HomeMy WebLinkAbout124 Quail RunFINAL SPECTrIONS: /
C APPLICATI N FOR BUILDING PERMIT
Plumbing VS - E D 3121 9
HVAC'-A - S-mot I c'% Date:01 /2 8/91
Sprinkler 1' QTTATT, RIM
El ctrie'), Estimated Cost $ 80 000. 00
Zoning Permit Fee$ 0
Affidavit ® (0 NO. 18991 Occupancy Fee $ 00
Eng. Dept. PR 3 zl 9 N fir )
COMPLETE RED BOXED AREAS.Fire Dept. Total Fee $ TYPE OR PRINT ONLYHealthDPt. SIGN ON REVERSE SIDE.Approved for CO:
T Additional Cost) $ /y, 996
TO BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT
The undersi n , hereby applies to do work according to the following specifications:
Job Locatf Lot No. Side of Street Zone A-3 0
Applicant DART HILL REALTY INC Tel. # 644-81 37
Address 658 ELLINGTON ROAD SOUTH WINDSOR CT Zip06O74 Lic.# 500356
STREET CITY STATE
Owner J .M.J . CONST . CO . INC Address SAME
Architect STEVE MICHAUD Address SAME
Size New Area: Ft. Front Overall 40 Ft. Deep Overall 112411 Total Area 1 , 9 2 0 Garages 2
Lavatories
No. of Families 1 No. of Stories 2 Construction 2 X 4 Bathrooms 2 Rooms 1st—4_2nd 4 3rd
Size of Lot 3 0 , 081 S . F.Dist. from Street Line 5 2 11 Dist. from Side Street Line "3 6 , 7"
Purpose of this Permit CONSTRUCTION OF A SINGLE FAMILY DWELLING
City Water Well Septic 0 Sewer
Approved by 6ec— Date fpVl BD1A 11/88
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 th proper distanc from all street lin s,side yard lin sand required distances from all other zon sand is
located in a zone in which this building and its use is allowed.
Signed
I hereby apply for a Certificate of Occupancy for the work described in this a plication for permit.
Signed
DO NOT WRITE BELOW THIS LINE/
ct I ' ,`
INSPECTION RECORD
1 ^ Footing , I-3 I F ram"'n S cP t
Foundatio Fireplace/Chimney In lation
G 6r
Plum in Permit# F77 Inspections: 7 U 4/6
HVAC Permit# Inspections 3 -2s-Q a(i
Electrical Permit# Inspections: 2 --S- /
Sprinkler Permit# Inspections:
Location of job AFFIDAVIT Additional F4.1 10..0 0.. . . . . . .
State of Connecticut
SS.
County of Hartford
J
I . !l ./j,11'(J G{./'. . . . ... . . . . . . . . . . . of .
Own
for building erected under
Contractor
Permit No. .. . . 18 9.91 . . .. . . . . .. . . . . . issued by the Dep't of Building of the'Ibwn of South Windsor being duly sworn,make oath
and say that the actual cost of the completed work authorized under said permit was.did..not .exceed. .thecur.rent.
accepted BOCA Value of $100,709 .00
Signed . . . . . . . .. . .. . . . . . . .
Subscribed and sworn to before me this . .. . (P. . ... . . . . . . . .day of A.D.19 Y . .
Estimate Cost:$ $8 9, 8 0 0
Difference: $ Nota ublic.
lor-M W rav«. -•--.,., ..r.
1
BUILDING INSPECTION DEPARTMENT
SOUTH WINDSOR, CONNECTICUT
FEE PAID: $3.00
CERTIFICATE OF OCCUPANCY
ZONE: DATED 3125 19 91
This is to certify that 124 Quail Run
Erected under permit No. 18991 conforms substantially to the requirements of the building ordinances and the
zoning regulations of the Town of South Windsor and is hereby approved for occupancy as indicated below.
