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HomeMy WebLinkAbout105 Gorski Drive (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR ��3 - BUILDING DEPARTMENT APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# �M� 644-2511 ext. 230 ©2 9 3 3� ��o-�z- ^� Date Buil i Inspector Application must be printed or typed Location of Job: FEE SCHEDULE / $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT J�i4 y$►uA2C l/P E�✓�.✓�- � APPLICANT ADDRESS /D.S 61-o fes k k _ . xnt WlwDfc72 Cam' CG�o7c� APPLICANT PHONE# W N S OWNER �/�/►1 F �q� OWNER ADDRESS OOWNER PHONE ESTIMATED COST$ SOOtG * � IS THIS A CONTRACT COST? Yes No FEE ENCLOSED$ IS' TYPE OF JOB: OR-Co 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 6 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 �C C SIZE OF SERVICE o� 1'�i-s,P SIZE OF MAIN CONDUCTORS �1^►,0%� NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS — f' NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES NO NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS ? NUMBER OF SWITCHES G NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES / 9 NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS C7 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. Z&YI e0aj"i FV CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE %��//Z0131—