HomeMy WebLinkAbout22 SUNSET TER DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR Z or- 3 L�U
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
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Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
�2 ��ti,5 6r -7FaA,4w
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
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APPLICANT C.!v. ��L=C-'m-tC Gej, Z 'Y/f
APPLICANT ADDRESS I Y" 1 i-Je S7—
C�����T��-- CT oGz3
APPLICANT PHONE# 0(o U- 7 ,Z 1 6 2Y —C e-t t $$.3- ';�LF/3
O W N S j , OWNER /V A NG gAer^Sj:1)
OWNER.ADDRESS ,?,Z S U^/->e-T
OWNER PHONE
ESTIMATED COST$ j! Oa
e
IS THIS A CONTRACT COST? ,ZYes _No
FEE ENCLOSED$ Z;), C.
5 O�� TYPE OF JOB:
OR•C New Installation
b"Alteration/Additio epair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED SIDENTIAL WITH A,/
BUILDING PERMIT APPLICATION? ❑YES e O
U BUSINESS
❑ASSEMBLY CURRENT USE AND OCCUPANCY &'S• � r3�Ni
❑MERCANTILE❑EDUCATIONAL FUTURE USE AND OCCUPANCY -S/9z, L
❑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 Cil- )4 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
STiA'l f L�.G✓l G� �.�;T �'Oti OyGT c / � !� Cdn'Q�U- _
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.
/2 --)- 7 S 7 C�' / cT-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 7
Shirley Wilhelm -CRS Approval Confirmation: Request No. 272899 Pagb 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 7/8/03 4:15PM
Subject: CRS Approval Confirmation: Request No. 272899
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 272899
House No: 22
Lot No:
Street Name: SUNSET TER
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Jul 08, 2003
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Electric# APPLICATION FOR BUILDING PERMIT
Plumbic:,Q# 22 Sunset Terrace
HVAC # Date:
Sprinkler# No. 28235
FINAL R Estimated Cost $ .<6b0 -/
Building) 3 t COMPLETE RED BOXED AREAS Permit Fee $
Engineeri g TYPE OR PRINT ONLY Occupancy Fee $
Affidavit SIGN ON REVERSE SIDE
Appr.for CO. Total Fee $
TO BULDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) $
The undersigned hereby applies to do work according to the following specifications:
Job Location 2-1 5�^s Er TC rr.LA- Lot No. Side of Street Zone
Applicant 1404►�cy Pj!�•+D Tel # (c`f`4-`1 k o't-
Address 1 t k-'d Zip ok 0'1'{< Lic#
Owner NA^(� bro^9 Address ZZ- S�.v� left- u, Cr 0 601
Architect Address
Sq. Ft.New Area: 1st FL 2nd FL 3rd FL Total New Area
#Rooms #Lavatories #Bathrooms #Garages
Purpose of this permit: U,q
City Water ❑ Well ❑ Septic System ❑ Sewer ❑
Ins. H.O. S.P. Cert. Area Base:: Construction
t Garage
Approved by�, _ Date -Of Use Group _ Type
R.v:«J 1197
I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of
South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this
permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required
distances from all other zones and is located in which this building and its use is allowed
Signed ?
X&"Alz
I hereby apply for a Certificate of Occupancy for the work described in this application for the permit.
Signed
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
Inspection / Approval Date By Appl
Code Description Due Whom Code Comment +
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**-28235-B 5,000
B10 FINAL 12/09/03 JFF A
B10 FINAL 12/09/03 JFF A CLOSEOUT