Approved for Occupancy— New single family dwelling -- Lot # 35
Use Group: R4 f
Constr. Type: 5H
V
Building Official
Notice:If this certificate is lost or destroyed, a duplicate should be obtained immediately from the Building Department.
Any change or extension of the use herein approved requires a new certificate of occupancy.
i..R• * 1....ina1,,d..w,....,r..+es_
yl Lv
CERTIFICATE OF OCCUPANCY CHECK LIST
Dart Hill Realty Certificate of Occ c
Applicant
Address l Bldg. Permit No.
Lot No. 35 Date Submitted 10-91
Project Partridge M _a6ow Reviewed By
Date
As required in the Zoning 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
inlcude:
Approved Denied N/A
1. Approved building permit plan.
2 . Finish grading per approved
building permit plan.
3. Site work; i.e. trees, shrubs, dumpsters ,
required parkingq
4 . Utility location
a. sanitary sewer
b. foundation drain
c. electrical & telephone
d. water
e. other
5 . Appropriate certification
6 . Bonding
Sewer Permit No.
Pavement Excay . No.
COMMENTS:
BUILDING PEJU1IT CFECK LIST
c?
A' Dart Hill Real Building Permit No. totLq'licantpp Realty
ate Submitted 29/91 f
Address
Lot No.Reviewed by
Project STrhrdDate
In accordance with the Subdivision Regulations, prior to the bui i g of
any structure on a lot, a Topographic Plot Plan shall be submitted
approval. The minimum requirements shall include :
Approved Denied N/A
1. Name, address & phone number of owner/
applicant.
2. Name, address & phone number of plan preparer.
3. Zoning information - i.e. zone, open space,
fl oodwaY, etc.
4 . Plot plan at 1" = 40 ' scale.
a. Subdivision reference, abutting
properties, etc.
b. Easements of record.
c. Lot description, bearings, - distances,
building lines, area, etc.
d. Contours, existing & proposed, 1 or 2 ft.
interval where appropriate.
f e. Building location with dimensions.
Elevations of proposed finish floor,
garage floor & center line of road at
driveway.
f. Elevations of gravity drainage systems,
sanitary & foundation drain at the
house and the street.
g. Tentative utility location gas, electric,
water, etc.
h. Title block with name and address of
preparer, date appropriate certification,
h live seal and signature.
5 . Sedimentation and erosion control.
6. Special Planning & Zoning, Inland/Wetlands
considerations. (Plans on file w/Town Clerk)
BUILDING DEPT.
PZC
IWA/CC
WPCA
OTHERS
COMMENTS: S v c -4o ftvi
515 Ma&f vr^es' P
U
PERMIT #
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT 116-52
Application is hereby :
TOWN OF SOUTH WINDSOR
APPROVED DISAPPROVED BUILDING INSPECTION DEPT.
644-2511 Ext. 230
Application must be printed or typed .
Date Bui ing Inspector
1. LOCATION OF JOB
07 6i)414__ Z?U/,J-
FEE SCHEDULE No. Street
0 - $19000 -10.00 Floor Apt . No.
