HomeMy WebLinkAbout12 Kelly Road (4) C�S � 23g2�t/
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT!,_,
Application is hereby: �
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
D Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE _ ,�-0.
�
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �-
APPLICANT ADDRESS �� ,4
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APPLICANT PHONE#
N S OWNER
�q� OWNER ADDRESS Rw
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OWNER PHONE 6ilo U ei 7 — 22 3
0
C ESTIMATED COST$ -7�
* IS THIS A CONTRACT COST? ✓ Yes No
FEE ENCLOSED
11rr� �� TYPE OF JOB:
SOR-C0 /New Installation '
Alteration/Addition/Repair
Revised 4/01//2002 r
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1
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
�J RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑NO
®
❑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 V-0-4,i 6C e iA k"
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS '-ILO 6'L
NUMBER OF METERS t NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES I NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS 15
NUMBER OF SWITCHES �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
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6
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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.
jF- I /0q7/� E r er
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 12,0(10