HomeMy WebLinkAbout10 Beachnut Lane LDERTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
plication is hereby:
BUILDING DEPARTMENT
�PRO 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230 Building Inspector
Application must be printed or typed
FEE SCHEDULE // Location of Job:
/a katki4 L 6,Ae.
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT IMC�711 eG G GL
APPLICANT ADDRESS A j6rV/1 P-J
CT 06 0 q3
APPLICANT PHONE# 5-33—10-Z
O� N S� OWNER J)aT', 6AMC-I(
z
q< OWNER ADDRESS A
0 _ OWNER PHONE
C ESTIMATED COST$ dy
� IS THIS A CONTRACT COST? Yes Pe***N o
FEE ENCLOSED$ O
TYPE OF JOB:
OR-Co New Installation
'"Alteration/Addition/Repair
// 2
Revised 4/01 200 I
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑YES ❑NO
❑RESIDENTIAL
❑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 /041rl5 Lc ��S G�d' ��r�Z�PSj �6 Cl/
P
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.
/�YZs/ 51 C-7-
CONTRACTORS LICENSE NO. TYPE STATE
'& -SIGNATURE OF APPLICANT � " DATE CI Z� y