HomeMy WebLinkAbout25 Niederwerfer Road (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
P IT#
Application is hereby:TOWN OF SOUTH WINDSOR f BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
ate Building Inspector
l
Application must be printed or typed
FEE SCHEDULE Location of Job-
7)
0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT a,/ECG 12 So,#'-(er Q /-
APPLICANT ADDRESS off-57 rY/.P W-9 BJ-2 t' 2 d a.c/
SO i -h, W/&.,C/s o C-T
APPLICANT PHONE# G O — & C/ C f QL
OW N OWNER S'Q 0 e
q< OWNER ADDRESS
OWNER PHONE
C ESTIMATED COST$
IS THIS A CONTRACT COST? Yes 93'No
1'
f
FEE ENCLOSED$
OR-CO TYPE OF JOB:
New Installation
0 Alteration/Addition/Repair Revised 5101
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 '. . ct C lei R re
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY S C '
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
VGARAGE
MIXED USE CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE Cn O SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS . 90
NUMBER OF PANELS / REMOTE DISCONNECT REQUIRED? YES NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS /
NUMBER OF SWITCHES r- NUMBER OF OUTLETS 5
NUMBER OF LIGHT FIXTURES_NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS o
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
M c7 ll c__ 0 T ej C/-'/a C 0/C
ric Lic - S o
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.
Gc3 A Pr
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICAN DATE/ cl=-