HomeMy WebLinkAbout190 Long Hill RoadDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: 3{BUILDING DEPARTMENT
APP -VED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date B g Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT A eJ 'DV L,ft.t-S
APPLICANT ADDRESS l`'Z c^ L=Ajg:(J 14<<-L- i -o
APPLICANT PHONE# 42-$q j:Z A_57
Milli
OWN S
4
OWNER
OWNER ADDRESS
O OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
1 r
S
TYPE OF JOB:
OR-CO New Installation
1 Alteration/Addition/Repair
I
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY L-''(
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
COY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD HAYnJ
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 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
l o AAX U)b PA^t
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 NO. TYPE STATE
SIGNATURE OF APPLICANT DATE Co ' Cc