HomeMy WebLinkAbout109 Bridlewood Road (3) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR q
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 2303�
9 2-1 M
ate I ding Inspector
Application must be printed or typed
Location of Job: i
FEE SCHEDULE j p n '
Fier ya-e—
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Fle-crje-f C-
APPLICANT ADDRESS
APPLICANT PHONE#
OWN S� OWNER C/l✓i L �� tlN`�< <
f,
q� OWNER ADDRESS !3,7 9' 5 f
Go 'N OWNER PHONE S 2, 0 �
Q `�. Ems'
C ESTIMATED COST$ d a/
* IS THIS A CONTRACT COST? !;�Ies 0 No
CPO
FEE ENCLOSED$ 4P
TYPE OF JOB:
S0R CO *ew Installation
0 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?XVE S ❑NO
RESIDENTIAL
b 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 SERVICE �'G SIZE OF MAIN CONDUCTORS /G' • s
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS r
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES O
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES_ - NUMBER OF OUTLETS C 0
NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS L
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
Cc; 6,(,l ,je, en�
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.
F/ -/ g;P-r �
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICA ��- -_ Y DATE ='�
R INSPECTOR DATE ' (O S TIME M
LOCATION k O'i e 1Q VD _f_LJ C (D
E
F -
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
5 ` j
ELECTRICAL: t,d3
Eo l
CR
PLUMBING:
• t
HVAC.:
OTHER:
Ll
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