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DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
TOWN OF SOUTH WINDSOR
Application is hereby:
BUILDING DEPARTMENT
APP 1540 SULLIVAN AVENUE
•644-2511 ext. 230 Bldg.Permit#
a�SS)
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE 1 ,71Location of Job:
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANTv S T N cs�4�'—' 7 _ . c.v
APPLICANT ADDRESS (K e 4 m At G
APPLICANT PHONE# (RAQ�' k q q
OW N SF OWNER 0-0ST awd ��olZtrc!
'4< OWNER ADDRESS
' 0o
!� OWNER PHONE C��b� wi q.-S31
ESTIMATED COST$
+� U
IS THIS A CONTRACT COST? 13 Yes ANO '
Q ;, CIO FEE ENCLOSED$ 30,
OR�CO� TYPE OF JOB:
0 Original Installation
�4,Alteration./Addition/Repair Revised 8/99
i
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS TINIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? DYES ❑ NO
1 \
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE❑ EDUCATIONAL FUTURE USE AND OCCUPANCY O WI
❑INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑ GARAGE
❑MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD !E�1 A^.1 DAR D /Z
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED Z .
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS 0
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES I'NO
NUMBER OF LIGHT CIRCUITS Z NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES Z NUMBER OF OUTLETS /X
NUMBER OF LIGHT FIXTURES l NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS D
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
�A ,q // DESCRIPTION OF WORK
V" r2,tv 6r OF �(D ' l 7' '8AsE N� Aei^
�s 2ma Itpex 2 1 ant Ca L
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 WO
94(, AL LEC71I
CONTRACTORS LICENSE NO. TYPE STATE
J
SIGNATURE OF APPLICANT DATE �� O3