HomeMy WebLinkAbout1118 Pleasant Valley Road DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: l���p
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE
Bldg.Permit#
S f � 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
_ �-
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$0-$1,000=$15.00 Street No. Street Q Lot No.
Over$1,000= ^-- > 1 1 t
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT , (, .
APPLICANT ADDRESS
APPLICANT PHONE# r// �' -7 ��I
O* N St OWNER `/�� �.r`�•(�✓�d E�f� i�/ ea A � 1'�
q4( OWNER ADDRESS
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_ OWNER PHONE
0
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes LXN o
FEE ENCLOSED$ ( 0
TYPE OF JOB:
OR-CO New Installation
✓Alteration/Addition/Repair
Revised 4/01//2002
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APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑YES ❑NO
❑RESIDENTIAL
❑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
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.
r / 7-3 t/L --, - �TYPE STATE
CONTRACTORS LICENSE NO
SIGNATURE OF APPLICANT DATE /'?