HomeMy WebLinkAbout21 Berle RoadDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR '
PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPROVE 1540 SULLIVAN AVENUE Bldg.Permit#
L J41— 644-2511 ext. 230
to Building Inspector
Application must be printed or typed
c on of Job:
FEE SCHEDULE
0-$12000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANTAe am/`- C
APPLICANT ADDRESS
APPLICANT PHONE#
OWN 3 OWNER
OWNER ADDRESS -ZL!
OWNER PHONE
C ESTIMATED COST$ Z UU
IS THIS A CONTRACT COST? 0 Yes CH157 -
1 { CJ FEE ENCLOSED$ G
TYPE OF JOB:dSOR,Cps 0 New Installation
on/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE UEkUDIN IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NOZSIDTIAL
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 04-) SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES alla-
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
CAD
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.
IZ2 V"-)/-? I/
C CTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT DATE