HomeMy WebLinkAbout102 Bridlewood Road (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
1 L4 5-77
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg P #
APPROVED 1540 SULLIVAN AVENUE N,Ta-
644-2511 ext.230
Date wilding Inspector Application must be printed or typed
6 Location of job
o
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER
or any fraction thereof
ADDRESS
OWNERS PHONE# 2877
APPLICANT
0 ADDRESS
0%
ESTIMATED COST$
0
IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED
OR-CO ZrE OF JOB:
Original Installation
Alteration/Addition Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from rcx,crse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION S NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE
EDUCATIONAL FUTURE USE ANIXOCCUPANCY
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
Othcr pleasc spccify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS 659
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED?YE /S
NUMBER OF LIGHT CIRCUITS LZ, 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.
4—/ .
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. G Ytle 2 7 DATE <,;'—/
INSPECTOR DATE f I TIME
1 J
LOCATION
a{_
INSPECTION: CODE: RESULT(D/A) :
4
Y
BUILDING:
ELECTRICAL:
PLUMBING:
HVAC:
TS.
OTHER: