HomeMy WebLinkAbout202 Strawberry LaneDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby: F,3 7BUILDINGDEPARTMENT
APPR VE 1540 SULLIVAN AVENUE Bldg.Permit#
lCZ C13
644-2511 ext. 230 02f 3 sQ
ate Building Inspector
Application must be printed or typed
6204 6 , Location of Job:FEE SCHEDULE
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0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
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APPLICANT J:
APPLICANT ADDRESS c2 7
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APPLICANT PHONE# 7 oZ Q -3 6 6
N S OWNER . v i gull
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OWNER ADDRESS
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OWNER PHONE y g oZ( CI
C ESTIMATED COST$ t12 b O . 0 d
haw IS THIS A CONTRACT COST? Yes No
FEE ENCLOSER'$
TYPE OF JOB: r
OR-Co New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
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
SIZE OF SERVICE 2 D O SIZE OF MAIN CONDUCTORS $/ Q
NUMBER OF METERS_ NUMBER OF DISCONNECTS AND RATINGS O
NUMBER OF PANELS_ REMOTE DISCONNECT REQUIRED? YES
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
V0 0 f" l Co l 1 h 0
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.
0 3 96 oJP)j0'j ,
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE .7 G p 3