HomeMy WebLinkAbout15 Barbara Road DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PEtMIT#
Application is hereby: TOWN OF SOUTH WINDSOR ,
BUILDING DEPARTMENT f 3
�PRQ 1540 SULLIVAN AVENUE B .permit#
644-2511 ext. 230 r
Date Building Inspector
A
t ;
�.� Application must be printe ,Qr typed
FEE SCHEDULE - -- Location of Job: , •!
$0-$1,000=$15.00 Street No. Street Lot No. •
Over$1,000=
$15.00 per$1,000 etaor any fraction thereof Tenant Designation Apt.No.
r'
_,• T
•' APPLICANT V Opts �I• L.� C�}L� t► .'
APPLICANT ADDRESS F.O. BOX '30OZ.'j 6
'o• APPLICANT PHONE# S O • 8 �}
r• i
OW N. S� OWNER . �t1S3�Lt. 6t-OyG
OWNER ADDRESS
1 r
.4 f-= , . 5ou7w WtArosm
O OWP*k PHONE 1V jA
C ESTRWATED COST$ 'Soo• 0 0 !' +
IS TIN A CONTRACT COST? Yes X No
FEE h*XCLQSED$ :22 0
TYPE,OF JOB:
OR-CO .-.f -
, ew Installation
X'Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
59 RESIDENTIAL BUILDING PERMIT APPLICATION? ❑YES ONO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCYS.
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME NIA PHONE
❑STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE Zoo A SIZE OF MAIN colOUCTORS 416 X yy Al.* .
.
NUMBER OF METERS NUMBER OF DI'$CONNECTS Afq)RATINGS " Zoo A
NUMBER OF PANELS REMOTE DISCONNEC FREQUIRWD? ❑YES ❑NO
NUMBER OF LIGHT CIRCUITS NUMBED OF P&VER CIRCUITS ,
NUMBER OF SWITCHES NUMBF.,,Of-,P14TIPTS"" '�• •. . +' ;�l
NUMBER OF LIGHT FIXTURES NUMBER Ok T'eMCUFF$ • • ,;
r
NUMBER OF A/C CIRCUITS '
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUS'V BE`S,UBMITTE4. •
.e :! ,# ., ,�•
DESCRIPTION OF WORD 'j •
Z Do A cam • :
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.
12 StS 3 E- 4- 0, r-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE '�.� •D Z