HomeMy WebLinkAbout1747 John Fitch BoulevardDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WIl TDSOR
PERMIT#
Application is hereby:BUILDING DEPARTMENT
A.' 1540 SULLIVAN AVENUE Bldg.Permit#
J2-
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE
Location of Job:
7Y$
0-$1,000=$15.00 Stree No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT l VY1.Q- W, /,Fo
APPLICANT ADDRESS S- Sa 4
17 C lz-e s a
APPLICANT PHONE# a
W N S OWNERal
OWNER ADDRESS
OWNER PHONE
C ESTIMATED COST$ o -
r IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB:
SOR-Cps New Installation
XAlteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
USINESS CURRENT USE AND OCCUPANCY X f-
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/W UNG METHOD C y
SIZE OF SERVICE 3IC-) Z--) SIZE OF MAIN CONDUCTORS 7 ,
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS I 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
JU
b
U
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.
I ') _-- G YO 2 l
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE