HomeMy WebLinkAbout0 BURNHAM ST MISC FILEDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
Y5_,3BUILDINGDEPARTMENT
APPR ED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 2306c$03
Date Bw mg nspector
Application must be printed or typed
FEE SCHEDULE L ation of Job:
2 N Ayw%
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT A l O rcj
APPLICANT ADDRESS CYd f
APPLICANT PHONE#
O W N St OWNER 1
I
OWN R ADD SS
Q
OWNER PHONE
C ESTIMATED COST$ D •O a
i IS THIS A CONTRACT COST? —Yes ego
FEE ENCLOSED$ e-
TYPE OF JOB:SOR.COS 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 A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
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 C> 01r
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
C C vv C
U
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.
CA
CONTRACTORS LICENSE
N
TYPE STATE
SIGNATURE OF APPLICANT O ff(\ ( DATE b 2All ''
Shirley Wilhelm-CRS Approval Confirmation: Request No. 301325 Page 1
A
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 10/31/03 4:11 PM
Subject: CRS Approval Confirmation: Request No. 301325
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#:301325
House No:
Lot No: RR
Street Name: BURNHAM ST
Town Name: SOUTH WINDSOR, CT
Inspector:CHRISTOPHER DOUGAN
Approval Date: Oct 31, 2003