HomeMy WebLinkAbout1648 Main Street CRs# �-)6S )-8�
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR 183114
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
6 A A /� 644-2511 ext. 230
D e Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
I e�''� dId nG,0 5�r
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT "7c1y� L Sj
APPLICANT ADDRESS _ I-7 („ fjcam, S�-
(Y)CrnC)�\Q,4-j f C,* O(00`10
APPLICANT PHONE# Lj S 3 3 9
OWN SF OWNER
'4� OWNER ADDRESS Ln`� �_1 c� �G'n�5 V
a
OWNER PHONE
C ESTIMATED COST$ /Cco-
I
IS THIS A CONTRACT COST? _des No
l� CJ FEE ENCLOSED$
TYPE OF JOB:
�SOR• �
New Installation
_ZAlteration/Addition/Repair
1
i
t
3
Revised 4/01//2002 E
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
kd'OBUILDING PERMIT APPLICATION? ❑YES ❑NO
RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL PHONE
❑FACTORY ENGINEER'S NAME
❑STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD Z � r�r
'�
SIZE OF SERVICE G '? SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES dNO
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
\,
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.
-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT - DATE ( -3 _Q 3