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DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
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Application is hereby: TOWN OF SOUTH WINDSOR PER
BUILDING DEPARTMENT
APPROV 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 0 7(,e 2S -
ate Building Inspector
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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �j�� G�Gf��G
APPLICANT ADDRESS
7�, r,,11AJ0sW,09
APPLICANT PHONE# Ae , Ella,�
OWN S OWNER
,r q� OWNER ADDRESS
0
OWNER PHONE
C ESTIMATED COST$ ®�
�. 4No
� IS THIS A CONTRACT COST? 0 Yes
FEE ENCLOSED$ 13- 00
TYPE OF JOB:
SpR.CO
w Installation
�eration/Additiofi/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
PRESIDENTIAL
❑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 �� _ XP 2
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
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 SUBIVIITTED.
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 CONNECI'ICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE _ STATE
SIGNATURE OF APPLICANT DATE