HomeMy WebLinkAbout109 Austin Circle (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: /Oa��
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE
Bldg.Permit#
t3 U Sxe- 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of J b:
C� 1 Y - -
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT rW YI CA
APPLICANT ADDRESS
Mi-c4-AltiTnIA�11 C-7 C)-6L/,S
APPLICANT PHONE# & U — 3 V6- D YU Lf
OWN S OWNER . n(-Ck-Ce Lei
q< OWNER ADDRESS I b 5 4U C/
OWNER PHONE
C ESTIMATED COST$ G�--
IS THIS A CONTRACT COST? es No
FEE ENCLOSED$ /
TYPE OF JOB:
SOR. New Installation
Alteration/Addition/Repair
i
Revised 4/01//2002 1
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse s
TYPE Oy LDING IS THIS APPLICATION ASSOCIATED A
al rSIDENTIAL
BUILDING PERMIT APPLrcl,�54271-r4-A
TION? S ❑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/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 HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
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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. TYPE STATE
SIGNATURE OF APPLICANT
DATE