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HomeMy WebLinkAbout10 Highview Road DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Applica' eby: BUILDING DEPARTMENT �U APPROVED 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date B it ng Inspector Application must be printed or typed Location of Job: FEE SCHEDULE /0 et 0,601Y $0-$1,000=$15.00 Street N Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT Ari 40AJi k APPLICANT ADDRESS JtA W�Iof & ©Go-1 y APPLICANT PHONE# gyy-7 G 7 OWN S OWNER jCGvti t', 4 S 9�0" q� OWNER ADDRESS So vw e a� C.,Ljt- OOWNER PHONE �r r,,,� CA S c, � C ESTIMATED COST$ ,OQ 0 � IS THIS A CONTRACT COST? vllYes No FEE ENCLOSED$ (90 TYPE OF JOB: SOR-C� New Installation Alteratio dditio epair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A K RESIDENTIAL BUILDING PERMIT APPLICATION? � YES ❑NO ❑BUSINESS CURRENT USE AND OCCUPANCY ,k) w►, ❑ASSEMBLY \, C ❑MERCANTILE FUTURE USE AND OCCUPANCY l YtU TGwj l gDo m ❑EDUCATIONAL ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE ❑STORAGE ❑GARAGE ADDRESS ❑MIXED USE CITY STATE ZIP (Other please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF SERVICE ZDO hm 12 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 6 0 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. Z 0.wty,v�lS fit- CONTRACTORS LICENSE NO. TYPE STATE r SIGNATURE OF APPLICANT _ DATE,117V 9-0 2