HomeMy WebLinkAbout169 Brookfield Street (10)PERMIT f
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT y
Application is hereby: BUILDING INSPECTION tDEPTMENT
APPROVED DISAPPRO TOWN OF SOUTH WINDSOR
236-3231
Date Building Inspector
Applications must be printed or typ .
I. LOCATION OF JOB
t oci QO o\S9 29
FEE SCHEDULE No. Street
Floor Apt. K .
1 .00 - $ 200 $3.00
201 .00 - $ 600 $4 .00 2. OWNER e pt \-loft601 .00 - $1000 $6.00
or fraction thereof 3. ADDRESS
4. APPLICANT
5. ADDRESS__._.__
1 ACTUAL COST $ FEE $6. ESTIMATED COST
ESTIMATED COST $ FEE $7. IS THIS A CONTRACT-COST? YES (3 NO
FILE COMP. BY BALANCE $ S. FEE ENCLOSED
9. TYPE OF BUILKNO:
RE.91 DENTT A i, CO,%SZRC IAL
10. TYPE OF Jf)d:-
OXIG.I XAF, ALTEF.ATIONQms,rA!.1 A•1 I().; Q ADDI*rIO`
REPA T It
APPLICATION FOR ::LECTR).CAlr PEPATT(Continued i cow ::ev:rse Side)
11. LOCATION OF JOB
NO. STREET FLOOR APT. NO.
12. TYPE OF INSTALLATION
13. SIZE OF MAIN FEEDER
14. NO. OF LIGHT LOOPS l5. NO. OF HEAT LOOPS 16. ti0. OF P('.'.• EZ L)()PS
17. NO. OF LIGHT OUTLETS 18. NO. CF Hc:',: ;:IkCT' TS 19. NO. OF P0,
20. NO. OF CONVENIENCE OMETS 21. NO. OF HEAT C-1 KCUITS 22. NO. Or
23. NO. OF LIGHT CIRCUITS 24. SIZE OF HEAT CIRCUITS 25. NO. OF
26. NO. OF PANELS 27. TOTAI, WATTAGE 28. NO. OF PO4i1'r:R PA,iK i.5
29. M. OF SWITCHES----.--- 30. A/C LOAD-- 31. SIZE OF PO*r:ER FEEOE:fS _
32. NO. OF FIXTURES 33. TOTAL HUKSEP0WfER_
34. t3AMES OF SUBCONTRACTORS AND THEIR TRADES_
M`
35. REMARKS AND FURTHER DETAILS:
Q_D e.u 0
ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE OWNER OF- THUS PROPERTY
AND WILL BE DONE TN STRICT ACCORDANCE WITH THE BUILDING CODE.
LICENSE O.
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it.T LCM F APPLIC T D.+I E
PHONE NUMBER: