HomeMy WebLinkAbout110 Country View Drive (5) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR PE 3�3
BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
AD C1-nt)NTQy V F-oj DR .
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 4+-
APPLICANT ADDRESS P. CX 1�-'n 2-(1 8
C F alo
APPLICANT PHONE# �C� Oq,41
.1O W N S Fq OWNER ` /
OWNER ADDRESS ``[ �O C Q c)�rr� V I-F—V V
PR-
WIND
OWNER PHONE
ESTIMATED COST$ ®E�D�
IS THIS A CONTRACT COST? Yes No
l� w4q�CJ FEE ENCLOSED$ �S
TYPE OF JOB:
SCR 0c, New Installation
Alteration/Addition/Repair
Revised 4/01//2002
1
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
4RESIDENTIAL BUILDING PERMIT APPLICATION? PfYES ❑NO
❑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 Y, Z AL.
SIZE OF SERVICE Q&v Amps SIZE OF MAIN CONDUCTORS `-t h} A-L,
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES ANO
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
NEW LAL)8DRY A-.DDrTibN -
KEuVEP.- tt� C M1e�G- RbDMe,, Tb Cn)-G
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.
1251 � - 1 C
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE