HomeMy WebLinkAbout207 Garden CircleDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:BUILDING DEPARTMENT
APPR' 1540 SULLIVAN AVENUE Bldg.Permit#
12 163 644-2511 ext. 230
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Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE
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0-$1,000=.'o1 :OQ Street No. Street Lot No.
Over$1,000=
per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS` r—
APPLICANT PHONE#
N S OWNER i S t=C—
OW d
pg
OWNER ADDRESS
OWNER PHONE
C ESTIMATED COST$Y' V D D 0 O
IS THIS A CONTRACT COST? , Yes 0 No
f FEE ENCLOSED$o '.O d
TYPE OF JOB:
soR,Co New 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? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE /O D SIZE OF MAIN CONDUCTORS U
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
4
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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.
CIO
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE Vh3