HomeMy WebLinkAbout124 Brookfield Street (7) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: Sao
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
�.S/k--
644-2511 ext. 230 rj F 70 7
ate Building Inspector
Application must be printed or typed
FEE SCHEDULELocation of Job:
12 y &N:z2bQ*eW ( c�C- cr �
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT lAeOCe0k4eC
APPLICANT ADDRESS Z.7 4f' M dW( P 1fq a/WC tea gze(
l C 46 V60 — / 7 6
APPLICANT PHONE# . z5'6 O- 3 M- S 3 f 0
�O W N S F,q OWNER .
OWNER ADDRESS
a a 6
OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? _,K Yes No
f ) FEE ENCLOSED$ G
an
TYPE OF JOB:
SCR'CO X.New Installation
Alteration/Addition/Rep air
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
ULBUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY // .l
❑MERCANTILE FUTURE USE AND OCCUPANCY (!o cJ $ruv��ol' �o CcnSe C !emu
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD 14 c " 1. Tf l N`e
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
t �Lw4e� v-,4e/U-16%4V 010y^'&,00y/
S 5^otaAc 7 e c Kos S
y n vLI-c' `Z7` u>�7` �u l/s�� o.Y .0
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.
/05 7/8 4 - 5 cc.-V xec u7`
CONTRACTORS LICENSE NO. TYP STATE
SIGNATURE OF APPLIC � DATE �� ^ 2