;D ESTIMATED COST$ 850. 00
IS THIS A CONTRACT COST? _Yes X No
s✓ FEE ENCLOSED$ 15. 00
TYPE OF JOB:SOR•CO New Installation
X Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑ YES U NO
❑RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY Residential
❑ASSEMBLY
O MERCANTILE FUTURE USE AND OCCUPANCY SAme
❑EDUCATIONAL
0 INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
O GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD Pv c & S e u
SIZE OF SERVICE 10 0 a SIZE OF MAIN CONDUCTORS # 2 a 1
NUMBER OF METERS 1 NUMBER OF DISCONNECTS AND RATINGS 1-100a
NUMBER OF PANELS 1 REMOTE DISCONNECT REQUIRED? U YES 13 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 BEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
Replace outside service cable and meterbox
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.
102888 E_1 Conn.
CONTRACTORS LICENSE NO.1 / TYPE STATE
SIGNATURE OF APPLICANT U-� �C l __ DATE August 11 , 0 3