HomeMy WebLinkAbout198 Norton LaneDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WIIVDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT 3
APPROVE 1540 SULLIVAN AVENUE
644-2511 ext. 230
Bldg.Permit#
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
Jo)3 1-0N N
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT S , F. S , CL 6 c YrL
APPLICANT ADDRESS OAk S T'
APPLICANT PHONE# C 6
OWN 8 F OWNER U 2 E,
q OWNER ADDRESS l q8 AU el RTy N
g o u-T J4 6t)11 4) 90r1--1 -r- -
OWNER PHONE
U
IS THIS A CONTRACT COST? k Yes No
f FEE ENCLOSED$ 5 .
TYPE OF JOB:
4toSOR.Co 'v'
New Installation
Alteration/Addition/Repair
G
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATEP WITH A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCYA'h
ASSEMBLY
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 / a u e A b L4
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 2 NUMBER OF OUTLETS K
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
AJ
LA-
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.
C /
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE07 1 l 8 3