HomeMy WebLinkAbout10 Wedgewood Lane (3)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: C( 3(o OBUILDINGDEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
9-U 3 40Q." 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
04C
0-$11000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000 P.r `40
or any fraction thereof Tenant Designation Apt.No.
APPLICANT I(Ile w
APPLICANT ADDRESS L
APPLICANT PHO #
W N S OWNER . &ali-e-c ,Q.f.L f—o- l SO l41
q< OWNER ADDRESS D
so LA-yfok Witto" <0 I o o 0 T
O - OWNER PHONE &_44' —g Y
o SO"6079
C ESTIMATED COST$ TJ!'O 00
IS THIS A CONTRACT COST? Yes No
f FEE ENCLOSED$
TYPE OF JOB:
OR-Co New Installation
i
Alteration/Addition/Repair
i
Revised 4/01//2002 f
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? JA YES NO
SE CURRENT USE AND OCCUPANCY l'e S`d
ASASSEMBLM13L Y
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/W UNG METHOD f``' X
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBER OF METERS_ NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES NO
NUMBER OF LIGHT CIRCUITS oZ 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.
DESCRIP N OF WORK
c
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. T STATE
SIGNATURE OF APPLICANT DATE O