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HomeMy WebLinkAbout140 Rye Street DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT#Fr Application is hereby: ,2 3 BUILDING DEPARTMENT APPROVE 1540 SULLIVAN AVENUE Bldg.Permit# ��mp 644-2511 ext. 230 Dat Building Inspector Application must be printed or typed FEE SCHEDULE Location of Job: 0 .5r. $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT �� /4;%�Jt � APPLICANT ADDRESS f Pf '50 Gy/ij;5�n;©,e �%�• APPLICANT PHONE# 360— -'-7;)/ OWNER J&� G �0 W N S��4 OWNER ADDRESS !�� ��UGLlU/�•d � OWNER PHONE ESTIMATED COST$ * � IS THIS A CONTRACT COST? Yes No FEE ENCLOSED$ �i f TYPE OF JOB: �SD R-C O New Installation _4/1Vieration/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 ❑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 A�o 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 oc 195 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. /a,;636 6-1 62-T CONTRACTORS LICENSE NO. T 7 E STATE " SIGNATURE OF ArrLICANT / L ' 'd — DATE /L'.7