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HomeMy WebLinkAbout120 Bridlewood Road (4) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT APPROVE 1540 SULLIVAN AVENUE Bldg.Permit# L-i�!- aonc!m- -> 644-2511 ext. 230A��Bu' g Inspector Application must be printed or typed 7FEESCHEDULE Location of Job: / 20 t3r� M. $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT C APPLICANT ADDRESS 3 cJ©L 1A Sd)i%A AS Or, 1 APPLICANT PHONE# O N S OWNERfb q< OWNER ADDRESS 1 2 b er,°�be&r-P66� x L 1/�/�0 _ OWNER PHONE ESTIMATED COST$ 9D0 a V IS THIS A CONTRACT COST? Yes No f� FEE ENCLOSED$ /5,' TYPE OF JOB: �SOR C� New Installation Alteration/Addition/Repair 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 ❑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 e %O l7 tit 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. 13?-,K 3 ?C-- T CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE , Z �J