Over $1,000 -10.00
per $1,000 or 2 . OWNER ,9 T //LL
fraction thereof
4. APPLICANT 0-
5 ADDRESS
r/on1 406 0"
6. ESTIMATED COST $Q,
7 . IS THIS A CONTRACT COST y
Yes No
8. FEE ENCLOSED $ d
9. TYPE OF BUILD G:
7FJOB:
TIAL COMMERCIAL
10. TYPE
Original Installation
Alteration/Addition/Repair
BD 3A 11/88
APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side)
11 . LOCATION OF JOB LO 35 4k)01 L
NO. STREET APT. NO
12 . TYPE OF INSTALLATION N-, Lj R 5 \ 17 1"l A-L-
13. SIZE OF MAIN FEEDER
14. NO. OF LIGHT LOOPS 15 . NO. OF HEAT LOOPS
16. NO. OF POWER LOOPS 17 . NO. OF LIGHT OUTLETSc
18. NO. OF HEAT CIRCUITS_ 19 . NO. OF POWER OUTLETS
20. NO. OF CONVENIENCE OUTLETS L),5_21. NO. OF HEAT CIRCUITS I
22 . NO. OF POWER CIRCUITS cQ 23. NO. OF LIGHT CIRCUITS
24. SIZE OF HEAT CIRCUITS_ 25 . NO. OF MOTORS
26 . NO. OF PANELS 27 . TOTAL WATTAGE W
28. NO. OF POWER FEEDERS a 29 . NO. OF SWITCHES
30. A/C LOAD --- 31. SIZE OF POWER FEEDERS 4L-
n
32. NO. OF FIXTURES C 33. TOTAL HORSEPOWER
34 . NAME OF SUBCONTRACTORS AND THEIR TRADES
35 . REMARKS AND FURTHER DETAILS :
7
LICENSE NO.SIGNATURE OF APPLICANT DATE
PHONE NUMBER:
Lot No. A r.
Building Permit'J c
Temporary Service
i Permanent Service
i Pursuant to Permit No.
r
E This Certifies that the Electrical Work for which the above named Permit was granted
has been duly inspected and is hereby approved.
Owner I>} R,t r '/4 Z Electrician All
Street,U-?
7 _ Z I 199 r.
Building Inspector
s
PERMIT NO.
F77?
DEPARTMENT DECISION APPL ICATI ON FOR
Application is hereby : PLUMBING PERMIT
TOWM OF SOUTH WINDSOR
APP OV D DISAPPROVED BUILDING INSPECTION DEPT.
644-2511 Ext. 230
l
ate Bu ing Inspector Application must be printed or t ed. 1
1. LOCATION OF JOB:
FEE SCHEDULE 2. OWNER:
0 - $l , 000 - 10.00
3. ADDRESS:
jCJ rfr Za'bD/L
Over $19000 - 10 .00
per $1 , 000 or f'u .1"61 f p 4. APPLICANT:
fraction thereof
5. ADDRESS:
A 2.
6. EST. COST: $ fL3q0,0,00
7. IS THIS A CONTRACT COST? 'AYES NO
60
8. FEE ENCLOSED: $ L"- L4
99
9. TYPE OF BU NG:
RESIDENTIAL COMMERCIAL
10. TYPE OF JOB:
ORIGINAL ALTERATION
INSTALLATION ADDITION
REPAIR
BD 2A 11/88
APPLICATION FOR PLUMBING PERMIT (Cont. from Reverse Side)
