HomeMy WebLinkAbout104 Benedict Drive (7) r.
'DSM°N APPLICATION FOR ELECTRICAL
CTRICAL PERMIT
1 `' a • . TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT 3 S
!` a 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.Permit#
Application must be prime or typedi J i Location of Job:
3:e r 104 BENI",PIC T Ml tle
.` _. _ .t $13.0 Street N
` °• Street
., t100*� C Lot No.
Y ' Tenant Designation
Apt.No.
APPLICANT
g - APPLICANT ADDRESS /O¢
sour 1 V1AIA 0�P cT
z,
APPLICANT PHONE# �B�D� 4r44- Z
,...; 9 7
v 4 OWNER SA/YJ .
OWNER ADDRESS
. iw OWNER PHONE
ESTIMATED COST$ Z Jam. Od
# IS' IS A CONTRACT
COST? ❑Yes No
ENCLOSED SED$
' = TYPE OF JOB:
f+Q3
�r` I ❑ New Installation
a/Alteration/Addition/Repair
Revised 5101
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? j(YES ❑NO
❑RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL ENGINEER'S NAME IV6�7�� PHONE
❑FACTORY
❑STORAGE ADDRESS
❑GARAGE
❑MIXED USE CITY STATE ZIP
GA Z�'BD
TYPE OF INS TALLATION/WIRING METHOD C�yoEiP��D U/N D 4._&Il 1,gelN457
SIZE OF SERVICE Z D A/710 SIZE OF MAIN CONDUCTORS 12 6W
S /1/ A NUMBER OF DISCONNECTS AND RATINGS 0) Zo X/NP
NUMBER OF METER
REQUIRED?
❑YES ZNO
NUMBER OF PANELS�� REMOTE DISCONNECT RE Q
NUMBER OF LIGHT CIRCUITS
NUMBER OF POWER CIRCUITS /V/
NUMBER OF SWITCHES AloM:' NUMBER OF OUTLETS _
NUMBE
R OF LIGHT FIXTURES Z. NUMBER OF HEAT CIRCUITS A140 AI G
NUMBER OF A/C CIRCUITS A19/U�
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
6AZZ:90 .
iNsTAZ ZEo !�/l/ / GPI 20 -9/YI� CIRC611 7-
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.
blo&Ml 40WN2r e
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT
. DATE