HomeMy WebLinkAbout104 Benedict Drive (7)r.
DSM°N APPLICATION FOR ELECTRICALCTRICAL PERMIT
1 `' a TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT 3 S
a 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.Permit#
Application must be prime or typediJ
i Location of Job:
3:
e
r 104 BENI",PIC T Ml tlet13.0 Street N Streett100* C Lot No.
Y ' Tenant Designation Apt.No.
APPLICANT
g - APPLICANT ADDRESS /O¢
sour 1V1AIA 0 P cTz,
APPLICANT PHONE# B D 4r44- Z 9 7
v 4 OWNER SA/YJ .
OWNER ADDRESS
iw OWNER PHONE
ESTIMATED COST$ Z Jam. Od
IS' IS A CONTRACT COST? Yes No
ENCLOSEDSED$
TYPE OF JOB:f+Q3
r`
I New Installation
a/Alteration/Addition/Repair Revised 5101
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? j(YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME IV6 7 PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
GA Z'BD
TYPE OF INSTALLATION/WIRING METHOD C yoEiP D U/ND 4._&Il 1,gelN457
SIZE OF SERVICE Z D A/710 SIZE OF MAIN CONDUCTORS 12 6W
S /1/ A NUMBER OF DISCONNECTS AND RATINGS 0) Zo X/NP
NUMBER OF METER
REQUIRED?YES ZNO
NUMBER OF PANELS REMOTE DISCONNECT REQ
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS /V/
NUMBER OF SWITCHES AloM:' NUMBER OF OUTLETS
NUMBE R OF LIGHT FIXTURES Z. NUMBER OF HEAT CIRCUITS A140 AI G
NUMBER OF A/C CIRCUITS A19/U
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
6AZZ:90 .
iNsTAZ ZEo !/l/ / GPI 20 -9/YI CIRC611 7-
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TOCOMPLYWITHALLLOCALORDINANCESANDSTATEOFCONNECTICUTBUILDINGCODESINTHE
PERFORMANCE OF SUCH WORK.
blo&Ml 40WN2r e
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT
DATE