HomeMy WebLinkAbout100 Bidwell Road (47) 5
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PEPWIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDS6
BUILDING DEPARTMENT
APP OVED 1540 SULLIVAN AVENL�_ Bldg.Permit#
N
644-2511 ext.230 a-�� 6
�Z -D 1
Date Bu;irlil Inspector
MMMMMUMMA
Application must.
bO 0 0Ud or qpqd
FEE SCHEDULE Locad
ob
$0-$1,000=$13.00 Street No. •` Lot No.
Over$1,000=
$13.00 per$1,000 '
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
C r-.rn�--J ky Or
APPLICANT PHONE# B�C� — �"'�t �► .�
W N St
OWNER
O sq .�..,:.�._..�.
OWNER ADDRESS
I PIN
r. OWNER PHONE
C ESTIMATED COST$
.� '�► IS THIS A CONTRACT COST? Yes Q No _
1� ICJ FEE ENCLOSED$ 1. 0%A O•W
1
TYPE OF JOB:
SOR CO 0 New Installation
R/Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATE�DYVITH A
BUILDI
NG PERMIT APPLICATION? YES ❑NO
❑RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
C]D(STITUTIONAL ENGINEER'S NAME PHONE
ACTORY
❑ STORAGE ADDRESS
❑GARAGE
❑MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
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
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.
"E
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT A DATE '7S