HomeMy WebLinkAbout1535 John Fitch Boulevard (14)DEPARTMENT DECISIONPERMIT#APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE 724
6. 4-2511 ext. 230
S
Date wilding Inspector Application must be printed or typed
Location ofjob
F—It-T CL,-
Street No. Street Lot No.
FEE SCHEDULE I
Floor Apt.No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER i?d 0—A 4('\i0n 0Q 0U e-tiA V
or any fraction thereof
cp
ADDRESS 0'1- U-)
covjAtO _S r
OWNERS PHONE#
APPLICANT w; \Y'• i G cv — C _' c. 0 .
W N S ADDRESS l e C
cco ei-vi
Gj ESTIMATED COST$ G .Cam'
C r IS THIS A CONTRACT COST?
1 V YES NO
C FEE ENCLOSED $
0 TYPE OF JOB:OR C Original Installation
Alteration/Addition/Repair
Revised 11/95 -
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION YES / NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY 14 r4 A F e S
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
Otlicr please specify)
TYPE OF INSTALLATION/WIRING METHOD C (° • 1
r
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED ; L U y A C u" to I.0 l
NUMBER OF METERS I NUMBER OF DISCONNECTS AND RATINGS Aim
NUMBER OF PANELS (REMOTE DISCONNECT REQUIRED?YES/NO
NUMBER OF LIGHT CIRCUITS I ;L NUMBER OF POWER CIRCUITS &
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES
NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS
SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
Cie—
3LIS)
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH W
rexj,00, C z U 3/c -
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. L P /
c- DATE /O—/ T 6
INS;ECTO R
r
DATE /d TIME I
LOCATION I -3S/ j
INSPECTION: CODE: RESU (D/A) :
r BUILDING: Z / JQ 3
ELECTRICAL:
PLUMBING:
HVAC:
OTHER:
t