HomeMy WebLinkAbout119 Trumbull LaneBectric#A APPLICATION FOR BUILDING PERMIT
Plumbing#Q t (O 119 TRUMBULL LANE
V1 2 -7HVAC # 3 N 24480 Date:l
Sprinkler# No.
FINAL APPROVALS Estimated Cost s175,006
Building 1G 13 J1 g t 3 p c COMPLETE RED BOXED AREAS Permit Fee B
Engineering d
a TYPE OR PRINT ONLY Occupancy Fee $ S
Affidavit 16 -4t I?SIGN ON RFVIFRSE InF
Appr.for CO. d ' Total Fee
TO BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT Additional Cost)3 5 8?'/v
The undersigned hereby applies to do work according to'the following specifications:
OWJobLocationCL Q f` - Lot No. Side of Street C7 Zon
Applicant11 Tel# 5OVS -Da
Address l/? r1 ip0 ic# 3s
C v11--i
n r Address A"-,V
Architect I icy f( Address
Sq.Ft.New Area: 1st Fl JQW 2nd FI. 10Y O 3rd Fl Total New Area C90,37
Rooms Lavatories Bathrooms Garages
Purpos of this permit: "W Q ptf FA M I L 4 kE S) D4--1V CG;,
City Water/4 Well Septic System 0 Sewer
Ins. H.O. S.P. Cert. Area 'tv Basement ') o Garage "7
Approved by Date 7 /7 Use Group Construction Type 52
RwimW1197
I hereby agree to conform to all the requir ments of the Laws of th State of Connecticut and the Ordinances of the Town of
South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this
permit is asked,and agree that this building is to be I ted the proper distance from all street lines,side yard lines,and required
distances from all other zones and is located in is t is building and its use is allowed.
Signed
I hereby apply for a Certificate of Occ cy for the w- ribo in this application for the permit.
Signed
DO NOT WRITE BEL THIS LINE
INSPECTION COMMENTS
Location of Job: AFFIDAVIT Additional Fees 4 3 2. 0 0
State of Connecticut
ss. South Windsor
County of Hartford
Owner
I t of Agent for the building erected
Contractor
under Permit No. 24480 issued by the Building Department of the Town of South Windsor being
duly sworn,make oath and say that the actual cost of the completed work authorized under said permit did not
exceed the most current accepted BOCA value of S 1 1 7Zh1 n n n ,
Signed
Subcribed and sworn to before me this I ay of A.D. 19 q 7
Estimated Cost S 81 , 8 0 0. 0 0
Difference: S 35r810. 00
Notary b is
Y 0 '
Inspection / Approval Date By Appl
Code Description Due Whom Code Comment
97-24480-B 75,000
B01 FOOTING 07/22/97 JFH A
B02 FOUNDATION 07/30/97 JFF A
E01 SERVICE 09/03/97 JFH A RELEASED OK
E01 SERVICE 09/08/97 JFH A RELEASED OK
P02 UNDERGROUND 09/08/97 JFH A
P03 ROUGH 10/03/97 JFH A
B03 FRAMING (ROUGH) 10/07/97 JFF A
E03 ROUGH 10/07/97 JFF A
B05 FIREPLACE/CHIMNEY 10/10/97 JFH A
PO4 GAS TEST 10/27/97 JFF A
B10 FINAL 10/31/97 JRC A APPROVED FOR CO & CLOSEOUT
PO4 GAS TEST 10/31/97 JRC A
97-10010-P 1,900
97-9936-H 1,900
97-14546-E 3,000
Total Est Value 81,800
Dwelling 2,084 85,277.28
Basement 990 12,276.00
Garage 484 6,001.60
Smoke Det 7 525.00
BOCA Value 117,610.26
Difference 35,810.26
SITE COMPLIANCE CHECKLIST
TOWN of SOUTH WINDSOR, CONNECTICUT
119 TRUMBULL LANE LOT_# 8 Reviewed By :5. R N En ineering)
JMJ CONSTRUCTION CO. Date Reviewed 10 pprove Denied
658 ELLINGTON ROAD,SOUTH WINDSOR,CT Reviewed By lanning)
BP_#_24480 Ph #_(203)282-0628 Date Review ppro /Denied
Date Submitted 10/27/97 FOR f 0 ****
As required in the Zoning and/or Subdivison Regulations, no Certificate of
Occupancy shall be issued until grading plans have been complied with and
approved by the Town Engineer. The minimum requirements shall include:
Approved Denied N/A
1. Approved building permit plan
Z 2. Finish grading per approved
building permit plan
3. Site work; i.e. trees, shrubs,
dumpsters, required parking
4. Utility location;
a. sanitary sewer/septic system
b. foundation drain
C. electrical & telephone
d. water
e. other U s
5. Sewer connection charge paid
6. Appropriate certification
7. Bonding
8. Planning & Zoning/
Inland Wetlands Considerations
Sewer Permit No. 6
Pavement Excavation No.
