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PERMIT /
DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING INSPECTION DEPT.
APPROVED DISAPPROVED 1540 SULLIVAN AVENUE
644-2511 Ext. 230
a e g Inspector Application must be printed or typed
1 . LOCATION OF JOB
Q2V3Dr-ue-
FEE SCHEDULE No . Street
0 - $19000 - 10.00 Floor Apt . No.
Over $1 ,000 - 10.00
per $1 ,000 or 2 . OWNER Tq,
fraction thereof
3. ADDRESS 7 loeri c- `I pf
sow vex &J
4, APPLICANT 4C-It C-
5 . ADDRESS - PJ/q 1--tC/'d ps.
oe_J'w pw
6. ESTIMATED COST
7 . IS THIS A CONTRACT COST
Yes N
8 . FEE ENCLOSED $
9. TYPE F BUILDING:
ESIDENTIAL COMMERCIAL
10. TYPE OF JOB:
Ori 1 Installation
iteration/Addition/Repair
ran 3A >1 ie8
APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side)
11 . LOCATION OF JOB 7 13N DOQ c r v e.
NO. STREET APT. NO ,
12 . TYPE OF INSTALLATION CJAet', ,p se-Ilk
13 . SIZE OF MAIN FEEDER 0'q
14. NO . OF LIGHT LOOPS 15 . NO. OF HEAT LOOPS
16 . NO . OF POWER LOOPS 17 . NO. OF LIGHT OUTLETS
18 . NO . OF HEAT CIRCUITS 19 . NO . OF POWER OUTLETS
20 . NO. OF CONVENIENCE OUTLETS 21. NO. OF HEAT CIRCUITS
22 . NO. OF POWER CIRCUITS 23 . NO. OF LIGHT CIRCUITS
24. SIZE OF HEAT CIRCUITS 25 . NO. OF MOTORS
26 . NO . OF PANELS 27 . TOTAL WATTAGE
28 . NO . OF POWER FEEDERS 29 . NO. OF SWITCHES
30. A/C LOAD 31. SIZE OF POWER FEEDERS
32. NO . OF FIXTURES 33. TOTAL HORSEPOWER
34 . NAME OF SUBCONTRACTORS AND THEIR TRADES
35 . REMARKS AND FURTHER DETAILS :
cn M 10 /e le 9cr o c co e
eo i o rc'
kCID -'s-6 1 i)AL
0
LICENSE NO .SIGNATURE OF APPLICANT DATE
UPHONENUMBER:
fj Z TIME
Ir4
INVECT JR Di ...
LOCATION 4
INSPECTION: CODE: RESULT(D/A) :
BUILDING:
ELECTRICAL:
r
L l Al
14
j PLUMBING:
f
HVAC:
OTHER:
I