HomeMy WebLinkAbout15 Apple Tree Lane (12) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
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Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
1540 SULLIVAN AVENUE 2Sk)--7-
644-2511 ext. 230
Date Building Inspector Application must be printed or typed
Location of job 042.0
/S Aa/t Ti -L- 4x-
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
$0 - $1,000 - $12.00
Over $1,000
$12.00 per$1,000 OWNER /U(/e-E-
or any fraction thereof
ADDRESS /E
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OWNERS PHONE# y�s
APPLICANT /� �yti T/�i4�TU �G. �'S J l
ADDRESS
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ESTIMATED COST$ d�
0
C = IS THIS A CONTRACT COST?
"3 V YES NO
FEE ENCLOSED $ 3 •D D
OR 0�� TYPE OF JOB:
C
Original Installation
Alteration/Addition/Repair
Revised I1/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIA A
RESIDENTIAL BUILDING PERMIT APPLICATIO YES / NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY D e +-
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 /�k
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED 7 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
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THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN. BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK
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NAME STATE LICENSE NO. TYPE SIGNAYrRE OF APPLICANT
PHONE NO. S a-gS,;IJ�o DATE d'J