HomeMy WebLinkAbout12 Betty Drive (9)VE RMITDEPARTMENTDECISIONAPPLICATIONFORELECTRICALPERMIT
Application is hereby:
APPROVED DISAPPROVED TOWN OF SOUTH WINDSOR
BUILDING INSPECTION DEPT.
644 -2-)*11 Ext. 230
Date Building Inspector
Applications must be printed or typed.
1. LOCATION OF JOB
FEE SCHEDULE No. Street
I
s Floor Apt. No.
S 0 - $10000 - 10.00
Over $1,000 - 10.00 2. OWNER L6 c
per $1,000 or Cfl
fraction thereof 3. ADDRESS 1)6r"
i V,
4. APPLICANT 2 r C --
5. ADDRESS
ACTUAL COST $ FEE $6. ESTIMATED COST $
ESTIMATED COST $ FEE $7. IS THIS A CONTPACT COST? YES CQ NO
FILE COMP. BY BALANCE $ 8. FEE ENCLOSED /00
9. OF BUI LDINO:
RES1DENTIA i Q COMIMERCIAL
10. TYPE OFF i0c):
0XIG EN-%I, ALTEF.ATION
INS'IAL'LATTO N Q AIDDITION
REPAIR
APPLICATION FOR ELECTRICAL- pesam6ontinued Ltom t:evarse Side)
lot
11.LOCATION OF JOB
NO. STRE FLOOR APT.
CCU12. TYPE OF INSTALLATION
13. SIZE OF MAIN FEEDER _
14. NO. OF LIGHT LOOPS 15. NO. OF HEAT LOOPS 16. NO. OF P(')v,T.Z LOOPS
17. N0. OF LIGHT OUTLETS_ _ 18. NO. OF HEAT CIRCUITS_ 19. NO. OF POWER
20. NO. OF CONVENIENCE OUTLETS 21. NO. OF HEAT CIRCUITS_ 22. NO. OF POWER CIRCUTTS`
23. NO. OF LIGHT CIRCUITS 24. SIZE -OF HEAT GIRCtJITS 25. NO. OF '110 ORS
26. NO. OF PANELS w
27. TOTAL WATTAGE 28. NO. OF POWER PANELS
29. N0. OF SWITCHES 30. A/C LOAD 31. SIZE OF POWER FEEDERS_
32. NO. OF FIXTURES 33. TOTAL HORSEPOWER
34. NAMES OF SUBCONTRACTORS AND THEIR TRADES
35. REMARKS AND FURTHER DETAILS:
Z-6
LICENSE:NO. SIGNATURE PLICANT DATA
MBPHONENUER. 6/i