HomeMy WebLinkAbout129 Benedict Drive (13) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application ' hereby:
TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT (3°Z
APPROVED 1540 SULLIVAN AVENUE
-0( 644-2511 ext. 230 Bldg.Permit#
Date Buil fg Inspector
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Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
d
APPLICANT PHONE#
O W N S F,q OWNER
OWNER ADDRESS
c OWNER PHONE
c '
ESTIMATED COST$ f-Uc)
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IS THIS A CONTRACT COST? 0 Yes No
FEE ENCLOSED$ 13,
OR 0 TYPE OF JOB:
C
O Original Installation
Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPX OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
a4SIDENTIAL BUILDING PERMIT APPLICATION?A YES ElNO
❑BUSINESS `
CURRENT USE AND OCCUPANCY Jr• G
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑ GARAGE
❑MIXED USE CITY STATE ZIP
l( e'r please specify)
TYPE OF INSTALLATION/WIRING 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
NUMBER OF A/C CIRCUITS
SEPARATE 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 CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
5,7- -f�7/- - ci
CONTRACTORS LICENSE NO. STATE
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SIGNATURE OF APPLICANT DATE