HomeMy WebLinkAbout12 Birch Road (15)DEPARTMENT DECISION PERMIT
APPLICATION FOR ELECTRICAL PERMIT JAL-12Applicationishereby :TOWN OF -SOUTH WINDSOR
APPROVED DISAPPROVED BUILDING INSPECTION DEPT.
1540 SULLIVAN AVENUE
f 3 644-2511 Ext. 230
ate u g Inspector Application must be printed or typed
1. LOCATION OF JOB
FEE SCHEDULE No • Street
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0 - $19000 - 10.00 Floor Apt . No.
Over $1 ,000 - 10.00
per $1 ,000 or 2 . OWNER
fraction thereof
3. ADDRESS xe
4, APPLICANT 114
5. ADDRESS
6. ESTIMATED COST $_ O CU
7, IS THIS A CONTRACT COST
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8. FEE ENCLOSED $
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9. TYPE OF BUILDING:
RESIDENTIAL COMMERCIAL
10. TYPE OF JOB:
Original Installation
Alteration/Addition/Repair
Rn 3A 11/88
APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side)
11. LOCATION OF JOB 12 Ul'G S
NO. STREET APT. NO ,
12 . TYPE OF INSTALLATION
13 . SIZE OF MAIN FEEDER
14. NO. OF LIGHT LOOPS 15 . NO. OF HEAT LOOPS
16. NO. OF POWER LOOPS 17 . NO. OF LIGHT OUTLETS
18. NO. OF HEAT CIRCUITS 19. Nn. OF POWER OUTLETS
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20 . NO. OF CONVENIENCE OUTLETS 21. NO. OF HEAT CIRCUITS
22 . NO. OF POWER CIRCUITS 23. NO. OF LIGHT CIRCUITS
24. SIZE OF HEAT CIRCUITS 25 . NO. OF MOTORS
26 . NO . OF PANELS 27 . TOTAL WATTAGE
28 . NO. OF POWER FEEDERS 29. NO. OF SWITCHES
30. A/C LOAD 31. SIZE OF POWER FEEDERS
32. NO. OF FIXTURES 33. TOTAL HORSEPOWER
34. NAME OF SUBCONTRACTORS AND THEIR TRADES
1
35 . REMARKS AND FURTHER DETAILS :
LICENSE NO.SIGNATURE OF APPLICANT DATE
PHONE NUMBER