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DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Applica' TOWN OF SOUTH WIlVDSOR
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
0 t
644-2511 ext. 230
Date Buil g Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT I-Alo47,J AIF-G 6 7-jal vl-4
APPLICANT ADDRESS C 6
f ) yy t r DS'o 7 Q 7
APPLICANT PHONE# 2Z Z /!? 7
O%q N S OWNER , Z-P-A L A-6
q< OWNER ADDRESS ld 6 k14 0 yt D 12
Ciw I OWNER PHONE t
C ESTIMATED COST$ l 100 -I
IS THIS A CONTRACT COST? XYes No
62)
FEE ENCLOSED$ 30.
os
TYPE OF JOB:
OR C New Installation
Z,Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY ZF--5
ASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCY 5EDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
1 6
SIZE OF SERVICE ' '1 SIZE OF MAIN CONDUCTORS p 6 Sf-
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS l REMOTE DISCONNECT REQUIRED? YES 4<0
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
SEPARATE 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 CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT DATE