HomeMy WebLinkAbout169 Brookfield Street (14) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN OF SOUTH WINDSOR PERMIT#S
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
(6-N-00 (�4) 644-2511 ext. 230 a73
Date Buildin Inspector
Application must be printed or typed
' of Job:
FEE SCHEDULE 1 O� r `ca��
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$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
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APPLICANT Olv
APPLICANT ADDRESS 0` 'Fa rrA Pat%8
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APPLICANT PHONE#
OWN 8�-4 OWNER O
F OWNER ADDRESS rO o 5 n
x� i 1 3
OWNER PHONE b Lk4 Oo T ES 4
ESTIMATED COST$
# V
IS THIS A CONTRACT COST? Ules 0 No
FEE ENCLOSED$ W
O�� TYPE OF JOB:
OR-C
O'briginal 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
RESIDENTIAL BUILDING PERMIT APPLICATION? DYES ❑ NO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY ] I
❑MERCANTILE FUTURE USE AND OCCUPANCY Re 571
❑ 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 MAIN FEEDERS AND RATING OF WIRE USED
NUMBER OF METERS NUMBER OF DISCONNECTS AND RA T iJGS
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 SUBMITTED.
DESCRIPTION OF WORK
E iec ri« 7 4.t' !-1s
42 ifeC
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.
CONTRACTORS LICENSE NO. TYPE STATE
'
SIGNATURE OF APPLICANT DATE