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HomeMy WebLinkAbout155 Niederwerfer Road (3) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT Application is hereby: TOWN OF SOUTH WINDSOR PERMIT#�02� BUILDING DEPARTMENT APPRO 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 Date Building Inspector Application must be printed or typed Fo EE SCHEDULE LocTe' r ' n of Job. jer We 15 )S�� �j ,E�r -$1,000=$13.00 Street No. Street Lot No. Over$1,000= 13.00 per$1,000 ny fraction thereof Tenant Designation Apt.No. APPLICANT r 1 6 r f 'C' APPLICANT K)EU) 72f RESS l ti"n - o APPLICANT PHONE# — �6 W N S t4 OWNER .1O OWNER ADDRESS t r C4 O-C�- r7 OWNER PHONE `tq I ESTIMATED COST$ ®© U IS THIS A CONTRACT COST? meyes ❑ No FEE ENCLOSED$ dSOR Cps TYPE OF JOB: ❑ Ne tallation Alteration/Addition/Repair Revised 5101 + f 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 ENGINEER'S NAME PHONE ❑FACTORY ❑ STORAGE ADDRESS ❑ GARAGE ❑MIXED USE CITY STATE ZIP 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? ❑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. (60qg CONTRACTORS LICENSE NO. YPE STATE 9/ SIGNATURE OF APPLICANT DATE ��