HomeMy WebLinkAbout116 Bramlebrae (2) r -
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE $ C7
644-2511 ext.230
Date Building Inspector
Application must be printed or typed
Location of job
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER �L.Y�%fit �RSSAQ/N®
or any fraction thereof
ADDRESS
k 4-0-re 7Y
OWNERS PHONE# ��3' Yoo/ /
APPLICANT 617VA.)
W N$ ADDRESS
)V, 10
epo
ESTIMATED COST$ '�
IS THIS A CONTRACT COST?
YES NO
.� , � .-•' C► FEE ENCLOSED
$ �o
f
SOR.CO /9ginal
PE OF JOB:
Installation
Alteration/Addition/Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
V RESIDENTIAL BUILDING PERMIT APPLICATION YES / NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD Drf�
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS I F
NUMBER OF PANELS I REMOTE DISCONNECT REQUIRED?YES ONO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES 33 NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES
NUMBER OF HEAT CIRCUITS 6A-,P,' NUMBER OF A/C CIRCUITS
SEPERATE 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 CONN.BUILDING CODE IN THE
PERFORMANCE OF SUCH WORK.
NAME STATE LICENSE°NO. TYPE SIGN O ANT
PHONE NO.!�yy-i�0��� DATE
INSPECTOR .�-- 25 �, Aj
- ; DATE TIME
+' LOCATION Lcl-
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
3
= ELECTRICAL:
PLUMBING:
HVAC:
OTHER: