HomeMy WebLinkAbout122 Dart Hill Road FDCISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
her TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
g Inspector
Application must be printed or typed
EE SCHEDULE Q
Location of Job:
FF.
I a Dal-+ ffi � � R
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT P_) )n H , A • (_.
APPLICANT ADDRESS j I W I n �
LA) i IQ nr; 63 0
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APPLICANT PHONE# �D��- L4 S
OWN S F OWNER + ni- A-eAe,
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OWNER ADDRESS
nt Zi nd-SOC, C-7F CroMLI
0 M - OWNER PHONE
ESTIMATED COST$
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IS THIS A CONTRACT COST? _ZYes No ;
l� t FEE ENCLOSED$ f , no
TYPE OF JOB:
�soR, �
New Installation
A 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 [`�-� ( e n�'1 Ca I
❑ASSEMBLY
❑MERCANTILE
❑EDUCATIONAL FUTURE USE AND OCCUPANCY
❑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 SIZE OF MAIN CONDUCTORS
NUMBER OF METERS—�— NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS � REMOTE DISCONNECT REQUIRED? )KYES ❑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 Ll
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
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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.
I R-7q6`�- �E ) CI
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT4. DATE �/6� 3