HomeMy WebLinkAbout16 Brookhaven Lane (7)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR G S
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
tffzro 644-2511 ext.230 a 77 S' (
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE k k
0-$1,000=$13.00 riTenant Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof esignation Apt.No.
APPLICANT
APPLICANT ADDRESS CAo
MCA rn C kg-s
1
APPLICANT PHONE#
Pool W N S OWNER
OWNER ADDRESS SGG rn
OWNER PHONE
C ESTIMATED COST$ Q°
IS THIS A CONTRACT COST? D Yes XNo,
olu
lG ` CJ FEE ENCLOSED$ /-3'
TYPE OF JOB:
FOR CO D New Installation
Alteration/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 ElNO
RESIDENTIAL
BUSINESS CURRENT U `,ND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MDMD USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD J y M
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
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.
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE