HomeMy WebLinkAbout103 Benedict Drive (3) DEPARTMENT DECISION PERMIT
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT e,Bld P #
APPROVED 154 .g 0 SULLIVAN AVENUE to
-7 644-2511 ext.230
Date g Inspector Application must be printed or typed
Location of job
Street No. ,w Street Lot No.
FEE SCHEDULE Floor Apt. No.
$0 - $1,000 - $12.00
Over $1,000 Ida
$12.00 per$1,000 OWNER
or any fraction thereof fF
ADDRESSbje
S� �/ �07
Y
OWNERS PHONE# �y� ��% g
APPLICANT
0*- ADDRESS Ai
ESTIMATED COST$
IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $ /•� �'
d
ds`
OR-CO TYPE OF JOB:
Original Installation
\4W_Alteration/Addition Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from rcvcrse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIA H A
RESIDENTIAL BUILDING PERMIT APPLICATION YE / 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
(Otlicr plcasc spccify)
TYPE OF INSTALLATION/WIRING METHOD- 4A401wr c/QI qw b Rene..
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_2,..
NUMBER OF SWITCHES 2 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
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THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
AME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. a�' DATE 7