HomeMy WebLinkAbout18 Norma Road DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: 17 7 7
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
k L 644-2511 ext. 230 02 F S-Vp-
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE /� Loc 'on of b:
/VO 44?4 a
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS �� S
APPLICANT PHONE#
OWN S'& OWNER
r 'f
q� OWNER ADDRESS
f
r
OWNER PHONE
o r
C ESTIMATED COST$
IS THIS A CONTRACT COST? �es No
FEE ENCLOSED$ �c
TYPE OF JOB:
OR C New Installation
yAlteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
SIDENTIAL
BUILDING PERMIT APPLICA ON? ❑ YES ❑NO
❑BUSINESS CURRENT USE AND OCCUPANCY ��d
❑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
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 WO
0 /,04� Z,;
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.
/Z.5Yix 27/ cf-7—
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE G/�/