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HomeMy WebLinkAbout1302 Mill Pond Drive i DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Applica ' ere by: /4F3 0 c2- BUILDING DEPARTMENT APPRO 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date/ B ld g Inspector Application must be printed or typed FEE SCHEDULE Location of Job: l ��z- M I C,� lam„ �� �R� � - $0-$1,000=$15.00 7 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT n h - O 2 iJ L A 1 1� APPLICANT ADDRESS 3 ©Z tiI 4-c boo,/Lj E v --" C-Jj n c(s ooe C i C�(�O O Z APPLICANT PHONE# 00,111,OWN S OWNER ��•�-� - q� OWNER ADDRESS r OWNER PHONE -- oa r?e O IC U ESTIMATED COST$ 7 ,� ��► IS THIS A CONTRACT COST? Yes No FEE ENCLOSED$ 1� �AV, TYPE OF JOB: �SOR-COS 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? d YES ❑NO RESIDENTIAL ❑BUSINESS USE AND OCCUPANCY /9 C ❑ASSEMBLY ❑MERCANTILE FUTURE USE AND OCCUPANCY A , ❑EDUCATIONAL ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE ❑ STORAGE ❑GARAGE ADDRESS ❑NUXED 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 BEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK �!7 ST/9 LL X f'I A La T C y�1E � iVL� L ; till 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 6 In 6-av C i CONTRACTORS LICENSE NO. TYPE STATE C,:�(.��F ,-'�l - DATE ,)- ��-I - 0 SIGNATURE OF APPLICANT �S 41� �--{, �� �