HomeMy WebLinkAbout15 Chase Farm RoadDEPARTMENT DECISION APPLICATIO ELEC `; AL ERMff
TO
Pan #
Application is hereby:
B DEPARTMVT
APPRQ 15 AWN s But.Permit#
511 ext.230
Date Building Inspector
f1A.4 F.
FEE SCHEDULE
Chi ' ; -r-, '
0-$1,000=$13.00 Street No. n Lot No,
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant DesignatiE Apt.No.
APPLICANT_ S En-Icap-i` ,S Sn ,e
z =
APPLICANT AD oY"Y r ,• - P
APPLICANT PH
OWNER egel
C pVr N 3 Fq OWNER
ADDRErV
OWNER PHONE' ' (c O '"
C ESTIMATED CO w>,
r U
IS THIS A CO COST? Q Yes Q No
G FEE ENCLOSED-
TYPE OF JOB: f x`
SpR.CO 0 New Ins
0 Alterati tion/Repair Reviled'
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? YESANO
BUSINESS CURRENT USE AND OCCUPANCY (e.5
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY o r-
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD ese.
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS- , . REMOTE DISCONNECT REQUIRED? YES NO'NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS ;:d
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
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.
ELc . iBCD ,- g3 E- I C-+
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT 7i DATE