HomeMy WebLinkAbout118 Steep Road DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR Iff3 7 Y
BUILDING DEPARTMENT
�RQ 1540 SULLIVAN AVENUE
Bldg.Permit#
-7f 163 644-2511 ext. 230 o2 �6 �
Date Building Inspector
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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT4<`I^�
APPLICANT ADDRESS ?`�rI
APPLICANT PiYoNE# 7Kq 7-7—�
OW N S OWNER - k),(/t ia-,,ft
'� q< OWNER ADDRESS / 119 S'7`-- F��✓
0 + OWNER PHONE
ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
fi FEE ENCLOSED$ rj,
TYPE OF JOB:
�SOR-Cps
New Installation
Alteration/Addition/Repair a
3
4
Revised 4/01//2002 3
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APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
❑RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ANO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑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
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
7
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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.
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CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICA rA DAT91—
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