HomeMy WebLinkAbout104 Ident Road (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
Z JI-e— 644-2511 ext. 230
Da a Building Inspector
Application must be printed or typed
FEE SCHEDULE i
oc on of Job•
p
0-$1,000=$15.00 Street No. Street---
Z - 9M.
Lot No.
Over$1,000=
15.00 per$1,000 POP
or any fraction thereof Tenant Designation Apt.No.
h,tj '',tXVCIIAPPLICANTjj,
APPLICANT ADDRESS
APPLICANT PHONE# 4,7 9r C 44,&. 4r, A
OWNER .
OWNER ADDRESS
OWNER PHONE 161 F(9 2
ESTIMATED COST$ I
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ Q.
flrr TYPE OF JOB:I SOR-Co Installation
7'Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
4dUJRESIDENTIAL
BUILDING PERMIT APPLICATION? YES NO
E3 BUSINESS
ASSEMBLY
CURRENT USE AND OCCUPANCY --
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/WIRING METHOD
SIZE OF SERVICE /J(P SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES ONO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS T
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.
DESC TION OF WPRK
U3,
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 HE
PERFORMANCE OF SUCH WORK.
CON TORACTOR S LICENSE NO. IVY E
SIGNATURE OF APPLICANT DATEC2-