La1--,
11. LOCATION OF JOB: L dT.r //tQ 1-le4c A;"fAk/
GENERAL PLUMBING
12. KIND OF INSTALLATION: Ufi4) 13. SIZE OF MAIN DRAIN
14. NO. OF TOILETS 3 STYLE7%Atd,l' 15. NO. OF URINALS STYLE
16. NO. OF BATHTUBS 16A. NO. OF SHOWERS 17. NO. OF LAVATORIES
18. NO. OF SINKS 19. DISPOSAL 19A. DISWASHER
20. NO. OF CONDUCTORS SIZE 21. NO. OF STACKS / SIZE
22. AREA OF ROOF 23. NO. OF CATCH BASINS 24. NO. OF FLOOR DRAINS
25. NO. OF OTHER FIXTURES KIND 0-`
26. ARE TOILET COMPARTMENTS VENTILATED TO OUTER AIR BY A WINDOW? 40
27. SIZE OF WINDOW
28. IF NO WINDOW, WHAT KIND OF VENTILATION IS THERE?
29. SIZE OF DUCTS 30. SEWER OR SEPTIC TANK? s,J C rC
31. SIZE OF WATER MAIN / 31A. SIZES OF WATER PIPING & RISERS
32. REMARKS AND FURTHER DETAILS /l/F 160,10" /n n 7'4 // vp
f9-s 4•
WATER HEATER
33. TYPE 34. MANUFACTURER
TANKS SAFETY DEVICES
TE14PERATURE
35. CAPACITY 0 E.**4 39. RELIEF VALVE
36. TEST PRESSURE LBS. 40. MANUFACTURER 1V jLTT
37. WORKING PRESSURE LBS. 41. PRESSURE RELIEF VALVE
38. TYPE 42. MANUFACTURER
03 74
LICENSE NO. DATE S G A OF APPLICANT
PHONE NO. C/9 ,0 2 7 f/9
FOR OFFICE USE ONLY APPLICATION FOR HVAC PERMIT DATE: Jh h
NO.TOWN OF SOUTH WINDSOR EST.COST:
BLDG.4TERMT NO. 1540 SULLIVAN AVENUE FEE 40 A.
SOUTH WINDSOR, CT 06074 01 EES:
i-25 - t. 230, splX3 ) $ 0 - $1,000 - $10.00
T- L v,. 1000 or fraction
LOCATION OF BUILDING thereof - $10.00
01
oe60eit'Ly_s
OWNER ADDRESS TOWT PHONE NO.
x5? 09
HV C CONTRACTOR ADDRPESS 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.
HYDRONIC_ WARM AIR
UNIT RADIANT HEATER (INCLUDING WOOD/COAL BURNING STOVE)
TYPE OF FUEL: OIL-GPM GAS IN-PUT LECTRIC 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 DIFFERENCE OF
TOTAL HEAT LOSS (BTUH) HEAT LOSS SHEET MUST ACCOMPANY APPLICATION)
DESCRIBE ALL HEATING EQUIPMENT (INCLUDING MAKE & MODEL NO.) : /% f i9 irl C61-
04P o vOD
GROSS HEATING CAPACITY (INPUT-BTUH) NET RATING ( UTPUT-BTUH)
IF AIR CONDITIONING: DESIGN TEMP. OUTSIDE OF INSIDE OF DIFFERENCE OF
TOTAL HEAT 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 of Conn. Building Codes in the performance of such work.
FURTHER DESCRIPTION OF WORK:TAG •
S l a
STATE LICENSE - NAME & TYPE #DATE GNATURE APPLICANT
uIt./
OVED DATE
I/
ell"
BD 4A 11/88
B= R CALCULATION SHEET 1503 (Modern Method) Copyright 1977 by The Hydronics Institute
OWNER ADDRESS DESIGN TEMPERATURE DIFFERENCE F. DATE
COL.A COL.B COL.C COL.D COL.E COL.F COL.G
ROOM Q
O H L W H L W H L W H L W H L W Design Water Temp.
2 ROOM DIMENSIONS, FT U BTUH per F of of
3 LENGTH EXPOSED WALLS, FT. Q Radiation Selected
4 WINDOW AND OUTSIDE DOOR AREA LL
BTUH BTUH BTUH BTUH BTUH
5 WALL CONSTRUCTION ROOM LIN. FT.OF
Table 9, Line 3 x H) TOTALS RADIATION
6 TYPE OF GLASS FROM LINE 12 SELECTED
Bottom of table used for Line 5) X1
7 CEILING CONSTRUCTION C
Table 9 L x W)
B FLOOR CONSTRUCTION? —
O—
Table 9, L x W or Lin F t) E
9 COLD PARTITION CONSTRUCTION F
Table 9, L x H)
10 _0 1 Wall(With Openings)C
m 2 Walls(With Openings) D X
e J 1
3 Walls(With Openings) or Ent Hall H.
11 TOTAL BTUH AT 70F TEMP DIFFERENCE'
12 TOTAL BTUH AT DESIGN TEMP DIFFERENCE K
L
COL A COL B COL.H COL. 1 COL J COL. K COL.L TOTAL BTUH TOTAL
OF BUILDING RADIATION1ROOMa: AT SELECTED
O H L W H L W H L W H L W N L W DESIGN TEMP.'
