HomeMy WebLinkAbout1192 Pleasant Valley Road I
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DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
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Application is hereby: TOWN OF SOUTH WINDSOR
PERMIT#
pp y BUILDING DEPARTMENT ° o 3
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
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Location of Job:
Fo
EE SCHEDULE � � AU.,,5
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-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
ny fraction thereof Tenant Designation Apt.No.
APPLICANT r; I �' [
APPLICANT ADDRESS �I
APPLICANT PHONE#
44 N S OWNER
OWNER ADDRESS 1 Wl;)cA <— d
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OWNER PHONE
_ ESTIMATED COST$ _ 4
IS THIS A CONTRA COST? Qofes O No
FEE ENCLOSED$ 13, 60
OR-CO TYPE OF JOB:
S i
D Original Installation
13 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED TH A
/SIDENTIAL BUILDING PERMIT APPLICATION? S ❑ NO
®'RE
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑ GARAGE
❑MIXED USE CITY STATE ZIP
k0iher please specity)
TYPE OF INSTALLATIONIWIRING METHOD
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
NUMBER OF METERS_ NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES ❑NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS
d
NUMBER OF A/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
cider,
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.
C TRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE gy I
INSPECTOR QC, DATE ( ( TIME
LOCATION - C C)
cQCIO, (-
INSPECTION: CODE: RESULT D/A :
BUILDING:
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ELECTRICAL:
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PLUMBING:
HVAC:
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OTHER:
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