HomeMy WebLinkAbout1386 Main Street Application No. 4321 Permit No. 061
TO THE BUILDING INSPECTOR
of the
TOWN OF SOUTH WINDSOR, CONN.
hereby make application for a permit to (erect ( ) a building according
to the following detailed statement of the specifications and plans herewith submitted. (Draw a line through
word "erect" or words "make alteration to" as the case may require.)
All provisions of the Building By-Laws (Sections 2 to 32 inclusive) shall be complied with in the execu-
tion of this work whether specified herein or not.
South Windsor, Conn., .� .�....... ......... 19...`.
.!Sign here ...... ... ...4. ..... .... .... . ......... .... .. .
r
Address .... ......... f...jew. ...
...,. . .................
Location? . .. ,,joplk. !,,��cc................side of? "............ .....................................` ....................... ...........................
Nearest cross street?1.5.7..I ? .. .... Street No. . Lot No. .
Owner of land is7- 1.0",,.1000/ Z6. .................. ddress �-�.���.... -� t�,/.�-��r.... .....
Owner of building is? . .`"..''................................`.'`... .............Address ..... ............................................... .............................
�. Architect is? `r ...........Address ... ....................... ....................................... ... ............ .......
... `...�...............................................
Builderis? .. .. .......................�.. ...Address ............ .........r............I.............................................. I.`. ..
i 41
Dimensions of building?/ X AkP Feet front? . ...... Feet rear? . .... .. ... ...... Feet deep? ..
Extreme height to highest point of r Z ... ... ............. No. of stories in height?.
Purpose of building is? . . .,c.... .... ......0..fe..r.....No. of stores? .... ............... ......... ........................ ............. ...............
Howmany families? .. ..................................................................................No. of rooms? .... . . ... ....... ..... ........... ........................ ..............
Distance from street line is? . . ..... ... .. .............................from building line is? . .... .... .. ...... ... ........ ....... .......
ADDITIONS AND ALTERATIONS
(Give Brief Description)
�*....,�_.. ;.. C.l, , .., ?j.. ......... ....c.o........... ............ .. . ......................................
94-
s........... .. ............oil. . ............. .......1.ae��e.... ....................
.....
..... . .... ........ : .. . .... `.............ram
0*11.1
Map No.
J
If of steel frame, what is exterior construction?
What kind of columns used? ...... . .. Size of columns used?
What length of columns used? . .How protected?
What kind of beams or girders? .. ... . Size of beams or girders?
Longest span of beams or girders? These rest on?
Roof construction is? ... ...... . . ..... ........ .......................... ....Roof covering is?
The floors are of ... .. construction and are calculated to carry a safe load of
lbs. per square foot.
(See Section 14, Building By-Laws.)
BRICK CONSTRUCTION.
Of what material will walls be constructed?
Compositionof mortar? . .. ...... .. . ................... ...... . ..... ...... . ............ ................ ..... . . .... .
Height and Thickness of Walls
Height Stories Front Walls Side Walls Rear Walls Partitlon Walls
Basement,
....................... . ............................................................................ ..........._................................................................ ................. .... .............. ........ ..........................................
1st Story
.......................... ......................................................... .................................................................. ............... ..... .. .............................._..... ..... ........ .... ...... ....... .........
2nd "
......................... ................_.......................................... .............................................................................. .. .... ......... ....................... . ........ . ... .....I...... .
3rd "
..................... .... ........................................................ ...................,............................................ ............................................ ,............................ .. .. . ... .. ...... .. ........ .. . .... .
4th "
. ................... ................_.-................................................... ...................... ................... .,......................................._..... ......................... ... ..... ........ .. . . .
5th 11
6th "
.................... . ...... ........._.................._........................................................................................................ . .... ............... ................. ..........................................................................
7th "
................ ........ ........... ................................................................................ I.. ........................................ ... . .......................... ...... ........ .......... ............. ...........................
8th
.................................................................................... ................ ........ ............ . .. .. ......... ... ........... .. .. .... .... ................. .....................
9th "
.... . .......... .... .... ............... ..
10t
Material.of Front? ..If stone, what kind?
Thickness of Ashlar? Thickness of Backing?
Backed up with what? Arches or lintels over openings?
