HomeMy WebLinkAbout189 Avery Street DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT d
LMPR 1540 SULLIVAN AVENUE
Bldg.Permit#
Z u� 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
Ajecv ��
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS j* :;:50Q 14-Ve
( 1) 1 n r--n
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APPLICANT PHONE# Y��
O W N S F,q OWNER ho r
OWNER.ADDRESS gq Amex,
—!So L+h t I Y I C�- nA 0-7'-/
OWNER PHONE 6
ESTIMATED COST$ �Q� 0
V
IS THIS A CONTRACT COST? Yes No
f �C� FEE ENCLOSED$ �
TYPE QF JOB:
�R-CO�� 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
SIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY f-e 7S
❑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 fir-Ctf-d'7Qr rKtC
SIZE OF SERVICE 1(7)n SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS I REMOTE DISCONNECT REQUIRED? ❑YES j4 NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS Z
NUMBER OF SWITCHES I 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
cP-n4:na l n c and -Ciman _
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.
FS)t T
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT ✓�� �i�� DATE l o