HomeMy WebLinkAbout258 Benedict Drive (14)RNUTDEPARTMENTDECISIONAPPLICATIONFORELECTRICALPERMIT 4
Application is hereby:TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE o S 3 C 1
1, 4—
644-2511 ext.230
Date Building Inspector Application must be printed or typed
Location of job
I* -D rZA?V\-e_J C-
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt.No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER RD 64 r-'t C O h Ltd -11
or any fraction thereof
ADDRESS S'J Ge ,,,4 c f or,
S , UJ sow C?—
OWNERS PHONE# Co `fy- of 0 ( 7
APPLICANT Co h y
N S ADDRESS oZ g h e c Or.
COW Se
S vk !n L-t)1 50r C
ESTIMATED COST$
p
C IS THIS A CONTRACT COST?
YES NO
CC)
4C FEE ENCLOSED $
TYPE OF JOB:S R CO
Original Installation
Alteration/Addition/Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATEDAVkTH A
RESIDENTIAL BUILDING PERMIT APPLICATION YES / NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY
MERCANTILE
EDUCATIONAL FUTURE USE AND OCCUPANCY
INSTITUTIONAL
FACTORY
TORAGE ENGINEER'S NAME PHONE
GARAGE
MIXED USE ADDRESS
CITY STATE ZIP
Other 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 7 YES/NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS j
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.
r,
NAME STATE LICENSE NO. TYPE SIGNATURE OF APPLICANT
PHONE NO. 6'V' 0 G —7 DATE /I—/ 7 — ?Y