HomeMy WebLinkAbout25 Blue Ridge Drive (17)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERIVIIT
R toApplicationisherebyI TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bl d Pi 'tg#7APPROVED1540SULLIVANAVENUE
Jac, 644-2511 ext.230
Date Building Inspector
Application must be printed or typed
Location ofjob
0
7
Street No. Street Lot No.
FEE SCHEDULE
Floor0 - $1,000 - $12.00 Apt.No.
Over $1,000
12.00 per$1,000
I
or any fraction thereof OWNER
ADDRESS,7-
OWNERS PHONE#
APPLICANT
0 VK S ADDRESS
ESTIMATED COST$
IS THIS A CONTRACT COST?
AWN YES NO
01FEEENCLOSED $ 12-
OR-C TYPE OF JOB:
PhgirW Installation
Alteration/Addition/Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE Ole BUILDING
IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL BUILDING PERMIT APPLICATION YES / NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY
STORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
Otlier please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF MAIN FEEDERS AND RATING OF WIRE USED
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
SEPERATE 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 CONN.BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO4:.- DATE/"
r