HomeMy WebLinkAbout18 Bissell Court (10) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
TOWN OF SOUTH WINDSOR Application is hereby:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
-74,L � Bldg.Permit#644-2511 ext. 230 �� 3�r�
ate i ing Inspector �1
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$1,000
or any fraction thereof Tenant Designation I VIA Apt.No.
APPLICANT k kkAl K�f/6 7-kA US 44,5
APPLICANT ADDRESS 1 g 8/ ,(r,L e U)CT
�S O U T W//yCS 0 dZ 7
APPLICANT PHONE# 6 yk ,6
OWN se OWNER A-'A V AET" US&4.S
OWNER ADDRESS Q UST
�3®0T l` GUIAy,D 50� , (2-T
cc) E'r
OWNER PHONE
y' ESTIMATED COST$
�'�► ',' IS THIS A CONTRACT COST? 0 Yes No
O1
FEE ENCLOSED$ /3-
l�� v TYPE OF JOB:
OR-CO
0 Original Installation
�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? ❑ YES ❑ NO
❑RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL
❑ INSTITUTIONAL ENGINEER'S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑ GARAGE
❑MIXED USE CITY STATE ZIP
(Other 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
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.
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CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE