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DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
9
Application is hereby :
TOWN OF SOUTH WINDSOR
APPROVED D PP 4S BUILDING INSPECTION DEPT.
644-2511 Ext . 230
61 Application must be printed or typed .
Date Building Inspe
1 . LOCATION OF JOB
FEE SCHEDULE No . Street
0 - $1 , 000 -10. 00 Floor Apt . No .
Over $1 ,000 -10 .00 f
per $1 ,000 or
2 . OWNER
fraction thereof
3. ADDRESS
4 . APPLICAN 4,N4,,liaq/ZA
5 . ADDRESS
6 . ESTIMATED COST $
7 . IS THIS A CONTRACT COST
Yes No
8 . FEE ENCLOSED $ /Q
9 . TYPE OF BUILDING :
RESIDENTIAL COMMERCIAL
10 . TYPE OF JOB :
1,!!!"0-riginal Installation
Alteration/Addition/Repair
BD 3A 11/88
APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side)
11 . LOCATION OF JOB LZ1
NO. STREET APT. NO ,
12 . TYPE OF INSTALLATION
13 . SIZE OF MAIN FEEDER
14 . NO. OF LIGHT LOOPS 15 . NO. OF HEAT LOOPS
16 . NO. OF POWER LOOPS 17 . NO . OF LIGHT OUTLETS
18 . NO. OF HEAT CIRCUITS 19 . NO . OF POWER OUTLETS
20 . NO. OF CONVENIENCE OUTLETS 21 . NO . OF HEAT CIRCUITS
22 . NO. OF POWER CIRCUITS 23. NO. OF LIGHT CIRCUITS
24 . SIZE OF HEAT CIRCUITS 25 . NO . OF MOTORS
26 . NO . OF PANELS 27 . TOTAL WATTAGE
28 . NO. OF POWER FEEDERS 29 . NO . OF SWITCHES
30 . A/C LOAD 31 . SIZE OF POWER FEEDERS
32 . NO. OF FIXTURES 33 . TOTAL HORSEPOWER
34 . NAME OF SUBCONTRACTORS AND THEIR TRADES
35 . REMARKS AND FURTHER DETAILS :
A-4
LICENSE NO . SIGNATURE OF APPLICANT DATE
PHONE NUMBER :