HomeMy WebLinkAbout1648 Main StreetCRs# -)6S )-8
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR 183114BUILDINGDEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
6AA 644-2511 ext. 230
D e Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
I e'' dId nG,0 5 r
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 7c1y L Sj
APPLICANT ADDRESS _ I-7 („ fjcam, S-
Y)CrnC)\Q,4-j f C,* O(00`10
APPLICANT PHONE# Lj S 3 3 9
OWN SF OWNER
4 OWNER ADDRESS Ln` _1 c G'n 5 V
a
OWNER PHONE
C ESTIMATED COST$ /Cco-I
IS THIS A CONTRACT COST? _des No
l CJ FEE ENCLOSED$
TYPE OF JOB:
SOR• New Installation
ZAlteration/Addition/Repair 1
i
t
3
Revised 4/01//2002 E
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
kd'
OBUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL PHONE
FACTORY ENGINEER'S NAME
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD Z r r
SIZE OF SERVICE G '? SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES dNO
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 ( -3 _Q 3