;k
WOOD CONSTRUCTION.
Give Size, Longed Span and Di#ance Between Centres, of J07utso Girders and CohamasJoan Gums= COLUMM
Men ffin LAnted Spas CMdm Z 109'9 She [Auffed fil" C*BkW Sh* L4Dg* C40*M
lift Moor
................................................................ ...........................
2nd
.. .....;;....... ............ .......................................
4 .. ............... ...................................... ......................
th
Size of outside studs? ......................................... Distance on centres? ................................................ Size of sill? ..............................................
01%
're
Size of rafters? ...... Distance on centres?............/..00*ja................... Size of plate? .....................................................
Sizeof ledgers or girts? .................................... ............................................Size of deck rafters? ..................................................................... ...............
Distance on centres? .............. .......................................................................Size of studs in bearing partitions? ..................................................
MISCELLANEOUS
4.. ..
Style of roof, flat,pitch, Mansard, or hipped? ..... 215-97 ................................ Fireplaces? .......................................................
Material of roof'covering? .. ....... .. ..............Material of Cornice? ......................................................................................
."o
Howis building heated? ...........................................................................Lining of flues? ... ............................................................................ ..............
Thicknessof shell of flues? .......................................................................Any elevators or lifts? .......................................................... ......................
What kind? ................. ........... .............. How many? ... .... ... ............... Any hoistwa 9
op
Howprotected? ........... ... . . ...................................... .................Total Value of Building .. .............................................
When will work be commenced? ....... Ae. -4.;P 000 7 ---C;/
a........ A::!�.. a 415:
.... ......e... .................
The applicant warrants that the lot for residential purposes, shown on a plot plan accompanying this
application, conforms to the zoning regulations of the Town of South Windsor.
Town of South Windsor since 1949.
X,Ir
;or Applicant
4061
BUILDING APPLICATION
Application No. ......4 3 21
...........................................................
East
on the ..... . ....... . . . ..... side of
Main Street.
1386
Street No,
Owner HT. Mi11s ITewberry
Same
Applicant
CLASSIFICATION
Carport & Tool House 12 t.r20 t
Permit issued on above Application.
Date, Aug.2,4 19 .62
i
i
TOWN OF SOUTH WINDSOR
i
4 BUILDING PERMIT
i
Date August 2. 19 62
i
2.00 10.
Fee Paid �$. Est. Value �$ 00
Permit 1r d 4061
East
on the side of
Main Street
Street No. 1386
Owner H.Mills Newberry
Applicant Same
CERTIFICATE OF OCCUPANCY ISSUED:
Date
No.
i
Fee Paid $
CLASSIFICATION
Carport & Tool douse 12tx20t
BUILDING PERMIT
N° 4061
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Windsor, Conn. Aug•2 19 62
Trio 'to to Terttfil, That H.Mills Newberry
is hereby• ranted permission to Carport and T001 HOuse 12 tx20 1
g
at estimated value of $15 0.00
on the Fast side of Main $t• Street on land
$.Mills Newberry
owned by
Said work to be as described in Application
No. 4321
and to conform to specifications and plans filed with said Application, and Building By-
Laws of THE TOWN OF SOUTH WINDSOR.
Issued August 2s 1962
A® Building Inspec or.
Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers
during the day and by both barriers and colored lights by night.
SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place
or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a
license therefor from the city or borough in which such highway may be situated, he shall pay said city,
town or borough all costs and damages which it shall sustain, or be compelled to reason therefor."
t _
TO BUj[[,jDING INSPECTOR
CIE die APPLICATION FOR
W PLAN EXAMINATION AND
BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, It, 111, IV, and IX.