2 ROOM DIMENSIONS, FT
DIFFERENCE
U
3 LENGTH EXPOSED WALLS, FT Q
4 WINDOW AND OUTSIDE DOOR AREA LL
BTUH BTUH BTUH BTUH BTUH
5 WALL CONSTRUCTION INCREASE BATHROOM
Table 9, Line 3 x H)TOTAL 20%
6 TYPE OF GLASS ----
Bottom of table used for Line 5)
tFOR CONCRETE FLOOR ON7CEILINGCONSTRUCTIONGROUNDORFILLAT
Table 9, L x WI GRADE LEVEL,USE LINEAR
g FLOOR CONSTRUCTION? FEET OF EXPOSED EDGE
Table 9, L x W or Lin Ft)
9 COLD PARTITION CONSTRUCTION
Table 9, L x H)
10 c 1 Wall(With Openings) G
0 03
c a 2 Walls(With Openings) G XeJ
3 Wells(With Openings) or Ent Hall
11 TOTAL BTUH AT 70F TEMP DIFFERENCE'
12 TOTAL BTUH AT DESIGN TEMP DIFFERENCE
This form is available from The Hydronlcs Institute,35 Russo Place,Berkeley Heights,N J 07922 FORM 1503
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CCILlN YPE IS: Unconditioned ttic Spoce Abovo
wlNDOW TYPE IS: S le wi t»rm k..h
W4LL CUNSTRUCrTON lS: F'ame, {nsulated
HE TiOS6
The lotal BTU|i for the out!S I d 0 Walls ar0 129
Tv,e Tota1 BTU/ < for t|`e E,pnsP5d Openi.ngi; are 2, 218
The tot a] BTUH Ior the ce ings 79
The total BTU | for the floors
The BTi/H Filtration for alls :1, '^
r*e BTUH zn [zl /ation for tbie ooen/ ngv; is
THE TOTAi BTUH F lH'1S RUC", IS 6, 419
lhp tW:sl feet nf rac,iaA;zon ' equired for h r :1om z . z
ESTlMATEn HEA` LOSS Cw| RULWTEll! FOP 9?ES1DFN7'lA1 IN/1iDTNY, C 00, 19C/ T4
M DROCM CLO13 Ur P ET[R SAVAy.
ROOM MUMBER 9 HEISH! 13 O. 00 4101.4MW I95 414P U UB FEET
r EXPO3ED [/PjvTN6S O LINb / 1. 0. n'` CQLAPF |1E7'
2 EXPO3FD WALLS, not including openings, 7OTALIAt! 120. 00 SQUAnE F7 77
OO udID[ TOrA1 I, G / 5C. o QUARE rEET
FLnw TYPE IS: Floor over any 1Don`1 Jt d Spac
CE [LTmG TYPE IS: Uncondzt oned Attzc Space Abnve
WlNDOW [PE I , 1;o openi:ms in thin room
WALL CONSTRUCTION JS, Frame` ln=ulated
HEA L[/SS
Tke Total B T U H for the outsidF walls are 792
The Total BTUH -0'`r the Expnsed Operi /`gs are
The total BTUH 1or the ceilings 2*6
The total BTC| | fnr t')e flnors 0
rhp FITUNI in+i \ t,oti. m--- for t|-ie wa] l j
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THF lT/T41 H ORROOM )
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ROOM N|]MBER 10 F.illL [P& HElGHT T3 8 VOLUMF lS 730';. W; C(/B/C IMF T
1 ExP()SED OF'ENINGS, [UTAL {NCO 9. 00 SQUARE FEL [
1 EXP/|SJ» QNii S, not ` n`'1uding openznOTALIN ) 39. 00 SQUARE FEET
k:O 1C 6. 00 i_UNG by O. /m W [DE, T TAL}N 48. 00 SQL|ARF FF-ET
FLOOn TYPE IS: loor o^er =oy Conditioned Space
CEIL1NG TYP IS: Unconditioned Attzc Space Above
WINDOW TYPE lS: Single w Itk s^ ' 'rm s40 h
ALL CONSTRUCTTON [S` Frame, }ns//la ed
HEAl |.OSS
T e Total BTUH for the outsz wal ] s a,e 257
The Tota] FIT UH for the Ewosed 0pen1.n13on ;11-e 44
The total )Fly fnr the cezl n s 2l1
rhp total BTt|H am- t|-ie f] oors
The FIT UI infiltrnytj for the wa ls J.
