HomeMy WebLinkAbout10 EDGEWOOD DRDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Applicat' by:TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT
PRO 1540 SULLIVAN AVENUE
Bldg.Permit#644-2511 ext. 230
DiAltaa ,
ng Inipect
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Application must be printed or typed
FEE SCHEDULE Location of Job:
O 6 E •.+oo p Awl.
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 77Yf r?i4-s,-J CpW 4,£GT7 d7
APPLICANT ADDRESS P O• /V x .S'—W
S. w • r 6ba-
APPLICANT PHONE# 2 T-y—I Cot I
O W N S F,q
OWNER P,4 4-a (;-, A- f C r+-*Iq-A.a P arc w
OWNER ADDRESS 0 F b 6 c w o F0 D DR ,
OWNER PHONE a Z9— &1 L-7
C ESTIMATED COST$ y 0
x IS THIS A CONTRACT COST? kYes _No
FEE ENCLOSED$3 O• "t
CO
TYPE OF JOB:bSOR New Installation
Alteration/Addition/Repair
Revised 4/011/2002
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APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES O NO4-RESIDENTIAL
O BUSINESS CURRENT USE AND OCCUPANCY 1(,`/ SASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCY p
El EDUCATIONAL L S
INSTITUTIONAL
O FACTORY ENGINEER'S NAME PHONE
OSTORAGE
GARAGE ADDRESS
MIXED USE
CITY ATE ZIP
Other please specify)
TYPE OF INSTALLATIONIWIRING METHOD C `' (0 .
SIZE OF SERVICE 13 SIZE OF MAIN CONDUCTORS /Ov
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES O 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
to d Ofrn to S-lJ r C-£ 411+'& .
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. STATE
SIGNATURE OF APPLICANT DATE ;y `'J
Shirley Wilhelm-CRS Approval Confirmation: Request No.449965 Page 1
From: clpsvc@nu.com>
To: WILHEL@SOUTHWINDSOR.ORG>
Date: 8/25/0512:09PM
Subject: CRS Approval Confirmation: Request No.449965
Your approval of the following CRS Request has been successfully
processed.
CRS Work Request M 449965
House No:10
Lot No:
Street Name: EDGEWOOD DR
Town Name:SOUTH WINDSOR, CT
Inspector:CHRISTOPHER DOUGAN
Approval Date: Aug 25, 2005
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