HomeMy WebLinkAbout20 Blueberry Circle (11)DEPARTMENTARTNT DECISION PERNIIT#
APPLICATION FOR ELECTRICAL PERMIT 2j4k-7Application is hereby TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230
DAM Iding Inspector Application must be printed or typed
Location of job
Cac"L
Street No. Street Lot No.
FEE SCHEDULE
F02-1
Floor Apt.No.F$0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER A
or any fraction thereof
ADDRESS
OWNERS PHONE#
APPLICANT kasJk'
ovi N Se ADDRESS
At 4<
C*
ESTIMATED COST$
IS THIS A CONTRACT COST?
NO
FEE ENCLOSED
41)SOR 0 ME OF JOB:
S-abriginal Installation
Alteration/Addition Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATE TH A
RESIDENTIAL 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 J-) < — PIrC. C;< °- 41
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED .. 'hJ
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
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 CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
p j 9 .
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. " 2.DATE