HomeMy WebLinkAbout19 Cody Circle FDERTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
plication is hereby: BUILDING DEPARTMENT
APPRO D 1540 SULLIVAN AVENUE Bldg.Permit#
� � 644-2511 ext. 230 �-i Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
(6, 60�
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT CC)Aj S-1AAJ-r A&IC11-
APPLICANT ADDRESS b 'vuFF-
� C'7,
APPLICANT PHONE# 7/- 3d 2 S
OW N St OWNER . 4� fi�AP l3eavl« y
'4� OWNER ADDRESS I Ca w—
OWNER PHONE
C ESTIMATED COST$ 10009 i
'U IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB:
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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? P,411ES ❑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 L `ems
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 Z- 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
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.
ZP 3C 2 J f
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE �-d