COMMENTS:
6"D IM6, AND SEFpInf CA Ncn GoMCtA-'f
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
45NZ6
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bid Pcrr #
APPROVED 1540 SULLIVAN AVENUE J;!4
T/f7 644-2511 ext.230
Date Building Inspector
Application must be printed or typed
It )IJ Location ofjob
b;&" 7-zdM,6zfL"-" LAje I
J,07-Z
FStreet No. Street Lot No.
FF-E SCHEDULE
Floor Apt.No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000
L
or any fraction thereof OWNER
ADDRESS L
77 0660r4ltoj-
OWNERS PHONE# 1,5 7
e,
4APPLICANTa] —
OW 4
ADDRESS
ESTIMATED COST$ B&OC) 0 C)
IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $
R-Co TYPE OF JOB:
Original Installation
Alteration/Addition Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATED WUH A
RESIDENTIAL BUILDING PERMIT APPLICATION NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY '—
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
Otlicr please specify)
t
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED iffin Q jl Ll b
NUMBER OF METERS j NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS 1— REMOTE DISCONNECT REQUIRED?YES O
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES d S
NUMBER OF HEAT CIRCUITS.__t NUMBER OF A/C CIRCUITS /
SEPERATE 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
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
er
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. DATE P
IF1:R'UCTOR DATE q /03 TIME A M
LOCATION
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:
40
PLUMBING:
HVAC:
OTHER:
INSPECTOR d" DATE ! TIME
LOCATION
11
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
y4
ELECTRICAL:
y ) 1V514,
PLUMBING:
HVAC:
OTHER:
SITE COMPLIANCE CHECKLIST
TOWN of SOUTH WINDSOR, CONNECTICUT
119 TRUMBULL LANE LOT_# 8 Reviewed By Pt LJ6/Oke (En ineering)
JMJ CONSTRUCTION CO.Date Reviewed 1 proved enied
658 ELLINGTON ROAD,SOUTH WINDSOR,CT Reviewed By7 ning)
BP_##_24480_ Ph_#_(203)282-0628 Date Reviewe c A rov d/Denied
Date Submitted 07/15/97 FOR BUIL I G PERMIT *****
In accordance with the Zoning and/or Subdivision Regulations, prior to the
building of any structure on a lot, a Topographic Plot Plan shall be submitted
for approval. The minimum requirements shall include:
Approved Denied N/A
RD 1. Name, address & phone number of owner/applicant
2. Name, address & phone number of plan preparer
3. Zoning Information - i.e. zone, open space,
floodway, etc.
4. Plot Plan at 1" = 40' scale
Rol _ a. Subdivision reference, abutting properties, etc
b. Easements of record
D c. Lot description, bearings, building lines,
p
distances, area, etc.
6 1 d. Contours, existing & proposed, 1 or 2 ft.
interval where appropriate
RDe. Building location with dimensions.
Elevations of proposed finish floor, garage
RDfloor &
centerline of road at driveway
f. Elevations of gravity drainage rgyaagesystems, sanitary
foundation drain at the house and the street
g. Tentative utility location (gas, water,
electric, septic system, etc.)
h. Title block with name and address of preparer,
date, appropriate certification, live seal and live
signature consistent with the Board of Registration
requirements. (P.E. & L.S.)
