HomeMy WebLinkAbout118 Steep RoadDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR Iff3 7 YBUILDINGDEPARTMENT
RQ 1540 SULLIVAN AVENUE Bldg.Permit#
7f163 644-2511 ext. 230 o2 6
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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT4<`I^
APPLICANT ADDRESS rI
APPLICANT PiYoNE# 7Kq 7-7—
OWN S OWNER - k),(/t ia-,,ft
q< OWNER ADDRESS / 119 S'7`-- F
0 + OWNER PHONE
ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
fi
FEE ENCLOSED$ rj,
TYPE OF JOB:
SOR-Cps New Installation
Alteration/Addition/Repair a
34
Revised 4/01//2002 3
i
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? YES ANO
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
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
7 f 4 C, -7,aee-Z7
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.
Z-4z-34 Lz--
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICA rA DAT91—r