HomeMy WebLinkAbout169 Benedict Drive (13)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
P#
TOWN of SOUTH WINDSOR7Applicationishereby:
BUILDING DEPARTMENT Bldg Permit#
1540 SULLIVAN AVENUEAPPROVE)"
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644-2511 ext.230
Date Building Inspector Application must be printed or typed
Location ofjob
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0
0. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
0 - $13,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER Lq I o
or any fraction thereof
ADDRESS b y-ni1 6oi
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6 . Via&wv - b
OWNERS PHONE# R4 - 40:-
APPLICANT- Ma nl -
ADDRESSIdENO-A-Al0*
d
ESTIMATED COST$
0
C :=,: 'IS THIS A CONTRACT COST?
NO
FEE ENCLOSED $ CY-)
R-CO TYPE OF JOB:
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
Z SIDENTIAL BUILDING PERMIT APPLICATION YES / NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
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
SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
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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 WO
NAME STATE LICENSE NO. TYPE ATURE O IC
PHONE NO. DATE _ /- _
INSPECTOR DATE TIME AE
LOCATION
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:t o1 I_
r
PLUMBING:
HVAC:
OTHER: