HomeMy WebLinkAbout114 Sally Drive (3)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WIlVDSOR
PERMIT#
Application is hereby:BUILDING DEPARTMENT
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
ibatl Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job: 77]S4//y
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
APPLICANT ADDRESS G > C cr /f. % p'.
APPLICANT PHONE# 2 0 3rr z K-8
o W N $• OWNER .TT c
q OWNER ADDRESS 1 Y
OWNER PHONE0
C a ESTIMATED COST$ 2 O 00, oTi-
IS THIS A CONTRACT COST? Yes No
f FEE ENCLOSED$
Cq
TYPE OF JOB:
OR-Co New Installation
Alteratio dditio epair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
C' ESIDENTIAL
BUILDING PERMIT APPLICATION? 20 YES NO
R
BUSINESS CURRENT USE AND OCCUPANCY i'as "Pe," c e
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY r S c a•. c eEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME M. /7'-0 G'rc PHONE
STORAGE
GARAGE ADDRESS 7 `( ` /I c.i S So a Li Sa. fc 9 e/
MIXED USE
CITY STATE c 7- ZIP 06'7 7 8
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD o x
SIZE OF SERVICE a)e ('f 7'/1-1 SIZE OF MAIN CONDUCTORS
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
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
a cPaP, f 'o o J a k^ lY /-o "^2 1.'9 f +q - ,oa r,.e'
Gc Gu i Y5 D /ece !ac% S
74i Gam.
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. TYPE STATE
SIGNATURE OF APPLICANT DATE 5--/-0 3