HomeMy WebLinkAbout115 Gail Lane (5)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
5-kaBUILDINGDEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building 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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS 2Lae
S w -
APPLICANT PHONE#1
O* N S OWNER S dZ i G'de PGc>
q OWNER ADDRESS S^_ V6- ef- C ,*e—r C
M OWNER PHONE Ae0
C ESTIMATED COST$t
i
IS THIS A CONTRACT COST? X es No
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FEE ENCLOSED$ f S_,611
f TYPE OF JOB:
SOR.CO New Installation
Alteration/Addition/Repair
I
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
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL PHONE
FACTORY ENGINEER'S NAME
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS Z
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS 2
NUMBER OF SWITCHES I 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 TOCOMPLYWITHALLLOCALORDINANCESANDSTATEOFCONNECTICUTBUILDINGCODESINTHE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. STATE
TE ay c53
SIGNATURE OF APPLICANT