HomeMy WebLinkAbout124 Brookfield StreetFDEPARMENT
DECISION APPLICATION FOR ELECTRICAL PERMIT
ation is hereby:TOWN OF SOUTH WINDSOR
PERMIT#
BUILDING DEPARTMENT
PO D 1540 SULLIVAN AVENUEBldg.Permit#
644-2511 ext111467a
230 g 7UBuiingInspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
For02 1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
ny fraction thereof Tenant Designation Apt.No..
APPLICANT 41#VW A~ZGAtleAl
APPLICANT ADDRESS 6F93 to
APPLICANT PHONE# 7
O W N S OWNER .3R40900e e7lE24,Ar cla ara
4< OWNER ADDRESS Qd•,G1'S
O .00 OWNER PHONE Jt/e 661F 117 2
ESTIMATED COST$ S J
IS THIS A CONTRACT COST? Yes .-No
FEE ENCLOSED$ j
TYPE OF JOB:
OR-CO New Installation
Alteration/Addition/Repair
f
Revised 4/01//2002
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 OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
PRRAGE 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
I
NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES ( NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS go?q e
SEPARATE 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 CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
apt 4
CONTRACTORS LICENSE TYPE STAT
SIGNATURE OF APPLICANT DATE
w
Hoodtech Inc.
20 Connecticut Ave.
West Springfield, MA 01089
413-783-9664
April 26, 2002
To whom it may concern,
I , Paul Saletnik who possesses an SM5 license with the State of Connecticut,
License # SHM. 66 that expires 08/31/2002 give permission to Douglas Seymour to
use this license # to apply for a permit to install a hood system.
Pa etnik
President, Hoodtech, Inc.
STATE OF CONNECTICUT # DEPARTMENT OF CONSUMER PROTECTION
Be it known that
PALL P SALETNIK
12 P ME RD
sz 1119
has been certified by the D `" `"ent Sumer Protection as a licensed
LIMITED ONTRACTOR
E•SM5
Owe r
Effective. 01/01/2002 j
Expires: 0$/31
2002 J T.Fleming,Commissioner