HomeMy WebLinkAbout106 Mountain Drive S 2 2, y 5a5�-
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Applica' TOWN OF SOUTH WIlVDSOR
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
-0 t 644-2511 ext. 230
Date Buil g 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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT I-Alo47,J �AI F-G 6 7-jal�vl-4
APPLICANT ADDRESS C �— ,6
f� ) yy t�r DS'o� �� )7 Q 7
APPLICANT PHONE# 2Z Z /!? 7
O%q N S OWNER , Z- �P-A L A-6
q< OWNER ADDRESS l d 6 k14 0 yt D 12
Ciw _ I OWNER PHONE `t
C ESTIMATED COST$ l 100 - I
IS THIS A CONTRACT COST? XYes No
62)
FEE ENCLOSED$ 30.
o��s TYPE OF JOB:
�
OR C New Installation
_,Z,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 ZF--5
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY �5
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD �1 6
SIZE OF SERVICE �� ' '1� SIZE OF MAIN CONDUCTORS �p /,,, 6 Sf-�
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS l REMOTE DISCONNECT REQUIRED? ❑YES 4<0
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
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. E STATE
SIGNATURE OF APPLICANT DATE