HomeMy WebLinkAbout110 Country View Drive (5)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
PE
3 3BUILDINGDEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
AD C1-nt)NTQy V F-oj DR .
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 4+-
APPLICANT ADDRESS P. CX 1-'n 2-(1 8
C F alo
APPLICANT PHONE# C Oq,41
1O W N S Fq
OWNER
OWNER ADDRESS O C Q c)rr V I-F—V V PR-
WIND
OWNER PHONE
ESTIMATED COST$ E D
IS THIS A CONTRACT COST? Yes No
l w4q CJ FEE ENCLOSED$ S
TYPE OF JOB:
SCR 0c, New Installation
Alteration/Addition/Repair
Revised 4/01//2002
1
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
4RESIDENTIAL
BUILDING PERMIT APPLICATION? PfYES NO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
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 Y, Z AL.
SIZE OF SERVICE Q&v Amps SIZE OF MAIN CONDUCTORS `-t h} A-L,
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES ANO
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
NEW LAL)8DRY A-.DDrTibN -
KEuVEP.- tt C M1e G- RbDMe,, Tb Cn)-G
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.
1251 1 C
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE