HomeMy WebLinkAbout114 Sally Drive (3) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WIlVDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
'ibatl Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job: 77]
S4//y
$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 G > C�cr♦ /f. %� p�'.
APPLICANT PHONE# 2 0 3rr z K-8
o W N $�• OWNER . TT c
q� OWNER ADDRESS /1 Y
OWNER PHONE
0
C a ESTIMATED COST$ 2 O 00, oTi-
IS THIS A CONTRACT COST? Yes No
f� FEE ENCLOSED$
Cq
TYPE OF JOB:
OR-Co New Installation
✓Alteratio dditio epair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
C�' ESIDENTIAL BUILDING PERMIT APPLICATION? 20 YES ❑NO
�R
❑BUSINESS CURRENT USE AND OCCUPANCY i'as "Pe," c e
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY r S c�a•. c e
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME M. /7'-0 G'r c PHONE
❑ STORAGE
❑GARAGE ADDRESS 7 `( `� /�I c.i� S� So a�Li Sa. f c 9 e/
❑MIXED USE
CITY STATE c 7- ZIP 06'7 7 8
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD o �x
SIZE OF SERVICE a)e ('f 7'/1-1 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
a cPaP, f 'o�► o J �a k^ lY /-o "^ &✓ /'-
,/" 2 1.'9 f �+q �- ,oa r,.�e✓'
Gc �Gu i Y5 �• �` D /ece !ac% S
74i Gam.
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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 5--/-0 3