ZONING
I• AT (LOCATION) OISTIIICT
LOCATION "a•) (sTlettT)
OF ,tTwttN -TeA 0ID AMC
BUILDING (CROSS sT461T) (CROSS sTR997)
LOT
SUM I V ISION LOT /LOCK 51 Zt
II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D
A. TYPE OF IMPROVEMENT D. PROPOSED USE — Fog"wrecking" most recent use
1 ❑ New building Residential Nonresidential
2 Q, Addition(1/ residential, enter teutlebe'? t2 One fancily Is❑ Amusement, recreational
o/now housing units added. i/any. 13❑ Two or more feebly — Enter 19❑ Church, other religious
in Part D. I3) "umber at units— — — — -►
3 ❑ Alteration (See 2 above) 20❑ Industrial
14❑ Transient hotel, newel, 21 ❑ Parking gerege
4❑ Repair, replacement or dormitory — Enter number
5 ❑ Wr eking (1/multi/artily residential, o/ units ——————— ——► 22❑ Service station, r pair$w"e
enter nimber o/ units to building in 1S❑ Garage 23❑ Hospital, Institutional
Pan D, 13) 16❑ Carport 24❑ Office, benle, prof ssional
6 ❑ Moving (relocation) 17❑ Other — specify 23❑ Public utility
7 ❑ F undation only
26❑ Scheel, library, other educational
B. OWNERSHIP 27❑ Steres, mercontiI*
9 CZ Private(individual, corporation, 29❑ Tanks, towers
n npr fit insti#utien, etc.) 29❑ Other — Spec:/y
9 ❑ Public (Federal, State, or
eel gov tnment)
C. COST (nneet eetets) Nonresidential — Describe in detail proposed use of buildings, e.9., food
processing plant, machine shop, loundry budding at hospital, elementary
10. Cost of improvement,,,,,,,,,,,,,,, school, secondary school, college, parochial'school, parking garage f r
department store, rental office budding, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed us
in the ab ve cost
a. Electrical.......................... VA B
b. Plumbing ......................
Zo NiA) e suy�"I i s's'c fl.y �a u r�
e.Meeting, air eenditiening.........
.�X'i'Slli�l� Ski�cK
d. Other( levater, ate.).............
11. TOTAL COST OF IMPROVEMENT Ov
III. SELECTED CHARACTERISTICS OF BUIL ING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J, for all others skip t /V.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 Masonry (well boating) 40± Public or private company 46• Number of stories................
31 weed items 41 ❑ Private(septic tank, etc.) 49• Total square feat of floor area.
all floors, based on exterior
32❑ Structural steel dimensions ......................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
50. Total lend area, sq. ft. ...........
34❑ Other — Specify 42 CZ Public or private company
43 ❑ Private(wall, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL 1. TYPE OF MECHANICAL 51. Enclosed .......................
3S❑ Go* Will there be central air 52. Outdoors.......................
36 M Oil conditioning? L. RESIDEIITIAL BUILDINGS ONLY
37 E1 etrieity 44❑ Y e 45 CZ He 33. Number f bedrooms..............
38❑ Cool
39❑ Other— Specify WiII there be an el voter? Full..........
'.14. Number of
46❑ Y • 47[Z N betltre•eees
Partial........
+V. IDENTIFICATION - To b compl ted by all applicants
Nam Mailing address — Number. street. city, and State ZIP cods* Tel. No.
Owner Or �� 7T �� //(/��� aJ �(D d? 7 -2Sz CIOS3
Lessee J,lW^Y A. W C �� "` •` �� �♦
Z. K -r-�Ris A
Controvor
3.
Arehreet or
En9in or
Th own r f this building and the undersigned agree to conform to all applicable laws of this jurisdiction.
Signature of app ' nt Address Application date
(/,-. /-� *�A 7 Dec-�C_ e
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD - For office use
Plans R view Required Check Plan Review Date Plans By Data Plans By Notes
Fee Started A pproved
BUILDING
PLUMBING S
MECHANICAL S
ELECTRICAL S
OTHER S
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Do Permit or Approval Chec)� Obtained Number By Permit or Approval Checkl Obta med Number 3V
BOILER PLUMBING
CURB OR SIDEWALK CUT ROOFING
ELEVATOR SEWER
ELECTRICAL SIGN OR BILLBOARD
FURNACE STREET GRADES
GRADING USC OF PUBLIC AREAS
OIL BURNER WRECKING
OTHER OTHER
V11. VALIDATION
Building
Permit numb r 1 kq
But Iding g
Permit issu d /� �a g 19
Building pp
Permit F S
rov
TITLE
TOWN OF SOUTH WINDSOR
BUILDING PERMIT
Date 1 2/2 , 19 97
Fee Paid $$00 4 00 Est Value $.1-00.,0i0
Permit N° 16468
on the side of
,MIS{... —St..AmAht Street
Street No. 3 '01 66
I
Owner-- 74. y watt
Applicant
CERTIFICATE OF OCCUPANCY ISSUED:
i Date
No.
