HomeMy WebLinkAbout178 Abbe Road (6)f
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN of SOUTH WINDSOR
i BUILDING DEPARTMENT Bldg Permit#
f APPRO 1540 SULLIVAN AVENUE
644-2511 ext.230
Date Building Inspector
Application must be printed or typed
Location ofjob
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER v
or any fraction thereof
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OWNERS PHONE# 1( 88
APPLICANTOK—= " ,14 A
W $ ADDRESSoel
ESTIMATED COST
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IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $
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111
SOR.CQ TYPE OF JOB:
Original Installation
A---Alteration/Addition/Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
SIDENTIAL BUILDING PERMIT APPLICATION YES /(!T>
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./mod
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED xt i y ty
NUMBER OF METERS, NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS oZ REMOTE DISCONNECT REQUIRED?YES
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 WORK.
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPKCANT
PHONE DATE O
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