S. Sedimentation and erosion control
6. Special Planning & Zoning, Inland/Wetlands
considerations (Plans on file w/Town Clerk)
COMMENTS:
DEPARTMENT DECISION PERMIT#
APPLICATION FOR PLUMBING PERMIT oo !v
Application is hereby-: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVE 1540 SULLIVAN AVENUE x 4 4 go
644-2511 ext. 230
Date Building Inspector Application must be printed or typed
19 Location ofjob
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt. No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER
or any fraction thereof
ADDRESS S
OWNERS PHONE#
APPLICANT
W N F ADDRESS G Lela.evC
C 4<
Gv
C!j ESTIMATED COST$ O
C IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $
f. .I
R.Co TYPEPE OF JOB:so
Original Installation
Alteration/Addition/Repair
Revised 10/96
APPLICATION FOR PLUMBING PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION YES / NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCYASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY a-EDUCATIONAL
INSTITUTION
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION SIZE OF MAIN DRAIN
NO. OF TOILETS 3 STYLE,04,C'. NO.OF URINALS STYLE
NO. OF BATHTUBS Z NO.6f SHOWERS / NO.OF LAVATORIES 3
NO. OF CONDUCTORS SIZE NO.OF STACKS / SIZE 3
AREA OF ROOF NO.OF CATCH BASINS NO.OF FLOOR DRAINS
NO. OF OTHER FIXTURES / KIND /U l"
ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW YES/NO
SIZE OF WINDOW 3)C2— IF NONE C.F.M.OF VENTILATOR
SIZE OF DUCTS SEWER OR SEPTIC TANK
SIZE OF WATER MAIN / SIZE OF WATER PIPING&RISER
WATER HEATER
TYPE MANUFACTURE
TANKS SAFETY DEVICES
TEMPERATURE
CAPACITY RELIEF VALVE
TEST PRESSURE WORKING PRESSURE PRESSURE RELIEF VALVE
TYPE MANUFACTURER
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 CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH
7NAMESTATELICENSENO. TYPE NATURE OF APPLICANT
PHONE NO,Io r?e DATE /
FOR OFFICE USE ONLY APPLICATION FOR HVAC PERMIT DATE: (? -.3 O
NO. TOWN OF SOUTH WINDSOR EST.COST: (
BLDC. PERMIT NO. 1540 SULLIVAN AVENUE FEE
SOUTH WINDSOR, CT 06074 FEES:
644-2511 - Ext. 230 0 - $19000 - $10.00
r 9 1000 or fraction
LOCATION OF BUILDING thereof - $10.00
OWNW ADDRESS TOWN PHONE NO.
HVAC CONIUCTOR WRESS , TOWN PHONE NO.
TYPE OF SYSTEM: HEATING TYPE OF BUILDING: RESIDENTIAL
A/C COMMERCIAL
VENTILATION _ BUSINESS _
INDUSTRIAL
IF HEATING: STEAM LOW PRESSURE LIMIT LBS. HIGH PRESSURE LIMIT LBS.
HYDRONI__Z W AIR
UNIT RADIANT HEATER (INCLUD G-YOOD COAL BURNING STOVE)
TYPE OF FUEL: OIL-GPM GAS iiVMT Z,W ELECTRIC KW
WOOD COAL
OIL TANK - SIZE & LOCATION INSIDE OUTSIDE CAPACITY
LPG TANK - CAPACITY_
EXISTING RADIATION_ ADDITIONAL RADIATION_ TOTAL RADIATION_
DESIGN TEMP. OUTSIDE OF INSIDE OF IDFFERENCEF
TOTAL HEAT LOSS (BTUH) HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEATING EQUI OT (INCLUDING—MU & MODEL NO.):
GROSS HEATING CAPACITY (INPUT-BTUH) NET RATING (OUTPUT-BTUH)
IF AIR CONDITIONING: DESIGN TEMP. OUTSIDE_j22F INSIDE E2:F DIFFERENCE 20 F
TOTAL SEAT GAIN (BTUH)
HEAT GAIN SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL COOLING EQUIPMENT (INCLUDING MAKE & MODEL NO.):
TONNAGE COOLING CAPACITY (BTUH)
IF VENTILATION: DESCRIBE ALL AIR-HANDLING EQUIPMENT (INCLUDING KITCHEN EXHAUSE EQUIPMENT):
TOTAL SIZE OF SYSTEM (CFM) FRESH AIR INTAKE (CFM)
PLAN MUST ACCOMPANY APPLICATION)
The undersigned hereby applies for a permit to perform the following work and is to comply
with all local ordinances and State f Conn. Building Co'd in the performance of such work.
FURTHER DESCRIPTION OF WORK:
STATE LICENSE - NAME b TYPE f DAIT GNATURE OF APPLICANT
U q
APPROVED DATE
BD as 11/88
I - B - R CALCULATION SHEET 1503 (Modern Method)Copyright 1977 by The Hydronks Institute
OWNER ADDRESS DESIGN TEMPERATURE DIFFERENCE ZG F. DATE /-3
COL.A COL.B COL.C COL.O COL.E COL.F COL.G
1 ROOM --- Lpt, I,/'?q i le r? e
O H L W HH L W H L W H L` W HHN W Oeslgn Water Temp.
