HomeMy WebLinkAbout197 Brook Street (7)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
143-57)
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE DIVA
41 7 1,17 644-2511 ext. 230
Date ding InspectorL Application must be printed or typed
Location ofjob
Streettreet No. Street Lot No.
FEE SCHEDULE
0 - $1,000 - $12.00
Floor Apt. No.
Over $1,000
12.00 per$1,000
OWNER C)or any fraction thereof
ADDRESS 1'5
OWNERS PHONE# Y 421- CCU
APPLICANT e!FAS
0,* N S ADDRESS
4
ESTRVIATED COST$
0
IS THIS A CONTRACT COST?
YES NO
FEE ENCLOSED $
R-CO ME OF JOB:
Original Installation
Alteration/Addition Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
LRESIDENTIAL BUILDING PERMIT APPLICATION YES / NO
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 Cr
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED 7 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
SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CO UILDING CO -IN THE
PERFORMANCE OF SUCH WO
lo,1b5
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. 7` J DATE l
INSPECTOR DATE TI Ems+
LOCATION l f
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:
100000/
U
L
PLUMBING:
f
HVAC:
r
y: OTHER: