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RTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
plication is hereby:
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 7
Building Inspector
Application must be printed or typed
For
EE SCHEDULE Location of Job:
1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
any fraction thereof Tenant Designation Apt.No.
APPLICANT 1*1i iy 4::'-o-----C-G-Tr a--;'J
APPLICANT ADDRESS Z10-6 r
9. t"i .
APPLICANT PHONE# l
OWN S OWNER
OWNER ADDRESS
r
QOWNERPHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
60r
FEE ENCLOSED$
ORC
TYPE OF JOB:
New Installation
Alteration/Addition/Repair
Revised 4/01//2002 I
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
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
Z
NUMBER OF SWITCHES 4z__ 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
7`le;e5- Cr--
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.
r
CONTRACTORS LICENSE NO. T STATE
SIGNATURE OF APPLICANT DATE 41p o.- a-3