HomeMy WebLinkAbout134 Brook Street (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
TOWN OF SOUTH WINDSORApplicationishereby:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
Rio K- SJ_1
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE#
OWN S OWNER
f*--
114' b ts S
q OWNER ADDRESS if
CIO qOWNERPHONECoy 77
C ESTIMATED COST$
l U
IS THIS A CONTRACT COST? W-Yes 0 No
l £ FEE ENCLOSED$ l 8
TYPE OF JOB:
OR-CO
0 New Installation
MAlteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES RNO
S RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD G
SIZE OF SERVICE ,d SIZE OF MAIN CONDUCTORS L
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES 6,NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS D
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.
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CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE Z7
INSPECTOR DATE Zi
iRT2 ME
LOCATION
INSPECTION:CODE: RE_LT(D/A) :
BUILDING:
ELECTRICAL:
AAA,
PLUMBING:
HVAC:
OTHER: