HomeMy WebLinkAbout126 Country View Drive (3) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
ZLI J- ` 644-2511 ext. 230 �q7
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
12-(,e C bLW TR`( Vi F-v,/ �Z
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS 3b(D2'1j S
APPLICANT PHONE# 6 29)- Sq 4q
SOW N St OWNER ,,rr `�
OWNER ADDRESS t2 6 1� � 1� i f—y)/
VV1ND5012, <2-T 06674-
OWNER PHONE
ESTIMATED COST$ )-oyot
IS THIS A CONTRACT COST? Yes No
" G FEE ENCLOSED$ d Cl-
TYPE OF JOB:
OR-CO
New Installation
A Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
.RESIDENTIAL BUILDING PERMIT APPLICATION? OYES ❑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 METHODERL
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS ALI'
NUMBER OF METERS�_ NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? RYES ❑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
KI 5 L w I
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.
11,5153 F- ) (�-r
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 7- 2 — 6?