HomeMy WebLinkAbout15 Ahern Drive (9) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
/"I , 4/,X- 644-2511 ext. 230 NA
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE y ��// nn
/ rY A NC h-n0 N� _
$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT t e- c 6 (f le- C Vt 1'
APPLICANT ADDRESS — l v --tl
^ /
1 ze/A-" l 0 (0-
APPLICANT PHONE# `�C- 02 '�7 /
SOWN SFq N OWNER �� - it '/o .&,jgc ��SNry
OWNER ADDRESS �� erns D V N
OWNER PHONE Lc-, Ll`c— `,
C ESTIMATED COST$ 5G
r� IS THIS A CONTRACT COST? es
FEE ENCLOSED$ �
��SOR Co
TYPE OF JOB:
0 New Installation
E3 Alteration/Additio air Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
iv�SIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑NO
❑BUSINESS CURRENT USE AND OCCUPANCY VfS
❑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 �LJ Se u C� U
SIZE OF SERVICE 1O0• A-,P SIZE OF MAIN CONDUCTORS AV
NUMBER OF METERS ( NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS 1 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
' Lo 9�e 2 iA w
-C)u w
6 XJ
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. TYPESTATE q
SIGNATURE OF APPLICANT r DATE
�•. -`f�`•.•:.A+ •3y :rA`'��n , _� :lr�:-S,-`Ai?..� �����r'-'K�j.�`,/Ei^au'I'-'k- -
INSPECTOR U G S DATE l ( TIME AM
LOCATION
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:
PLUMBING: ,
1
HVAC:
OTHER:
i Iu CC�,/
6
i