HomeMy WebLinkAbout118 Palmer Drive DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERNIIT#
Application is hereby: 'J j
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
j ;41e�^ rO9-
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Y� L — S e.✓,V 1(-t 1-- (f-C 1fe i C.
APPLICANT ADDRESS � M ►'4 i d
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APPLICANT PHONE# C 9- o 0) 0 I
OWN S� OWNER . M 112 J 0 R2 1-C Ciy 12A S 14 1
q� OWNER ADDRESS I A-i e V
S CA `N 1`cGQscs� , e
OWNER PHONE
ESTIMATED COST$ Cam- ?cam
IS THIS A CONTRACT COST? Yes
FEE ENCLOSED$ / 5
TYPE OF JOB:
New Installation
-Z� teration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
—'RE/SIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑NO
El BUSINESS
❑ASSEMBLY CURRENT USE AND OCCUPANCY
❑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 WORK
TN
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.
I1�0g0 -2 E( C l
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT/' DATE