HomeMy WebLinkAbout151 Berle Road (13) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby:
TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT t r7 6 33
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg./Permit#
�l aeJo Building 7 ��
Inspector
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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS _71
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APPLICANT PHONE#
O W N 8 F,4 OWNER ✓�4'�i�- �t s .�(r�r/
OWNER ADDRESS
0 E.r OWNER PHONE
C - ESTIMATED COST$ a ,
V ;-&'
IS THIS A CONTRACT COST? 9rYes O No
FEE ENCLOSED$ o
R TYPE OF JOB: 94 GG t-rm�
C
Original Installation
t"Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? tYES ❑ NO
❑RESIDENTIAL
c
❑BUSINESS CURRENT USE AND OCCUPANCY sr S J d ch
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY 5� �
❑EDUCATIONAL
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑ GARAGE
❑MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATIONIWIRING METHOD S zae-,)L
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
NUMBER OF METERS 1 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 /.;9, NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
C,
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.
fe,�?!F:e �r y f-- 1
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT / D��G DATE