2 ROOM DIMENSIONS, F T. V 0 S / d / A O OTUH oor F of of
3 LENGTH EXPOSED WALLS,FT. o 0 lF' 30 Radiation Selected
4 WINDOW AND OUTSIDE DOOR AREA IL
MTUH TUH BTUH OTUH BTUH
5 WALL CONSTRUCTION
T able 9.Line 3 x H) 110 6! 00 lRdO poo rp0o a00 ROOM LIN.FT.OF
TOTALS RADIATION
6 TYPE OF GLASS i f
FROM LINE 12 SELECTED
IB ttom I table used for L ins 6) 0 v T 0 0 J-0Q p 0 760
7 CEILING CONSTRUCTION C la, /?t,
IT able 9.L a W 06 /a 00 FOO i0o 7 00 4? 0
6 FLOOR CONSTRUCTION1
Table 9, L x W r Lin. F t) 4 E 0 la !O
9 COLD PARTITION CONSTRUCTION F 00 J
Table 9.L a HI
10 1 Wall 1 With Openings) l ( 7500
G
PO
y 3p d /D -` '
H
i 2 Wells{With Openings)
J (
0O 0 3 Q a
1 LI! O
3 Wan•1With Openings)or Ent.Hell
11 TOTAL dTUH AT 70F TEMP DIFFERENCE'300 G 00 35f00 &-00 J pOo
12 TOTAL STUH AT DESIGN TEMP DIFFERENCE 0042 f(P 00 IV/0 0 DQ K`h0
C L.A — _-- COL B COL.H COL.1 COL.J COL.K COL.L TOTAL STUH TOTAL
1 ROOM E u1' a a46 Of •DATING
SELECTED"
O H L W H L W H L W H L W H L W DESIGN Tamp.-
2 ROOM DIMENSIONS, FT U g / O
DIFFERENCE
3 LENGTH EXPOSED WALLS, FT.
d WINDOW AND OUTSIDE DOOR AREA IL
p
STUN STUN BTUH STUH TUH
5 WALL CONSTRUCTION INCREASE BATHROOM
Table 9,Una,3 x HI I D 7 700 00 TOTAL 20%
6 TYPE OF GLASS
19 it m I table used f r Line 5) U Q v 0
7 CEILING CONSTRUCTION GROUN/l
FOR CONCRETE FLOOR ON
LL AT
Table 9,L x WI 0 -7 DV D T O v GRADEDLEVEL!USE LINEAR
FLOOR CONSTRUCTIONt FEET OF EXPOSED EDGE
ITable 9,L x W r Lin Ft.)
9 COLD PARTITION CONSTRUCTION
Table 9,L a H)
10 -0 1 Well(With Openings) v"^ 0L --- -- l C) P - - ------- i
2 Wens(With Openings) e x -01 C
3 Wane(With Openings)or Ent Hall F J
II TOTAL STUH AT 70F TEMP DIFFERENCE' ZK100
12 TOTAL STUH AT DESIGN TEMP DIFFERENCE - z
FORM 1503
This form Is available from The Hydronlcs Institute 36 Russ Piece,Berkeley Heights,N J 01922
Electric#APPLICATION FOR BUILDING PERMIT
Plumbing# 119 Trumbull ,Lane
HVAC # 27176 Dat
Sprinkl r#
FINAL APPR V LS Estimated Cost $ 150000
Building 4 C.S s COMPLETE RED BOXED AREAS Permit Fee 2 0
Engineering TYPE OR PRINT ONLY Occupancy Fee $ 5
Affidavit SIGN ON REVERSE SIDE
Appr.for CO. I 1 1. Total Fee Z)
TO BIJI DW- DEPARTMENT,TOWN OF SOUTH W1 DSM Cr Additional Cost) $ '3c=>c)o
The undersigned hereby applies to do work according to the following specificationx.
