HomeMy WebLinkAbout162 Cornerstone Drive FSION APPLICATION FOR ELECTRICAL PERMITTOWN OF SOUTH WINDSORPERMIT#
y: BUII.,DING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS I�► .��i'ti.�1�' � ,� \
APPLICANT PHONE# 1-(0 U S ` ` L44
O
W N S t , OWNER ,
. OWNER ADDRESS 1(0,2
OWNER PHONE
ESTIMATED COST$ w
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB:
SOR-C0 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
',RESIDENTIAL BUILDING PERMIT APPLICATION?XYES ❑NO
❑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[W UNG 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
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.
L
L�
CONTRACTORS LICENSE NO. TYPE ST TE
SIGNATURE OF APPLICANT DATE �w---