Fee Paid $
CLASSIFICATION
Addit4en
BUILDING PERMIT N o 16468
OFFICE OF
THE BUILDING INSPECTOR
of the
Town of South Windsor, Conn.
South Wiadsor, Conn. 12/2 8 i9 87
94is is to Crrt'tf#, That Jimmy A. Watt
is hereby granted permission to -Ru a d- an- ad-d i f i n n
at estimated value of $10 0 ,0 0 0
n the side of 1386 Main S Tre e t Street on land
owned by Nancy & Jimmy A. Watt
Said Work to be as described in Application
No.16 7 6 6 and to conform to specifications and plans filed with said Application, and Building By-,
Laws of THE TOWN OF SOUTH WINDSOR.
Iss q 9 87
Building Inspector.
Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers
during the day and by both barriers and colored lights by night.
SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place
or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a
license therefor from the city or borough in which such highway may be situated, he shall pay said city,
t wn or borough all costa and damages which it shall sustain, or be compelled to reason therefor."
INSPECTION REPORT
Permit # /Z 4/L9 Job /3'fz
1 Footing I M M,y 1�w'�9 NG'Y )114 Te
2 Foundation AV I p 4 OCZ:�
3 Framing 2,1 � -3 R.
4 Wiring `j . J �t o�A•
5 Plumbing ,,; / Ay (�( aT
6 Heating PEE vu 1.ET P1-a•4)4rG
7 Lathing
8 C.O.
W
i J
}- m
L� o o O ;
a
W 6
Z M CD
M
41
•I
I
•t,"
0� �l< ~
c co
� Q
w N
z -J
z - w
Q 1
r �
2 %2STORY
MOUSE
(FRAME)
SBA
�p •30,,LvilWiLINE
\0� I00.0� M.S.
0 � —
} STRONG
to RD. a
M.S.
.REST
I N S'
MA ;
00
OC,
5,e
'4
IZ"os
kjI
P 11AL AMMTM
M 1`t d
1
Owwr V
E n
RM IN OF
1
WHO`lectrkal Wwk AM be t1w1ed MO a Fw-
mit a granted by Ow Brrdlog laq"tr.
In New Dollilop M wltltt: iM be NwM/
until tint phaminp aM beaft/piped Md rt be
stops lit of woo an irttN Mrble — a Nddd
permit Inm ow yet of dw WAS11106 lospeeler.
Biectrial Permit Na _ 14,40 Z24..
Hastsr, Liosass Na 3
T,OJWN OF SOUTH WINDSOR Bu Permit NO. 4��
BUILDU4G DBPAIrMENT Daft FU'd
Date rumd A ro'al
APPLICATION FOR ELECTRICAL WORK
OB LOCATION• d d 9 ; S 1013 OWNER•
_..._......_ Side f .......-._..._ ._.....w.._......___ Between - — sod
Name of Building Owner ...... - -
Address ._.Z ��to C� Ld
If work is for Lasee- ATO name r....._._. .. -• Address
Buildins nor occupied as (unless osw) Na of &may gaits now
Buildias to be occupied as N of Umily mils to be
Is this work included in a Boildin Permit? - .._. Pe(Ifrmit Fet =1VA.
�, sawn pauk)
�1 �Q .... _.......__.. Basler AAddsess a 7
Perudttss -•--
COST OF INSTALLATION: _._ ..D o v U e r o
TO BE FELLED (= ST PElthtl'!'=
TO BE WIRED mas I II rG APPLJANCES
Number of light outlets to be installed
Number of present Appliance C."ircaits
Number. f convenience outlets to be installed -... ......_... ..
Number f switches to be installed . . . —. . .....- Do this include Ranp ❑ Water ❑
Number of sppiisoc" to be installed . . .
(as tinted balm) Dryer ❑ Air Condidmdr ❑ OB BMW ❑
TYPE ttA'fLNG NO.
