HomeMy WebLinkAbout255 GRAHAM RD ..................
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Revised 4/01//2002
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
TOWN OF SOUTH WINDSOR
Application is hereby:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg. Permit#
i�•3 ob �+�
Date Building I
Application must be printed or typed
FEE SCHEDULE Location of Job:
ds-15- 6)equgm &.�
$0-$1,000=$15.00 ETfenant
'r Street Lot No,
Over$1,000=
$15.00 per$1,000
or any fraction thereof ation Apt.No.
APPLICANT 1 f��/ -e Ic C 4�r;
APPLICANT ADDRESS _BfrL l„v�
L006
:;ouir Windsor
;IL( ARTMENT APPLICANT PHONE# 6
��
�O W N 8Fq OWNER IC_nc f
OWNER ADDRESS ��� t�c�� �,ky 1
OWNER PHONE lLr---T—� -�
t" ESTIMATED COST$ fDO
IS THIS A CONTRACT COST? _Yes
FEE ENCLOSED$
TYPE OF JOB:
SOR•CO � New Installation
?Iteration/Addition/Repair
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? 0 YES 0 NO
?BUSINESS SIDENTIAL
❑ASSEMBLY CURRENT USE AND OCCUPANCY
0 MERCANTILE FUTURE USE AND OCCUPANCY IF
0 EDUCATIONAL
0 INSTITUTIONAL
0 FACTORY ENGINEER'S NAME PHONE
OSTORAGE
0 GARAGE ADDRESS
0 MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE e2po icSIZE OF MAIN CONDUCTORS ' A ,C IL Of
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? O YES ❑NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FDCTURES NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
F DESCRIPTION OF WORK
1a� 04�i r✓t�s �IYSA A /f/a t��• �C e � 02 P O /9!r w
NCAA-2 ?-00 4 -,1 co
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.
4 L, arp nr p
Q0NtkACf0'R9'LICEN7SET4o. E STATE
SIGNATURE OF APPLICANT DATE
Electric# APPLICATION FOR BUILDING PERMIT
Plumbing# 255 Graham Road Date:
HVAC #
Sprinkler# 800115
----- ----- Estimated Cost $ 00
Buildings � J� i COMPLETE RED BOXED AREAS Permit Fee $
Enginee g (� TYPE OR PRINT ONLY I Occupancy Fee
Affidavit j Eng. Insp. Fee $
A r. for CO. ► SIGN ON REVERSE SIDE
PP - Total Fee
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $_
The undersigned hereby applies to do work according to the following:
Applicant r1n t" Location of Work 125 9 Lot No.
Applicant's Address Tel.# AL4 - 7 L
Townzai,A�� W<dacn < Zip 0607 q Lic.#
Owner 30AY--e_ Architect
Owner's Address Architect's Address_
Zip Zip-
-Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this ermit Gt 0- f— - �i
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO Area Basement Garage
Approved by D e Use Group Construction Type
Revised 6/02
l J vl�
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 i o be located the pr d�tance from all street lines,side yard lines,and required
distances from all other zon d is located in which this s use is allowed.
I
I hereby apply for a Ce fi of Occupancy for the work described in this application for the permit.
Signed
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
05/07/2009 15 04 TOWN OF SOUTH WINDSOR
aliceakehoe (INSPECTION ENTRY
Location Type Department Scheduled Sched Tm Performed
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255 GRAHAM ROAD FINAL 1440 - BUILDING DEPARTMENT 05/05/200S