HomeMy WebLinkAbout140 Commerce Way (6) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: AF3 O 3
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
6 644-2511 ext. 230 0< 53
ate Building 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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT SC C ov-l 4 S�%-k%e nS !SO-e C ja 1 t- �-
APPLICANT ADDRESS to( R cw bon St 1 IZcsa(j
"1 6 , C-�.. OCOUR�of o�
APPLICANT PHONE# _ �QC} S(09- -7 a33 �O - 9� - 3 l,10
10 W
N S OWNER . 21► 0 ?v-a sec, LL.
�q� OWNER ADDRESS SG1rne as e t,,-60n
OWNER PHONE R(d)- I 11
M ESTIMATED COST$ LKI M
IS THIS A CONTRACT COST? V/Yes No
FEE ENCLOSED$ taO ,00
TYPE OF JOB:
OR-CoS /New Installation
Alteration/Addition/Rep air
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
0BUSINESS CURRENT USE AND OCCUPANCY 7
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY 0 Q C c-.
El EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY -- STATE ZIP '
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD SSCCQVIA �4zpryx
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
�
1 i — 'UJ v Y1 S°-�c�� C�`�l a� °P � C(� 1
S l�(3c��S 3 Safi��a c��c�r, . �. 5��o ( 5 CYto1� 'D,Q,�.e c�U/ � �lQa�' C�T�c i�►S
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.
I P too L- S C-T"-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE s"� ' 03