HomeMy WebLinkAbout10 Debbie Drive (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: 1-7dg
BUILDING DEPARTMENT
AP ROVE 1540 SULLIVAN AVENUE Bldg.Permit#
fi Z 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS 0 D 6f 4 �
APPLICANT PHONE# j �` �6 (�
OWN 3 OWNERr�'`�
q� OWNER ADDRESS f�
v�, OWNER PHONE �_�-�
C ESTIMATED COST$ r FF
% 50 0
IS THIS A CONTRACT COST? 0 Yes 0 No
FEE ENCLOSED$ cx�6. 6)
TYPE OF JOB:
�SOR.Cps
0 New Installation
0 Alteration/Addition/Repair Revised 8/99
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 ENGINEER'S NAME PHONE _
❑FACTORY
❑ STORAGE ADDRESS
❑GARAGE
❑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
Aor-
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.
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CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE