HomeMy WebLinkAbout110 Brook Street (8)DEPARTMENT DECISION PERMIT#APPLICATION FOR ELECTRICAL PERMIT L(4S W3
Application is hereby:TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVE0 1540 SULLIVAN AVENUE 11r R
J Z-4&0
644-2511 ext.230
Date wilding Inspector
Application must be printed or typed
Location ofjob
f r® 8 ?-a6 /C S*7—x-,c
Street No. Street Lot No.
FEE SCHEDULE
0 - $1,000 - $12.00
Floor Apt.No.
Over $1,000
12.00 per$1,000
or any fraction thereof OWNER F
ADDRESS / C-) LS O-00 k S f—
OWNERS PHONE# 0 Z
APPLICANT .,, l/A I/0E- f6;rt L .. 1(f--
O WN$ ADDRESS 3,Y 2-
4 P--
A- 7 42 ,,,c tf/• Q
F) 7 ESTIMATED COST$ ® c1
o
C IS THIS A CONTRACT COST? !/
YES NO
FEE ENCLOSED
SOR Q TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
r/ RESIDENTIAL BUILDING PERMIT APPLICATION YES / NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCYoa-
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
Other please 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?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
CA", 7-,
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
o
ERFORMANCE OF SUCH WO
l p
NAME STATE LICENSE NO. TYPE SIG TURF OF AP LICANT
PHONE NO. 2 ij`/-- 5,5,,& DATE t2 u
4
INSPECTOR D C J DATE C //TIME
y_ LOCATION lv
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:
PLUMBING:
HVAC:
OTHER: