HomeMy WebLinkAbout23 ARNOLD WAY DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
TOWN OF SOUTH WINDSOR
Application is
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
Date Bu di Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
F:TetnantDesignation
4 - Qw$0-$1,000=V 5.00 Street Lot No.
Over$1,000$15.00 per$1,000
or any fraction thereof Apt.No.
APPLICANT i--LJ-/ & , 14wIJlz-k50
APPLICANT ADDRESS 3 S-S SO u %of S T .
A-G A4, 0;� M , M4 , G/o a f
APPLICANT PHONE# La 0 - S-y 7- 001 E
OW N S4. OWNER 4r'JTN-0,V Y S L4gFt.4
OWNER ADDRESS 5,4-M F
U d a OWNER PHONE G O 3 j - 3 4p ,?S- -
C ESTIMATED COST$ DDO G G
b
IS THIS A CONTRACT COST? _Yes ----No
FEE ENCLOSED$ 6b
r� TYPE OF JOB:
DSO R•CO New Installation
✓Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
SIDENTIAL BUILDING PERMIT APPLICATION? ❑YESXNO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD t�SIZE OF SERVICE �� SIZE OF MAIN CONDUCTORS `/� *4 L
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS I 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
— tAP6-k4-40 �c To aco
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.
1? V053 F'/ C 1
CONTRACTORS LICENSE NO. / E STATE
SIGNATURE OF APPLICANT �fA} DATE 9 Q 3
Shirley Wilhelm-CRS Approval Confirmation: Request No. 288847 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 11/4/03 4:26PM
Subject: CRS Approval Confirmation: Request No. 288847
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 288847
House No: 23
Lot No:
Street Name: ARNOLD WAY
Town Name: SOUTH WINDSOR, CT
Inspector: CHRISTOPHER DOUGAN
Approval Date: Nov 04, 2003
Electric# APPLICATION FOR BUILDING PERMIT
Plumbing# 23 Arnold Way Date: 9• Z3 US
HV.AC #
Sprinkler# 32113
FINAL P — -- _-- - — Estimated Cost b c7
Building �� Permit Fee
$--�
Enginee ' g ; COMPLETE RED BOXED AREAS Occupancy Fee $ /U
Affidavit
TYPE OR PRINT ONLY Eng. Insp. Fee $
Appr. for COE o ► SIGN ON REVERSE SIDE / e�
— _ - — - _ _ Total Fee $ 5
---- - - -- — - -- - - - - ---- - - - - --� .H$9l
TO THE MING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant -' ' —1 `6.ocation of Work Z3 AWC)LO �QACI Lot No.
Applicant's Address 'Z9 A2&-)oun 1&)M del.# suo �3Z I lD8l
Town S kQ%K)o So C- Zip 60 0-1+ Lic.#
Owner Architect
Owner's Address Architect's Address
Zip Zip
Sq. Ft. New Area: 1st FI. 2nd Fl. 3rd FI. Total New Area
Purpose of this permit W cameo 1=Suy-oi &-)Q ,z:mngP
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO LZ
SA�t�Da -11-6
ea Basement Garage
Approved by Use Grou onstruction Types
Revised 6/02
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 LC - lkkd ctv
I hereby apply for a Certificate of Occupancy for the work described in this application for the permit.
Signed T ���(diLl l-u-C Pal.
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
10'$N SE4
FLi
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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
l�Osoe•co� TELEPHONE(860) 644-2511
2IHNIMO HlIM v aar 90/90/TO rIVNiIA OTg
005'Z g-£TTZ£-**
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