HomeMy WebLinkAbout18 Garnet Lane DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WI DSOR if,23?
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
3 3 644-2511 ext. 230 y-
Dat Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE Lt4 —�
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT :So 64-W �c?Y�l ll�rJ dL�S(Cc
APPLICANT ADDRESS i g &�k,,� Lt+tj c—
APPLICANT PHONE# G 4 4 " 009,
N S OWNER . bl� Rum�� Sly
OWNER ADDRESS l 6 GA-J'0� C 6,r'�
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0 _ OWNER PHONE G 4 4 fQ [1 O �
WID ESTIMATED COST$ U
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ [S�
TYPE OF JOB:
SOR-C0 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/W UNG 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
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
1 1
SIGNATURE OF APPLICANT17, DATE 4 ^2 3