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HomeMy WebLinkAbout25 Green Lane (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT# Application is hereby: TOWN OF SOUTH WINDSOR AR Yk 9BUILDINGDEPARTMENT APPROVE 1540 SULLIVAN AVENUE Bldg.Permit# 1/103 4_644-2511 ext. 230 q Date Building Inspector Application must be printed or typed FEE SCHEDULE l Location of Job: 0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= 15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT 015 V 7 V U 6 4 Al APPLICANT ADDRESS 4 Y id U,&** G'Y APPLICANT PHONE# 75' W N $t,4 OWNER za ;-5 S , OWNER ADDRESS o7 5" Green 46 COP) OWNER PHONE r,` IY --30 6 C x,ESTIMATED COST$ 1, 460 • a IS THIS A CONTRACT COST? 4W Yes No CJ FEE ENCLOSED$ ,3a• 06 TYPE OF JOB:dSOR-C New Installation Alteration/Addition/Repair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A 0 RESIDENTIAL BUILDING PERMIT APPLICATION? ElYES ElNO 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 `?004MP-5 SIZE OF MAIN CONDUCTORS NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS NUMBER OF PANELS vZ 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. a0e !7a? Z z C-r CONTRACTORS LICENSE NO. TYPE STATE SIGNATURE OF APPLICANT DATE 711137 ©