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DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT T#MRI
Application is hereby:TOWN OF SOUTH WINDSOR
PER
BUILDING DEPARTMENT
APPROV 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 0 7(,e 2S -
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT j G Gf G
APPLICANT ADDRESS
7, r,,11AJ0sW,09
APPLICANT PHONE# Ae , Ella,
OWN S OWNER
r
q OWNER ADDRESS
0 OWNER PHONE
C ESTIMATED COST$
4NoISTHISACONTRACTCOST? 0 Yes
FEE ENCLOSED$13- 00
TYPE OF JOB:
SpR.CO w Installation
eration/Additiofi/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NOPRESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD XP 2
SIZE OF SERVICE 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 SUBIVIITTED.
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONNECI'ICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO. TYPE _ STATE
SIGNATURE OF APPLICANT DATE