Job Location 11 vM1b0 J-Wt:. Lot No. Side of Street Zone
Applicant bfl, t IX l bNA ldy AiC01 Va-* CA I IAbk,1F-9. Tel# 6 W • 19 20
Address d-&t e Zip b60 Lic.#
Owner SaIRE G b AW LZe A),-r-%' Address
Architect Address
Sq.Ft.New Area: lst FI. 2nd FI. 3rd Fl. Total New Area
Rooms Lavatories Bathrooms Garages
Purpose of this permit: JV t 1 -cie,2 ZK 2g
Ci Water Well Septic System Sewer
Ins. H.O. 00" Cert. Area Basement Garage
Approved by Date -1 loloo Use Group U Construction Type
R.vked 1197
I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of
South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this
permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required
distances from all other zones and is located in which this building and its se is allowed.
Signed
I hereby apply for a Certificate of ccupancy r he work d ri this applicatio o the permit.
w
Signe
DO NOT RITE BELOW THIS LINE
INSPECTION COMMENTS
P
Location of Job:AFFIDAVIT Additional Fee$ a g
State of Connecticut
ss.South Windsor
County of Hartford
Owner
I (fe w6 1Z t' Ge'Y•TSU`^ of S v,cr Yt' L-L-C Agent for the building erected
Contractor
under Permit No. issued by the Building Departme t of the Town of South Windsor being
duly sworn,make oath and say that the actual cost of the completed worl authorized under said permit was
GS1Oned
Subscribed and sworn to before me this day of A.D.200
Estimated Cost$ rev U
Difference: $ 3U v v
Notary Public
s
Inspection / Approval Date By Appl
Code Description Due Whom Code Comment
27176-B 1,500
BO1 FOOTING 05/25/01 CJD A LEFT TICKET
B10 FINAL 06/19/01 CJD A
B10 FINAL 06/19/01 CJD A CLOSED OUT.
Town Of South Windsor
Building Department 1
Location j 61 N Building Permit# Z 530
SWIMMING POOL REQUIREMENT .
This list is not all inclusive;please refer to pool packet.
A 48"barrier will be provided to protect the pool access. Including temporary fence
for inground pools prior to filling.
Access gates will be self closing and self latching(if less than 54"hi they shall be on
the pool side and be protected within 18"of release mechanism).
Doors providing direct access to the pool shall either have an alarm, selfclosing self
latching device 54 above the floor,or a safety cover over the pool.
No receptacles within 10'of pool.(locking type receptacle for pool equipment must be
at least 5' from pool and GFCI protected).
All metal parts of pool structure,fixed metal parts within 5'of pool,pump motors etc.,
shall be bonded with a minimum#8 solid copper wire.
Convenience GFCI receptacle shall be provided between 10'and 20'from pool.
Trench depth for 20 amp.circuit to pool equipment shall be 12"minimum.
A surface pool alarm shall be installed pursuant to Public Act 99-140I.
All swimming pool pumps must be equipped with a time clock.
Heated pools require a pool cover unless over 20%ofthe heating en rgy is from non-depletable sources.
REQUIRED SWIMMING POOL INSPE
The following is a list ofinspections that need to be performed prior to the continuation of work. Requests for
inspections can be made by calling the Building Department at 644-25 1 ext.230.
1. TRENCH AND BONDING-Electrical trench depth verification an bonding of pool and metal appurtenances
including metal reinforcing for gunite pools.
2. FINAL ELECTRICAL-Location of equipment and GFCI protection. Convenience outlet provided.
3. FINAL-Swimming pool access protection must be provided before pool can be used.
Each swimming pool installation requires a Building and an Electrical permit. Additional permits and inspections
are required for pool decks.
I have read and unders the requirements listed above.
Applicant Signature Date
Homeowner Signature Date lw-v
i
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
f(( c)b
644-2511 ext. 230 2 Co 9 3 0
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
0-$1,000-=$13.00 Street No. Street Lot No.
Over$1,000=
per
or any fraction thereof Tenant Designation Apt.No.
APPLICANT O 5 14
APPLICANT ADDRESS o2^7 r r-h -er' `' r .
crAO'.
APPLICANT PHONE# 7 o- '3 (v Co
OWN S OWNER c, C r-
q OWNER ADDRESS
s„
r' OWNER PHONE G Y 19 -0
C ESTIMATED COST$ 4
IS THIS A CONTRACT COST? VYes 0 No
FEE ENCLOSED$
1 TYPE OF JOB:
soR,Co 1New Installation
0 Alteration/Addition/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 NO
RESIDENTIAL
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
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
F C c t a 1D D
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.
o 3 S'- 9 D F- t 33 .
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE S aO