HomeMy WebLinkAbout23 BROADLEAF DR APPLICATION FOR ELECTRICAL PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT
API rRO)ff1540 SULLIVAN AVENUE Bldg:Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 C r
Over$1,000= Street No. Street Lot No.
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT . L CU(
APPLICANT ADDRESS
APPLICANT'S PHONE# O r
OWNER
OW OWNER ADDRESS
O OWNER PHONE
C ESTIMATED COST$ —
r I U IS THIS A CONTRACT OST? Yes —_No
ENCLOSED-$.
j� a TYPE OF JOB:
dsOR-COS New Installation
Alteration/Addition/Repair
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Revised 03/05/10
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A.
BUILDING PERMIT APPLICATION? ❑ YES NO
. �RESIDENTIAL
CURRENT USE AND OCCUPANCY P.�s,d i, ,t_ 1.
❑ BUSINESS
❑. ASSEMBLY FUIURE USE AND OCCUPANCY
❑ EDUCATIONAL
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
O FACTORY
❑ STORAGE ADDRESS
❑ GARAGE
❑ MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
J.
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
wumaER OF SWITCHES. NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS.
NUMBER`OFA/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
TIRE UNDERSIGNED HEARBYAPPLIES 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 S CH WORK
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CONTRACTORS LICENSE Q TYPE STATE
SIGNATURE OF APPLICANT DATE
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�q,�, 4 ,��►' PROPERTY OF
SURNE'-
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NO . BROAD LEAF DRIVE SOUTH WINDSOR, CONN.
Being Lot No. 28 on map entitled "Mnp of OAK RIDGE ESTATES
Foster St . South Windsor, Conn. Scale : I " = 40' Sept. S, 1465
Hayden L .-Griswold C. E. Sheet I "
Scale I " = 40'
HAYDEN L . GRISWOLD C.E. � dyL ` � D
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1700126 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER ELECTRICAL PERMIT
DATE: 05/10/2017
GIS ID: 14100023 FEE: 15.00
MUNIS APPLICATION# 201700478 BUILDING DESCRIPTION:
APPLICANT LOCATION
NAME: MCCARTHY WILLIAM F A ADDRESS: 23 BROADLEAF DRIVE
ADDRESS: 23 BROADLEAF DR OWNER: MCCARTHY WILLIAM F JR&MORGANNE
SOUTH WINDSOR,CT 06074 23 BROADLEAF DRIVE
SOUTH WINDSOR,CT 06074
DESCRIPTION OF WORK: SERVICE UPGRADE FROM 100 AMP TO 200 AMP.
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
5/10/2017 11:25 AM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE