HomeMy WebLinkAbout206 Bourbon Street (3)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR i l
BUILDING DEPARTMENT
p 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 y 7
u3
Efatt Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
C v
0-$1,000=$15.00 rt No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof nt Designation Apt.No.
APPLICANT COA,61A P06i
APPLICANT ADDRESS S6 S (3(j:Fr- Ce(a 41,
r.(44 d ems.
APPLICANT PHONE# _7 I r-3d Z S
W N S OWNER . A(X rA Q (-!q JI!C e-
O q OWNER ADDRESS bo N 31 •
L4 C,1
OWNER PHONE 6 y— 1' Z
ESTIMATED COST$ CGUO
IS THIS A CONTRACT COST? Yes No,
FEE ENCLOSED$
1 TYPE OF JOB:
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 ASSOCIATEDWITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? Z YES NO
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 ,m: Sc C
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBER OF METERS / NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES EHgO—
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES 116 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
J r
A) tng= rt 4l T C O
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.
ors/ jF"]6 F 6 6-e— le, C--7-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DAT4j5' e