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PERMIT #
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT ! l7 5A,
Application is hereby: TOWN OF SOUTH WINDSOR
Ci
P OVED DISAPPROVED BUILDING INSPECTION DEPT.
i 644-2511 Ext. 230
2
Application must be printed or typed .
a tle Building Inspector
1. LOCATION OF JOB (7rrznf,
7-RA1LCC,
#�i3 9b
FEE SCHEDULE No . Street
$ 0 - $19000 - $10.00 Floor Apt . No .
Over $1 ,000 - $10.00 /
p e r $1 ,0 0 0 or
2 . OWNER
fraction thereof
4. APPLICANT j&-0piysA/
5 . ADDRESS
6 . ESTIMATED COST $ BGZ�Xk'
7 . IS THIS A CONTRACT COST
Yes No
8 . FEE ENCLOSED $
9 . TYPE BUILDING:
ESIDENTIAL COMMERCIAL
10 . TYPE OF JOB :EO
Original Installation
Alteration/Addition/Repair
BD 3A 11/88
APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side)
11 . LOCATION OF JOB '004,
NO . STREET APT. N0
12 . TYPE OF INSTALLATION
13 . SIZE OF MAIN FEEDER
14 . NO . OF LIGHT LOOPS 15 . NO. OF HEAT LOOPS
16 . NO. OF POWER LOOPS 17 . NO. OF LIGHT OUTLETS
18 . NO. OF HEAT CIRCUITS 19 . NO. OF POWER OUTLETS
20. NO. OF CONVENIENCE OUTLETS 21. NO. OF HEAT CIRCUITS
22 . NO. OF POWER CIRCUITS 23 . NO. OF LIGHT CIRCUITS
24 . SIZE OF HEAT CIRCUITS 25 . NO. OF MOTORS
26 . NO. OF PANELS 27 . TOTAL WATTAGE
28 . NO. OF POWER FEEDERS 29 . NO. OF SWITCHES
30. A/C LOAD 31 . SIZE OF POWER FEEDERS
32 . NO. OF FIXTURES 33 . TOTAL HORSEPOWER
34 . NAME OF SUBCONTRACTORS AND THEIR TRADES
35 . REMARKS AND FURTHER DETAILS :
;E7
WE
LICENSE NO. SIGNATURE OF APPLICANT DATE
PHONE NUMBER:
Lot'No.
Building it
Temporary Service 7iF)-itec/2 ¢
Permanen rvice i
Pursuant to Permit No. V-7 S Z
This Certifies that the Electrical Work for which the above named Permit was granted
has been duly inspected and is hereby approved.
Owner �� v"`'� v Electrician
Street S-
G, ( I U +V-Q ,--
3 19 1 X,4A
Building Inspector