HomeMy WebLinkAbout130 Cornerstone Drive (4)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: l 3 gBUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 POP"
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
3 b o Y2M N he rz--
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT ]?1.2.. 2)O+e-4E(--
APPLICANT ADDRESS vC (0 F,-AP—s TQNE
50 U0i n5n,a.2, lo(174-
APPLICANT PHONE# 4-4--"P-)!2 q J?
N S OWNER . PE ga OC
OWNER ADDRESS C oe KA
0 40074-
OWNER PHONE (0
ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
fir,
f FEE ENCLOSED$
TYPE OF JOB:
SOR-Cps 1./-New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIA D WITH A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIALB1**tUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
El FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE 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 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
P RFORMANCE OF SUCH WORK.P=
CONTRACT(JRS ENSE NO. TYPE STATE
SIGNATURE OF APPt' ANT DATE V 7i