HomeMy WebLinkAbout180 Avery Street (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR �Q
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg. Permit#
to Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
I I ue V 171-,
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
h1.APAPPLICANT
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PLICANT ADD
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APPLICANT PHONE# 3�9(0/(
OW N Stq OWNER
OWNER ADDRESS Auew-y ,
0 ! OWNER PHONE (4-1 — /3
C ESTIMATED COST$
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IS THIS A CONTRACT COST? 0 Yes M
FEE ENCLOSED$
OR,CO � TYPE OF JO
Ori inal Installation
Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑ NO
❑BUSINESS CURRENT USE AND OCCUPANCY 00vn �
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
I"1 !`ADA�r, -
I U MIXED USE I CITY C'T'A TF 7TU I
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED �00 VkA
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS 0 =�pO IAVK�
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES &
eO
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 Q -
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
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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. STATE
SIGNATURE OF APPLICANT �- h7L, DATE q?S D