HomeMy WebLinkAbout111 Birch Hill Drive (9) PERMIT 0
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT I OQ 69
Application is hereby : TOWN OF SOUTH WINDSOR
BUILDING INSPECTION DEPT.
APPROVED DISAPPROVED 1540 SULLIVAN AVENUE
/o 644-2511 Ext. 230
bate ��10��di�ngInspector Application must be printed or typed
1 . LOCATION OF JOB
_ /1 / z i'r- C// LV., // RX.) A,�
FEE $CIIEDULE No • Street
$ 0 - $19000 - $10.00 Floor Apt . No.
Over $1,000 - $10.00 2 . OWNER 6 T -7G A) l�
per $1 ,000 or '�
fraction thereof r p
3. ADDRESS
4, APPLICANT !( -
5 . ADDRESS `� �r 7— TD j&eA 5 7—
S roL FOL—L t)- czlog'
6. ESTIMATED COST $
7 . IS THIS A CONTRACT COST V _
Y a No
8. FEE ENCLOSED $ G '�
9. TYPE F BUILDING:
RESIDENTIAL COMMERCIAL
i
10. TYPE OF JOB:
Original Installativ n
t-,4fterat ion/Addition/Repair
Rn 3A 11/88
APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side)
11 . LOCATION OF JOB 1 � I
NO. STREET APT. NO ,
12 . TYPE OF INSTALLATION
13 . SIZE OF MAIN, FEEDER
14 . NO . OF LIGHT LOOPS 15 . NO. OF HEAT LOOPS
16 . NO . OF POWER LOOPS 17 . NO. OF LIGHT OUTLETS
18 . NO . OF HEAT CIRCUITS 19 . NO. OF POWER OUTLETS
20 . NO. OF CONVENIENCE OUTLETS 21. NO. OF HEAT CIRCUITS
22 . NO ,, OF POWER CIRCUITS 23. NO. OF LIGHT CIRCUITS
24. SIZE OF HEAT CIRCUITS 25 . NO. OF MOTORS
26 . NO . OF PANELS 27 . TOTAL WATTAGE
28 . NO . OF POWER FEEDERS 29 . NO. OF SWITCHES
30 . A/C LOAD 31. SIZE OF POWER FEEDERS
32. NO . OF FIXTURES 33. TOTAL HORSEPOWER
34 . NAME OF SUBCONTRACTORS AND THEIR TRADES
35 . REMARKS AND FURTHER DETAILS :
.CIL
26 a, Azia-,i-A IS" to
V boor
LICENSE NO. YIGNATURE 0 APPLICANT DATE
PHONE NUMBER: 2-a 2 — ��
INSPECTOR D�iTE TIME
LOCATION
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
7z
ELECTRICAL C a
PLUMBING:
HVAC:
OTHER: