HomeMy WebLinkAbout100 Arnold Way (64)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT tg&S7
Application is hereby-: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg "#PROVED 15d0 SULLIVAN AVENUE Z`f
40 1 7 E— 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location ofjob
Timl& Flwan1-S fur SA nj G 4SZ
Street No. /
N(
Street Lot No.
FEE SCHEDULE Cl
Floor Apt.No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER Oky, of SX-1 A LA"&50eoranyfractionthereof
ADDRESS
OWNERS PHONE# 75k
APPLICANT nnLll., 1 cc,l Con mAw-S. lr- Arv,-5+tkm
tCw N SF,q
ADDRESS 3S lbers
26
ESTIMATED COST$ -r"+'
C " IS THIS A CONTRACT COST?
YES NO
r CJ FEE ENCLOSED $ I L/
OR.'CO TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE O1l BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION YES / NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
Other plcasc specify)
TYPE OF INSTALLATION/WIRING METHOD
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
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.
6A 1031S7 E
NAME slrATE LICENSE NO. TYPE E71 SIGNATURE OF AhUICANT
PHONE NO. &Lb-qIL-gl{y7 DATE 0117tqZ
r' rw .
INSPECTOR G DE TIMEZ:I`j M
LOCATION IbO wlP1l.p Q Y
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
K,wuego Y €..c .
ELECTRICAL:
PLUMBING:
HVAC:
OTHER: