HomeMy WebLinkAbout149 Brookfield Street (13) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PE'
Application is hereby: TOWN of SOUTH WINDSOR I Im 3 6Z
BUILDING DEPARTMENT Bldg Permit#
..............APPROVED 1540 SULLIVAN AVENUE
644-2511 ext.230
Date Building Inspector
Application must be printed or typed
Location of job
jqq x ��
Street No. Street Lot No.
FEE SCHEDULE
C:�"7�PROVED
$0 - $1,000 - $12.00 Floor Apt.No.
Over $1,000 1
$12.00 per$1,000 OWNER
or any fraction thereof
ADDRESS N
OWNERS PHONE#
APPLICANT 4)liz 1.9,rn 77.
0*N S ADDRESS 6-3 "Ovoe"Ar
4(
IVAVa&99S LE ,r- 4
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ESTIMATED COST$ A00,00
IS THIS A CONTRACT COST?
Vol J%e
YES NO
FEE ENCLOSED $ C'0
1�SO R 0 TYPE 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
NTIAL BUILDING PERMIT APPLICATION YES / NO
V/RESIDE
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY PHONE
STORAGE ENGINEER'S NAME
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD � O�DUi'T -
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
ED AND
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM IS
TO COMPLY WITH ALL LOCAL ORDINANCES
OF SUCH WORAND STATE OF K.SIGNATURE PLICANT
NNBUILDING CODES IN THE
PERFORM
NAME STATE LICENSE NO. TYPE
PHONE NO. 0 J ��7�3 DATE q 7