HomeMy WebLinkAbout214 Newberry RoadDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT F0 O2 S'
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
1-J ASS
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job-
Z/Roaj
0-$1,000=$15.00 FTenant o. Stre Lot No.
Over$1,000= I
15.00 per$1,000
or any fraction thereof esignation Apt.No.
L dAPPLICANT1' 6
APPLICANT ADDRESS ff\ff--v- Ribad
O241
APPLICANT PHONE# Z
N OWNER T 1
oilSOW Sc
r,OWNER ADDRESS t l f
M.OWNER PHONE
ESTIMATED COST$ 000 CX!)
U
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
40t TYPE OF JOB:
OR-COS New Installation
Alteration/Addition/Repair
Revised 4/01 H2002
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 SIZE OF MAIN CONDUCTORS
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
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.
4-m P_e)(4ill er
CONTRACTORS LICENSE NO. YPE STATE
SIGNATURE OF APPLICANT DATE 2,