HomeMy WebLinkAbout129 Benedict Drive (13)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application ' hereby:TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT 3°Z
APPROVED 1540 SULLIVAN AVENUE
0( 644-2511 ext. 230 Bldg.Permit#
Date Buil fg Inspector 3a
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$13.00 Street No. Street Lot No.Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
d
APPLICANT PHONE#
O W N S F,q
OWNER
OWNER ADDRESS
c
OWNER PHONE
c ESTIMATED COST$f-Uc)U
IS THIS A CONTRACT COST? 0 Yes No
FEE ENCLOSED$ 13,
OR 0 TYPE OF JOB:C
O Original Installation
Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPX OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
a4SIDENTIAL BUILDING PERMIT APPLICATION?A YES ElNO
BUSINESS CURRENT USE AND OCCUPANCY Jr• G
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
l( e'r please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
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
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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.
5,7- f 7/- ci
CONTRACTORS LICENSE NO. STATE
SIGNATURE OF APPLICANT DATE