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 Inspectorctor
Application must be printed or typed
Location ofjob
Str6et No. Street Lot No.
FEE SCHEDULE
0 - $1,000 - $12.00
Floor Apt. No.
Over $1,000
12.00 per$1,000
or any fraction thereof
OWNER
ADDRESS wtcJS-WC-
OWNERS PHONE#
APPLICANT ,CCU jZLecAwnL(5 r"-r—
ADDRESS /S-9
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ESTIMATED COST$ /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
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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 CO DING CODES IN THE
PERFORMANCE OF SUCH WORK.
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NAME STATE LICENSE NO. TYPE SI ATURE PLICANT
PHONE NO. 66 0 K61,7-e YS27 DATE "7 715' 7
DATEINSPECTORe TIME
V ;7LOCATION
INSPECTION: CODE: RESULT(R/A) :
BUILDING:
ELECTRICAL:
Ye
PLUMBING:
HVAC:
OTHER: