HomeMy WebLinkAbout100 Arnold Way (51) DEPARTMENT DECISION
APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED ---------- 1540 SULLIVAN AVENUE
-7/-7/f7 644-2511 ext. 230
'Date Inspector ctor Application must be printed or typed
Location of job
Str6et No. Street Lot No.
FEE SCHEDULE
$0 - $1,000 - $12.00 Floor Apt. No.
Over $1,000
$12.00 per$1,000
or any fraction thereof OWNER
ADDRESS ---wtcJS-WC-
OWNERS PHONE#
APPLICANT ,CCU jZLecAwnL( 5 r"-r—
ADDRESS /S-9
t!�I�
ESTIMATED COST$ /QZ d?7
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IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $_LJ'11,t/'�d
R.CO TYPE OF JOB:
pW 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 ScQ,
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY �a t
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
(Othcr plcasc spccify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED _- 35-0
NUMBER OF METERS v2 NUMBER OF DISCONNECTS AND RATINGS c2 009 +
NUMBER OF PANELS oZ REMOTE DISCONNECT REQUIRED?YES/10
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.
11 II DESCRIPTION OF WORK p
��5--4�vl � 'L� �e�.�c.✓r �� �ac��1 � J�cssS�^bo�
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CO DING CODES IN THE
PERFORMANCE OF SUCH WORK.
cT k2s5V6
NAME STATE LICENSE NO. TYPE SI ATURE PLICANT
PHONE NO. 66 0 K61,7-e YS27 DATE "7 715' 7
DATE INSPECTOR e TIME
V ;7
LOCATION
INSPECTION: CODE: RESULT(R/A) :
BUILDING:
ELECTRICAL:
Ye�
PLUMBING:
HVAC:
OTHER: