HomeMy WebLinkAbout119 Robert Drive r PERMIT #
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT P
Application is hereby:
TOWN OF SOUTH WINDSOR
APPROVED DISAPPROVED BUILDING INSPECTION DEPT.
644-2511 Ext. 230
�•Z`� �1 � �� Application must be printed or typed.
Da ee Building Inspector J�
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` 1. LOCATION OF JOB
FEE SCHEDULE No . Street
$ 0 - $1,000 - $10.00 Floor Apt . No.
Over $1,000 - $10.00
per $1,000 or 2 . OWNER ��f �� (IY2/;�R K)
fraction thereof 1 � �
3. ADDRESS 0 ) ,
0 u W T V-/d IsiZ.
4. APPLICANT
5. ADDRESS f O � -
�� Cam , 06c�10
2 �s
6. ESTIMATED COST $ c`;�o
7 . IS THIS A CONTRACT COST
Yes No
8. FEE ENCLOSED $
9. TYPE F BUILDING:
RESIDENTIAL COMMERCIAL
10. TYPE OF JOB :
Original Installati
Alteration/Additio /Repair
BD 3A 11/88
APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side)
11 . LOCATION OF JOB
NO . STREET APT. NO
12 . TYPE OF INSTALLATION Z,�`��
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 :
r)c- C) -�do(:)-\-Z- PJ U tv� t--LL's 0 c-k-c 1-
+kip" k e'd
LICENSE NO. S ATURE OF APPL ANT DATE
PHONE NUMBER:
"I M, 7w + .
Lol No.
Building Permit
Temporary Service
Permanent Service
Pursuant to Permit No.
This Certifies that the Electrical Work for which the above named Permit was granted
has been duly inspected and is hereby approved.
Owner Electrician
Street
19
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