HomeMy WebLinkAbout244 BARBER HILL RD DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspect
Application must be printed or typed
FEE SCHEDULE Location of Job:,
aeZ
$0-$1,000=$15.00 F;Ye—nant
Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof gnation Apt.No.
APPLICANT
APPLICANT ADDRESS
`illol o S
APPLICANT PHONE# 81 o6 BZ 2 -
S OWN S F,q OWNER 04-F-0 -Zrzr->7-N4L-s
OWNER ADDRESS 1 071- LDVI&Sp O�1" tZ,41
E 40-n �.
Ll.l milli T.__ D(a o 2�
Or �, �, OWNER PHONE S(o O (p 8 13 5 5
C = ESTIMATED COST$ �d bi►-''�
�l a ;'► U
.� IS THIS A CONTRACT COST? _Yes _No
FEE ENCLOSED$ o- In
1� TYPE OF JOB: 2-"O
�SOR CO� `Fa New Installation
_Alteration/Addition/Repair
Revised 4/01//2002 I7
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑YES ❑NO
❑RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
U MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
U STORAGE
❑GARAGE ADDRESS
❑MIXED 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? 0 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
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 C)q I! �
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT Z, DATE,b/2 310 -7-
ERGROUND STORAGE PG. of STATE OF CONNECTICUT EPHM-6 REV 3i9C
Deportment of Environmental Protection A.SITE LD.
FACILITY NOTIFICATION 3' UNDERGROUND STORAGE FACILITIES PROGRAM gIQ I 3. FOR STATE
Q HAZARDOUS MATERIALS MANAGEMENT UNIT `� '
AGENCY USE ONLY
Z 165 Capitol Avenue,Hartford,CT 06106
O FIRST B.DATE RCVD BY D.E.P C.DATE ENTERED
►= la. NOTIFICATION TEL. 566-4630
lJ SITE I.D.
IL OR PLEASE TYPE.ALL THREE COMES MUST BE LEGIBLEI k" D.GRID COORDINATES !E.DOES FACILITY MEET NEW REQUIREMENTS?
SUBSEOLIENT (if checked,
1 Refer to INSTRUCTIONS FOR FILING NOTIFICATION before completing form. X Y ❑YES ❑NO
bg NOTIFICATION enter No.)
SITE NAME T NO.AND STREET t NEAREST INTERSECTING STREET CITY OR TOWN STATE 5.LATITUDE N LONGITUDE r rs
4. OF FACILOCATILITY z�`"1 '(�V S .1. L a � F��+�/fC�✓ /X// /�I IM. ✓ r a Ca
BUSINESS NAME AND NAME (� T NO.AND STREET ,�/ / / CITY OR TOWN / STATE ZIP CODE u TELE�ONE
6. MAILING ADDRESS G ZPh Fo lie fi g. .1 AC _ ______ _ —�1 J� JV'f I{r y►/Fr'tFr� 5. !"�� .`ipS�Y I
NAME
NO.AND STREET CITY OR TOWN STATE ZIP CODE `TEEL'EPHONE/�1�1
0 7 FACILITY OWNER G�►n Al Nr - ] /✓r��P`����Pf� �e -------- 1 sVi ) 6 7 7
H
w 8. TYPE OF OWNER /K] PRIVATE ❑ STATE ❑ MUNICIPAL 0 FEDERAL(G.S.A.No.
OPERATOR/CONTACT NAME " NO.AND STREET CITY OR TOWN STATE ZIP CODE TELEPHONE
9• PERSON
10 - 16.PROTECTION 17.INTEGRAI
110. 11b. 120. 12 b. STATUS 13. TYPE OF 14. CONTENTS- I15.CONSTRUCTION 18. 19. FAILURE
> DATE CONTENTS MATERIALS a.INTERNAL b.EXTERNAL PIPING SYSTEM
TANK ID TOTAL a. b. DATE OF MONITORING DETERMINATION
DATE OF y— o EST.QUANTITY CHEMICAL NAME OF PRINCIPAL
t w TANK U rn o I U Z Z ? INSTALLATION
INSTALLATION tj Y CAPACITY U I LEFT STORED o 3 SUBSTANCE co W O �� U
Z d o J U v oe 2 i p a W O o = SYSTEM CONDUCTED?
