HomeMy WebLinkAbout10 Abbe Road (11) DEPARTMENT DECISION ��i�T#
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPRO 1540 SULLIVAN AVENUE
/z 644-2511 ext.230,,kv
Date ding Inspector
Application must be printed or typed
Location of job
Street No. Street Lot No.
FEE SCHEDULE Floor Apt.No.
$0 - $1,000 - W-60-
Over $1,000
$12.00 per$1,000 OWNER
or any fraction thereof
ADDRESS
OWNERS PHONE#
APPLICANT
0000, 0*1111 Sk-1 ADDRESS
-7 <
z"o
ESTIMATED COST$
4W.
IS THIS A CONTRACT COST? Z,
YES NO
FEE ENCLOSED $- 45,00
OR- 0 E 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
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD ��yi/IOpC
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED 14 O )(f
NUMBER OF METERS ` NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS e� REMOTE DISCONNECT REQUIRED YES/NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES( L 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 NN.BUILDING CODES IN THE
.,� PERFORMANCE OF SUCH RK.
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO.— �5�� DATE
INSPECTOR DATE_ TIME (� M
LOCATION 10 A L U e IL
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
jELECTRICAL:
PLUMBING:
HVAC: �
OTHER:
I