HomeMy WebLinkAbout115 Pine Tree LaneDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPR 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Dfi2to Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
1 r
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 1
APPLICANT ADDRESS
APPLICANT PHONE#
OWN S F,q
OWNER
OWNER ADDRESS
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OWNER PHONE0
ESTIMATED COST$ f cDa
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IS THIS A CONTRACT COST? Yes 1 To
FEE ENCLOSED$
TYPE OF JOB:
OR-Co New Installation
4Alteration/Addition/Repair
Revised 410IH2002
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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
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS 2—
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS_ REMOTE DISCONNECT REQUIRED? YES UNO
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
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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.
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C- -/o .33v
CONTRACTORS LICENSE N -TYPE STATE
DATE
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SIGNATURE OF APPLICAN Z