HomeMy WebLinkAbout20 Baker Lane (11)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR 1 CIS- 2ABUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
0-$11000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS 4 oo erj A P frl
s04'rij 1A11tibsaAe
APPLICANT PHONE#
N S OWNER TEh r 13E -H A)L1-E
let, f F,q OWNER ADDRESS
f y
J O•J71,1 1/1/bS A t.,
OWNER PHONE
ESTIMATED COST$ b 7 oyv
IS THIS A CONTRACT COST? I/Yes E3 No
CJ FEE ENCLOSED$1 1
TYPE OF JOB:
CO aVNew Installation
0 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? OYES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
Ia ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME /' PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY Ilk STATE r_ ZIP 2.1 Z 1 ep7
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD M C Ca I L E Lo N D N)t j TH N ^/
SIZE OF SERVICE /Z G d q SIZE OF MAIN CONDUCTORS (4)5e rs or 3TO
NUMBER OF METERS 1 NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS (p REMOTE DISCONNECT REQUIRED? YES Ua NO
NUMBER OF LIGHT CIRCUITS 30 NUMBER OF POWER CIRCUITS G o
NUMBER OF SWITCHES 7S NUMBER OF OUTLETS IS-0
NUMBER OF LIGHT FIXTURES s y NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
W1 A Av4 a n) /F w TIEMOP LE: &A. P S j S FFC-1 S T'y MFrr toe-% 1
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.
Jasazj.y F-1 GT
CONTRACTORS LICENSE NO. TYPE STATE
DATESIGNATUREOFAPPLICANT