Loading...
HomeMy WebLinkAbout0 Collins Crossing RNIIT DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT j E Application is hereby: TOWN of SOUTH WINDSOR BUILDING DEPARTMENT ldg Permit# APPROVED 1540 SULLIVAN AVENUE � 644-2511 ext. 230 Z II fG Date B g Inspector Application must be printed or typed Location of job 9174 Street No. Street Lot No. FEE SCHEDULE Floor Apt.No. $0 - $1,000 - $12.00 Over $1,000 $12.00 per$1,000 OWNER �lf A or any fraction thereof ADDRESS 2— 7e: le w i o"4 Soo-/Gc ��"��'o.mil OWNERS PHONE# APPLICANT ADDRESS 3 3 �l GC G�C!�©k/'o 0 9'G( rjd�CG OWN S F,q (� ESTIMATED COST$ C --r C IS THIS A CONTRACT COST . YES NO ` CJ FEE ENCLOSED $ E OF JOB: sOR CO Original Installation Alteration/Addition/Repair Revised 11/95 APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A RESIDENTIAL BUILDING PERMIT APPLICATION YES / NO BUSINESS ASSEMBLY CURRENT USE AND OCCUPANCY MERCANTILE EDUCATIONAL FUTURE USE AND OCCUPANCY INSTITUTIONAL FACTORY STORAGE ENGINEER'S NAME PHONE GARAGE MIXED USE ADDRESS CITY STATE ZIP (011icr please specify) TYPE OF INSTALLATION/WIRING METHOD SIZE OF MAIN FEEDERS AND RATING OF WIRE USEDf�'G��'cC/fl � NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS REMOTE DISCONNECT REQUIRED 7 YES/(NO) NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES NUMBER OF OUTLETS NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. DESCRIPTION OF WORK _ 'g--/- z�, -Z/ THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN. BUILDI G CODES IN THE PERFORMANCE OF SUCH WORK. NAME STATE LICENSE NO. TYPE SO4ATURE Of APPLICANT PHONE NO. a 3 y� �3� DATE Z ��