HomeMy WebLinkAbout126 Country View Drive (3)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
ZLI J-
644-2511 ext. 230
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Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
12-(,e C bLW TR`( Vi F-v,/ Z
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS 3b(D2'1j S
APPLICANT PHONE# 6 29)- Sq 4q
SOW N St OWNER
rrOWNERADDRESSt261 1 i f—y)/
VV1ND5012, <2-T 06674-
OWNER PHONE
ESTIMATED COST$ )-oyot
IS THIS A CONTRACT COST? Yes No
G FEE ENCLOSED$ d Cl-
TYPE OF JOB:
OR-CO New Installation
A Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? OYES NO
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 METHODERL
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS ALI'
NUMBER OF METERS_ NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? RYES 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
KI 5 L w I
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.
11,5153 F- ) r
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 7- 2 — 6?