HomeMy WebLinkAbout1535 John Fitch Boulevard (14) - - DEPARTMENT DECISIONPERMIT#
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE 724
6. 4-2511 ext. 230
S
Date wilding Inspector
Application must be printed or typed
Location of job
F—It-T CL,-
Street No. Street Lot No.
FEE SCHEDULE I
Floor Apt.No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER i?d 0—�A 4('\i0n 0Q 0U e-tiA V
or any fraction thereof ^�cp
ADDRESS �0'1�-� ��U-)
covjAt O� _S��� r�
OWNERS PHONE#
APPLICANT w;�� \Y'• i G cv — ► �. �C _' c�. 0 .
W N S ADDRESS l � e C�
cco ei-vi
Gj ESTIMATED COST$ G�� .Cam'
C r IS THIS A CONTRACT COST?
•�1 '� V YES NO
C� FEE ENCLOSED $ �
0 TYPE OF JOB:
OR C Original Installation
Alteration/Addition/Repair
Revised 11/95 -
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION YES / NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY 14 r4 ,A F e S
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
(Otlicr please specify)
TYPE OF INSTALLATION/WIRING METHOD C (° •� 1�
-r
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED ; L U y A C u" to I.0✓✓l
NUMBER OF METERS I NUMBER OF DISCONNECTS AND RATINGS� � Aim
NUMBER OF PANELS ( REMOTE DISCONNECT REQUIRED?YES/NO
NUMBER OF LIGHT CIRCUITS I ;L NUMBER OF POWER CIRCUITS &
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES
NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS
SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
Cie—
3LIS)
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH W -
rexj,00, C z �U�3/c �-
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. L P �/c�- DATE /O—/ T �6
INS;�ECTO R r DATE /d TIME I
LOCATION I -3S/ � j `
INSPECTION: CODE: RESU (D/A) :
r BUILDING: Z / JQ 3
ELECTRICAL:
PLUMBING:
HVAC:
OTHER:
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