HomeMy WebLinkAbout20 Baker Lane (12)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT 1G
APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
AD 2Z Co 644-2511 ext. 230
a 7RLFDate1WI410norgInspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
2 3( K-)e- ,fn n --f-
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Leo a r P l S C<<r 0
APPLICANT ADDRESS S-0 6 ra c e &-d'e e t-
APPLICANT PHONE#
OWN 's OWNER nif 7 f-I
q OWNER ADDRESS
OWNER PHONEC0
ESTIMATED COST$ a
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x IS THIS A CONTRACT COST? Yes 0 No
N`
G FEE ENCLOSED$ j j, yU
1
TYPE OF JOB:SOR-CO
Original Installation
0 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH
RESIDENTIAL
BUILDING PERMIT APPLICATION? YES NO
BUSINESS CURRENT USE AND OCCUPANCYASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONEFACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
s
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED A/ f
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
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.
00 10(0 2.3 z- S^ Cr7-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT J v DATE
i
INSPECTORI'' DATE i 7, TIME
LOCATION
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:
a
z
PLUMBING: 1
HVAC:
a
OTHER:i
i
i
i
d
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