HomeMy WebLinkAbout26 ALLEN DR DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
pp y. TOWN OF SOUTH WINDSOR PERM
Alica 5
BUILDING DEPARTMENT
OVE 1540 SULLIVAN AVENUE
zBldg.Permit#
MA 2 4 2004 644-2511 ext. 230
Date truilding In
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE#
OWN SF OWNER 0 B;
OWNER ADDRESS
0
F, OWNER PHONE �f/ 9 ,5'L
C ESTIMATED COST$ /, Y 7S,G0
x * IS THIS A CONTRACT COST? _Yes --[!10
l� Q '_" ' ��.► FEE ENCLOSED$ �U•
5 o TYPE OF JOB:
R C 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
RESIDENTIAL ��
BUILDING PERMIT APPLICATION? ❑YES l9 NO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑STORAGE
❑GARAGE ADDRESS
❑MIXED USE
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD `�� /�� SC LL
SIZE OF SERVICE Q570 SIZE OF MAIN CONDUCTORS x1 /!�P/ SC G[
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
6-2 L d:2!`teiv! Sir"y�ce rDc u
4b CJrGo f'P'S Li ,A rii c.C ( _
i
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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
Shine Wilhelm:CRS A proval Confirmation: Request No. 339033 Page 1
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 6/10/04 2:49PM
Subject: CRS Approval Confirmation: Request No. 339033
Your approval of the following CRS Request has been successfully processed.
CRS Work Request M 339033
House No: C26 J
Lot No:
Street Name: IACCENbR_,
Town Name: SOUTH WINDSOR, CT
Inspector: CHRISTOPHER DOUGAN
Approval Date: Jun 10, 2004
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