HomeMy WebLinkAbout198 Natsisky Farm RoadDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
fed g,3BUILDINGDEPARTMENT
59iD3> 1540 SULLIVAN AVENUE Bldg.Permit#
e7Uo-5 39-C. 644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
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0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT C6AJ5-j.+AJ:L POCJ-er
APPLICANT ADDRESS Sao 6J Fr M 101r
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APPLICANT PHONE# k 2/â-iU Z S
OW N S OWNER l'(,C r /'T,Z l ]â,O day
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q OWNER ADDRESS F /vq ; S lcy 4/' o',
OWNER PHONE qqâ 90 V/
C ESTIMATED COST$ /Ob co-
IS THIS A CONTRACT COST? Yes ---No-
FEE ENCLOSED$ /S.
fA TYPE OF JOB:
VOR-C0 New Installation
L<Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
Ud'RESIDENTIAL
BUILDING PERMIT APPLICATION? CTYES NO
BUSINESS CURRENT USE AND OCCUPANCYASSEMBLY
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/WIRING METHOD Wev&l -fix
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS A/ /
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 0 NUMBER OF OUTLETS 2â,
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
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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 CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
Coo/F-36 ? ( 6-- C -7,
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT 41F DATE r