W LAST ec t //not trade name. w -" O O u w a 0,_ ec Lt_ ,aa OR
X'0 (cols.) w 8 5 I rf an ). > a`O U_ l ) l9 O'n 2 i� W 0 w ~•d O U W •'"` _v'n (If"YES enter DATE"
(Mo./Yr.) I[O d ( Y W of v. C Z Q =W •� ,�
W; j Z O USED o.o. f- (Enter C.A.S. No. If known) uw W z 5 ' 4 E W ''~ t-►- nE T - ; REPLACEMENT (Spec;
(Gals.) � D r w m o_10�a O o 0 v`f o ti type and ottach results).
m— I w (Ma./Yr.f O� 2O � Xo: Z Z Ucr U3 <& i_�Iz' Mo. Yr. from )
Z Q of j U 7 �/ a U d ( ) ) (If'NO',enter"NO"
Example X X Heating fuel#2 X Xv H 3 H 5/75 U NO
5/75 30 5000
Example 7/60 5000 X 8/78 X I I I CASTricI#7901h6ne X X E 7 ;W 7/60 Uelse
A- kf 1cl 18�U 1 r r ; GAs ►;,E X, u U 1AV 0
NO
A/�
NO
--
r
20. HAVE YOU ATTACHED SKETCH OF TANKS AND LOCATION? 22a.SIGNATURE 22b.DATE SIGNED
0 YES 22. CERTIFICATION: I certify under penalty of law that 1 have personally examined �/
z 21. COMMENTS: I Q ( / (� and am familiar with the information submitted in this and all attached documents and that X
O [[�� based on my inquiry of those individuals immediately responsible for obtaining the '�—
(/"t �T� information, I believe that the submitted information is true, accurate and complete. 22c NAME T' e r Print 22d.OFFICIAL TITLE of owner or authorized
U U �jJ) y/{ Penalties:any owner who knowingly fads to notify shall be subject to a civil penalty not to representative).
W C f l I j �a�` ' �� al I V �� exceed$10,000 for each tank for which notification is not given or for which false information
J ( )
in J l is submitted _ JU n
COPY 2. SEND TO LOCAL FIRE MARSHAL
A r
1K 1
�i .n1 y �• �.
e
7-7
fq
+Ti: . ..
E
�S 7�%
3
ut
t"
- —__�<_a .s, - - __ �'•Mwr_-_tea - _ *�9__.._� _ �.� ��.�. da:�_ A �
.e p
ol
KC ik'
e
�. 4�:.� r .4-`!.d-.4_� -.m-r-��-. �_ •=� a � y :v��- �, - .-,Yr..�...w.
r6
;Y
,-WcGead Gurding`s), use(s) andlor stri CW-
sElo on finis Dian appear(s) to
2) 11009w� _ .:.Oiltor,-Pajnce Withcurrer�� South V`:';;
�e tionS. Variances ark special excer.
,:lay apply. ��v- Z /
- - .ate
o in, Ersfo.mrient Officer
ii
n ,
7 i
..
----- — 71�ds cirfid`ttiaf t13_
of the proposed boil"'sr atteraiI ns to blr
!�_.. rutted at
J-I N Zit•1 Q�Q�R ��I�- F I Street
_. _ JtmaeElgr wliis amaadm4 hated in app nHnn art r
Soui�� Windsor filed with plan 3nd I agree o n aTr-;
1 S ds�.r ttuildinq and state taws'and such orders! shalt be
3U1�UIN issued by,the Building Department dlfi' Pendency
G DEPARTAIEN F __ _-- -- --
Jt this i'Uni'a-64
lwtion-aiid�--�riaT"ii
permit.
Signed
,� '�"• '('his plan IS approved subject to he eo441tion that
-
�,. -- - •' - •� ^• p- '"_ 461;i:rj ;"iiu,nces regulating building: shall be
- ---- Cie ,,iied with. ..
Conditionallif,'Approved These lacd with