Dish Washer ❑ Gas Barak ❑
Ramp . . . . . . . . Well Pump ❑ Fl e. Healers ❑
Range TOP . . . . . .
O►<a .
Water Heater . .
Se- ru iG� C�avrq aY)
Clothes Washer . . . . lJ
Clothes Dryer . . . . GU r e :� a Q�G� J
Dish Washer . . . . .
re,a T`
Air Conditioning Motor . .
Oil Burner Motor . . . .
Gas Burner . . . . . .
Circulator M tar . . . .
Attic or Lame Faa .
Well Pump
Electric Hest . . . . .
Other . . . . . . . .
Number of new Lighting Circuits .
Number of new Appliance Circuits . . .
Number of rotor'�=-
' ts . . . . . .
Number f . . . . . . .
Sin of praeat service -
Sin of say to be
PLUMBING APPLICATION
App. . W
us the ......_.._....._ side of
.................... 4 � i Sees
Street w ......
Owner ..S,.- a
'dumber ..L .
Filed in OEice of
The BArog Lrpome
`v.......................
No person shall oo11um add oe or alas MW
portion of the deakw wom of ay bwl&s
(except to repair lab) un" a Besaik is fined
by the Buil&og Ina saw
APPLICATION FOR PLUMBING PERMIT (Continu d fr m Revers Sid )
TOWN OF SOUTH WINDSOR, CONN.
�� f
11. LOCATION OF JOB )Ni vk S_574-
NO. STREET FLOOR APT.NO.
GENERAL PLUMBING
12. KIND OF INSTALLATION e_� 13. SIZE OF MAIN DRAIN 3
14. NO. OF TOILETS=STYLE 42{ 15. NO. OF URINALS STYLE
16. NO.OF BATHTUBS 17.NO.OF LAVATORIES S- 18. NO.OF SINKS 19. NO. OF WASHTUBS
20. NO.OF CONDUCTORS_SIZE 21. NO. OF STACKS SIZE 3
22. AREA OF ROOF OF CATC'FI BASINS 24. NO. OF FLOOR DRAINS r
25. NO. OF OTHER FIXTURES � KIND l .5.�
26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW? 5 27. SIZE OF WINDOW
26. IF NO WINDOW,WHAT KIND OF VENTILATION IS THERE? ' `�
29. SIZE OF DUCTS 30. ARE SEWAGE AND WATER FACILITIES AVAILABLE?
�' /N�So2 `2�-
SIGNATURE ADDRESS -�yd Srn i �
0&P?
LICENSE NO. ��� ESTIMATED COST �D�D- TELEPHONE bl
OWNER 13 ADDRESS
WATER HEATER
31. TYPE 32. MANUFACTURER
TANK SAFETY DEVICES
33. CAPACITY 37. TEMPERATURE RELIEF VALVE
34. TEST PRESSURE_ 38. MANUFACTURER
35. WORKING PRESSURE 39. PRESSURE RELIEF VALVE
36. TYPE 40. MANUFACTURER
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE OWNER OF THIS PROPERTY
AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE.
3- 7 E�-
C0962 DATE SIGNATURE OF APPLICANT
• Application For
DEPARTMENT DECISION $� P rmit �a
APPLICATION IS NKMV:
DBPAwTMBM' OF LWARM AND D�®I:1'10,1id
� O AN'ROrEo O DISAPPRovn
•� 41 TOWN OF SOUTH VYIN DSOR
W Mft CM M-lCTM MTLICATitM NMI M raw= M TVPNL KYMI um •YMCA saw
•� 0. LOCATION OF Jot
S
slow
Lff III. VLMII A/T. IIO.
