HomeMy WebLinkAbout104 Ident Road (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
Z JI-e— 644-2511 ext. 230
*Da a Building Inspector
Application must be printed or typed
FEE SCHEDULE i
oc on of Job•
_p
$0-$1,000=$15.00 Street No. Street---Z - 9M. Lot No.
Over$1,000=
$15.00 per$1,000 -POP
or any fraction thereof Tenant Designation Apt.No.
'h,tj '�',tXVCII�
APPLICANT jj,
APPLICANT ADDRESS '
APPLICANT PHONE# 4,7 9r�C 44,&. 4r, A
OWNER .
OWNER ADDRESS
OWNER PHONE -161 F(9 2
ESTIMATED COST$ I
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ Q.
flrr �� TYPE OF JOB:
I�SOR-Co Installation
7'Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
4d
UJRESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑NO
E3 BUSINESS
❑ASSEMBLY CURRENT USE AND OCCUPANCY --�
❑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
SIZE OF SERVICE /J(�P SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES ONO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS T
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.
DESC TION OF WPRK
U3,
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 HE
PERFORMANCE OF SUCH WORK.
CON TOR ACTO R S LICENSE NO. IVY E
SIGNATURE OF APPLICANT DATEC2-