HomeMy WebLinkAbout1766 Main Street (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
j
644-2511 ext. 230 a 7
ate Building Inspector
i
Application must be printed or typed
FEE SCHEDULE f
Location of Job:
J746
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Dr,' I S''t 0$d
APPLICANT ADDRESS f1 8)C C/v Z-
APPLICANT PHONE#
OW N S OWNER . Pet e a- )A sitQ m K0A1
OWNER ADDRESS
OWNER PHONE Z 9 O
0
ESTIMATED COST$ f4 0 .0
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ 15,00
TYPE OF JOB:
SO R-CO New Installation
Alteration/Addition/Repair
Revised 4/01H2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? 9 YES NO
W'RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY aEDUCATIONAL
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 —3 NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES 12. NUMBER OF HEAT CIRCUITS o
NUMBER OF A/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
l+
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 TYPE STATE
SIGNATURE OF APPLICANT DATE 1-6 0