• OWNER J ~-► w�
0
L ADDRESS
_ 4.FNON
v, B. APPLICANT l
�. ADDRESN yo s✓►� r c5
LICENSE NO. 3 Z 9 7
Q 9. EXPIRATION DATE OF LICENSE
4
.S Ir SO. ESTIMATED COST • OOS
a TNa A CONTRACT oom ,avu 0 �
1s. M EMCLOM •
IO. TnE DINLDINte
ML ❑ COIIMIKI"
1O. TYPE OF X0. ❑ IMOYltiTC1AL
A A o�ISY>wa n AITE eve TIOM
APPLICATION FOR HEATING PERMIT c Revem se)
/3 ���
I. LOCATON of No. vivo" room rt.se.
LLATION: �L BURNER CllucTRlc ❑ TM ❑ e
2. TYK of INSTA
am BURNQ ❑ srAcE ❑ IWNERATOR ❑ MIs m"
7J sm
LOCATION
4's OF Flit Z - OF vmr
�. OFT
. R.T.U. EQUIP. AT REGISTER _FURNACE MAKE AND N0. �ei '�G�i th AT BONNET FIRING RATE
BOILER OR FURNACE MAKE ANO NO. P-38& S.T.U. OR SQ. FT. NETS—B.T.U. OR SQ. FT. GROSS—�FIRING RATE
Z I owr'S NEW OR OLD BUILDING /d iN ULATED — YES OR NO N°
FLOORS TO BE HEATERS INSULATION
3�
TYPE OF WALL ZX� SDI INSULATION �-�S ('-��t ROOF OR CEILING
AVG. SYSTEM WATER TEMP. _ '( yoB•T•
iJeJSQ. FT./HR. EMISSION
INDOOR-OUTDOOR TEMPERATURE DIFFERENCE � i'�b� �FAIiRENHEIT_
MAKE OF RADIATION: BASEBOARD. C R C NVECTOR . OR C.l. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ.
FT. OR B.T.U. 4 0
pLiCRIlTION OF •ORE 01t l�r �o a oho o n S
ts. 70 K DON • s
t�. =AT LOW SCMmYLE. (TO BE IMCLUDW FOR ALL JOBS):
AIItA � lONAwt R>ZR �.T.1� s.T.Y. �t F O1�RIWTION IMfTALLtQ
00"was A" GOO" ��� TOTS •OTI� ovum
Mo. Mr • wr asM.iMs ��� Tws A"
R• �°` ` www. wp90AW
«ss �, ew�swesw
� MST
waY ` 1 M Atl0 �L f 1M/I6TJ DOW. t MtA
was
00000wo ml00000m000000 ......
.....00000000
=mo—0000000
TOTALS
A. HEAT LOSS FROM BUILDING LT.UJHR.
S. DOMESTIC HOT WATER DEMAND B.T.UJHR.
C. PIPING.OTHER THAN NORMAL LT.UJHL
ALLOWANCE FOR HEAT VALVE OF FUEL (A S C) FACTOR
17. WORK BY. MAllt
t e. CDC TORS AND
ALL WORK COVERED BY THIS APPLICATION HAS SERA AUTHORIZED BY THE(OWNS) OR IAGOM OF THIS PROPERTY AND WILL
SE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE
JCATION TO BE COMPLETELY FILLED IN.
r �■r
PERMIT
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT /,;�53 S
Application is hereby:
TOWN OF SOUTH WINDSOR
APPROVED DISAPPROVED BUILDING INSPECTION DEPT.
644-2511 Ext . 230
Application must be printed or typed .
�` 'n Date g In pector
1. LOCATION OF JOB
zo 56 11
FEE SCHEDULE No . Street
$ 0 - $12000 - $10.00 Floor Apt . No .
Over $19000 - $10.00
per $1 ,000 or 2 . OWNER
fraction thereof
3. ADDRESS
E, W ;,r, e4 c 0
4. APPLICANT
5. ADDRESS 7 Z.c)Gb'A Lo f- /OP-
GrhoYn
6. ESTIMATED COST $ R,EQ , 60
7 . IS THIS A CONTRACT COST
Yes No
8 . FEE ENCLOSED $
9 . TYPE OF BUILDING:
RESIDENTIAL COMMERCIAL
10 . TYPE OF JOB :
Original Installation
Alteration/Addition/Repair
BD 3A 11/88
APPLICATION FOR ELECTRICAL PERMIT, (Continued from Reverse Side)
11 . LOCATION OF JOB 1336 L
NO . STREET APT. NO
12 . TYPE OF INSTALLATION 0r- O 0 A U
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 . N. O. 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 :
_ 103S- 90
LICENSE NO . CV�G407TURE OF APPLICANT DATE
PHONE NUMBER: 7 a 3 6