HomeMy WebLinkAbout1668 Main Street (3) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby:
TOWN OF SOUTH WINDSOR PERMIT#_.. BUILDING DEPARTMENT &Q 3 5—
A PPR(J 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 NO
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$13,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS T 00 C 4?&e"
APPLICANT PHONE#
0W N S OWNER . Zlljdt�" I-94e.57a.?j
q� OWNER ADDRESS /G 69- O L6 (4,0f-m' 5 +
bo r1jDSa/
OOWNER PHONE �� -" C 7Q
ESTIMATED COST$ (,� ~ `�
IS THIS A CONTRACT COST? _>'Yes No
(� FEE ENCLOSED$
TYPE OF JOB:
dSOR-Cp� )Z- 1�Installation
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
SIDENTIAL
❑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 7Xu rC4.1-
SIZE OF SERVICE 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 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.
CONTRACTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT DATE �—