HomeMy WebLinkAbout15 Chase Farm Road DEPARTMENT DECISION APPLICATIO ELEC `;� AL ERMff
TO Pan #
Application is hereby:
B 'DEPARTMVT�APPR�Q� 15 AWN � °
s But.Permit#
511 ext.230
Date Building Inspector -
f1A.4 F.
FEE SCHEDULE
/.� Chi ' ; -r�-, ' . - -
$0-$1,000=$13.00 Street No. �� #� . n Lot No,
Over$1,000= }
$13.00 per$1,000
or any fraction thereof Tenant DesignatiE Apt.No.
APPLICANT_ `�S En-Icap�-i` ,S Sn ,e
z =
APPLICANT AD �oY"Y�► r ,• �-� P
APPLICANT PH �
OWNER egel
'C pVr N 3 Fq ,'
OWNER ADDRErV
: OWNER PHONE' ' (c�O '"
C ESTIMATED CO w>,
r� U ..
IS THIS A CO -COST? Q Yes Q No
G FEE ENCLOSED- •
TYPE OF JOB: f x`
�SpR.CO
0 New Ins
0 Alterati 'tion/Repair -Reviled'
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ANO
❑BUSINESS CURRENT USE AND OCCUPANCY (�e.5
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY �o►r�-�
❑EDUCATIONAL
❑INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑GARAGE
❑MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD ese.
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS-�� , . REMOTE DISCONNECT REQUIRED? ❑YES NO'NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS ;:�d
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
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.
ELc . iBCD ,-� g3 E- I C-+
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT . /7i DATE