HomeMy WebLinkAbout109 Bridlewood Road (4) DEPARTMENT DECISION L
APPLICATION FOR ELECTRICAL PERMIT Tlw�
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230
Date B or t Application must be printed or typed
Location of job
/,Z�-w000 A024-4 Q
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt. No.
$0 - $1,000 - $12.00
Over $1 9000
$12.00 per$1,000 OWNER Uc-ce—U-0 j4t,,^J0 ZACLIV�--
Fe/4---14 Street
or any fraction thereof
ADDRESS 7 4,tlrZe, ,4VZC".'
Y, 6Z14-4-0 C-7111, "067
z
OWNERS PHONE# ^2 572
APPLICANT 4atG'�Z2z���
ADDRESS 2,2 Z-fyAkeZ4040
oea
ESTIM[ATED COST$ a5
16"
0
C! s, '' IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $ 12,
AV
OR- 0 TIRE OF JOB:
/Original Installation
Alteration/Addition/Repair Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
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
(Othcr pleasc 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
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 CODES IN THE
PERFORMANCE OF SUCH WORK.
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. YG ��,5'7 DATE 6—9�
INSPECTOR DATE L7 TIME
LOCATION a
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECT RICA : o
Jq4
PLUMBING:
K.
HVAC:
:; OTHER: