HomeMy WebLinkAbout167 Tumble Brook Drive (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 02 cl 7
. off
Date B ld' g Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE �1 7 7a-mb l e brow- r� re�
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT a rl age A GrqL,
APPLICANT ADDRESS /� 7 7"u ntbl4rpok- bt*C,
56 ilt I)L W-
,nd5ok ,,-- C 7_ D
74
APPLICANT PHONE# &(p® ' T ' �o 45
W N S F OWNER f/ ILe— - G
� q4( OWNER ADDRESS
L ArV ,
Cr
6014--�A All
vJ OWNER PHONE C) '6o - 6 D S
0
ESTIMATED COST$ j o C)
IS THIS A CONTRACT COST? Yes V/No
(� FEE ENCLOSED$ S.
TYPE OF JOB:
�SOR-C�� New Installation
Alteration/Addition/Repair
Revised 4/01H2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑NO
❑BUSINESS CURRENT USE AND OCCUPANCY /,?- �� d L
❑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.
h0V-1"e0w" P(,.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT s DATE �6 �3