The TVTU[ nfi ) t.0:|on 'or openzng 0C
TH[ TOTAL BTUY FJR -` ( ES ROOM i n", 1 . 5Y
The t ta| fee+ o+ `'sr!1 mt1 or' rog' .: 1-10 r' `- th/ ` wo:/ 2. 7
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E:n d o r vn D r tt
FINAL INS IS..IS..
CaBuildinga APPLICATION FOR BUILDING PERMIT
Plumbing
HVAC 124 QUAIL RUN IDate.-
Sprinkler
Electric Estimated Cost $ 00
Zoning Permit Fee$ 20
Affidavit NO, 19961 Occupancy Fee $
Eng. Dept. COMPLETE RED BOXED AREAS.
Fire Dept. TYPE OR PRINT ONLY Total Fee $ Zd
Health Dept. SIGN ON REVERSE SIDE.
Approved for CO: Additional Cost) $
TO BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT
The undersigned, hereby applies to do work according to the following specifications:
Job Location v' v^ Lot No. Side of Street Zone
Applicant o1x.45 f' i- HYLLIS C AyF3 Tel. # G44-7Z.3(
Address 124 U-4 t L- IZ LAN S• W)AV Sgo CI Zip 0(g6 74 Lic.#
STR ET CITY STATE
Owner -; pntAs a PULL/S 114'ICS Address—
Architect
Z Q u-A tL u ry S, 1.so C .
Address
Size New Area: Ft.Front Overall Ft. Deep Overall Total Area Garages
Lavatories
Size of Lot Dist. from Street Line Bathrooms Rooms 1 st 2nd 3rd
Purpose of this Permit A in :1)ZECK r- f40(AS
City Water Well Septic Sewer
Use Grou Construction Type A-4
Approved byIf4 Date Le L BD1 A 11/88
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 a zone in which this building and its use Is allowed.
L
Signed cc r / •
I hereby apply for a Certificate of Occupancy for the work described in this application for permit.
Signed
DO NOT WRITE BELOW THIS LINE—
g
r 1,,2 J INSPECTION RECORD
Footin 'i Framing
Foundation Fireplace/Chimney Insulation
Plumbing Permit# Inspections:
HVAC Permit# Inspections:
Electrical Permit# Inspections:
Sprinkler Permit# Inspections:
Inspection / Approval Date By Appl
Code Description Due Whom Code Comment
92-19961-B 1, 100
B01 FOOTING 06/11/92 001 A
B10 FINAL 07/22/92 004 A CLOSEOUT
Total Est Value 11100
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: 1'7 7(aBUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
4 644-2511 ext. 230
ulf -
bate Building Inspector
Application must be printed or typed
For
EE SCHEDULE Lo tion of Job:
N(II'le/
1,000=$15.00 Street o. Street Lot No.
Over$1,000=
15.00 per$1,000
any fraction thereof Tenant Designation Apt.No.
APPLICANT A/24? "if T
APPLICANT ADDRESS 46!
APPLICANT PHONE#
N S OWNER
OWNER ADDRESS
Yif
l
0 iWA OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes o
r (
W, FEE ENCLOSED$
TYPE OF JOB:
OR C New Installation
ation/Addition/Repair
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
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE '0 Uu 14 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
da
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.
CONTRACTORS LICENSE NO. STATE
SIGNATURE OF APPLICANT DATE
U
O