HomeMy WebLinkAbout10 Wedgewood Lane (3) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: (C( 3(o O
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
9�-U 3 40Q." 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
04C
$0-$11000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000 P.r���► `�40
or any fraction thereof Tenant Designation Apt.No.
APPLICANT I(Ile w
APPLICANT ADDRESS �.L
APPLICANT PHO #
W N S OWNER . &ali-e-c� �,Q.f.L f—o- l�SO l41
�q< OWNER ADDRESS D
so LA-yfok Witto" <0�I ¢', o o 0 T
O - OWNER PHONE &_ 44' —g Y o�SO"6079
C ESTIMATED COST$ T J!'O 00
IS THIS A CONTRACT COST? Yes No
f� ) FEE ENCLOSED$
TYPE OF JOB:
OR-Co New Installation
i
Alteration/Addition/Repair
i�
Revised 4/01//2002 f
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? JA YES ❑NO
/
❑ SE `
CURRENT USE AND OCCUPANCY l'e S�`d�� �
❑AS ASSEMBLM13L Y /
❑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/W UNG METHOD ®f``' �X
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 oZ 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.
DESCRIP N OF WORK
c
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.
CONTRACTORS LICENSE NO. T STATE
SIGNATURE OF APPLICANT DATE O