HomeMy WebLinkAbout275 PIERCE RD DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Applicatio TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
PRO 1540 SULLIVAN AVENUE Bldg.Permit#
2 OLI644-2511 ext. 230 J
Date Buil ng Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job: /
Fi
� L 5 01�$0-$1,000=$15.00 Street Lot No.
Over$1,000$15.00 per$1,000 or any fraction thereof gnation Apt.No.
APPLICANT 4 ' 46C
APPLICANT ADDRESS
APPLICANT PHONE# —
OWN S F,q OWNER
OWNER ADDRESS
CT
a E" OWNER PHONE
O
C ESTIMATED COST$ f DDD, DD
.� IS THIS A CONTRACT COST? --Yes _No
FEE ENCLOSED$ 1 v''-1 n U
_ o
sO .CO�� TYPE OF JOB: L, (v
R New Installation
_Alteration/Addition/Repair
Revised 4/01//2002
s
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
❑RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑NO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE❑EDUCATIONAL FUTURE USE AND OCCUPANCY
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE 190 SIZE OF MAIN CONDUCTORS_ i�
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
✓ ' P60426-115 4 /1 r
,zack-
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.
141 RSVP C7-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE x
Shirley Wilhelm -CRS Approval Confirmation: Request No. 312407 Page I
From: <clpsvc@nu.com>
To: <WILHEL@SOUTHWINDSOR.ORG>
Date: 12/31/03 2:06PM
Subject: CRS Approval Confirmation: Request No. 312407
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 312407
House No: DSMDS POND
Lot No:
Street Name: PIERCE RD
Town Name: SOUTH WINDSOR, CT
Inspector: CHRISTOPHER DOUGAN
Approval Date: Dec 31, 2003