HomeMy WebLinkAbout26 Castlewood Drive (4)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT ,
Application is hereby:TOWN of SOUTH VIINDSOR
BUILDING DEPARTMENT Bld
APPRO 1540 SULLIVAN AVENUE c
r L 644-2511 ext.230 6
e
Date Building Inspector
Application must be pripted or typed
Location ofA
Street No. Street Lot No.'F 4
FEE SCHEDULE
Floor ApL
0 - $12000 - $12.00 1
Over $1000 1
12.00 per$1,000
OWNERoranyfractionthereof
A'ADDRESS' "d
a os
r
r'.
OWNERS PHONE# s2 -Old
APPLICANT
OWN $ ADDRESS V' t (c
ESTIMATED COST$
a
PFS rfflS A CONTRACT COST?a
YES NO
FEE ENCLOSED $ oa
S O TYPE OF JOB:OR C
Original Installation
rAlteration/Addition/Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF 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
Other please specify)
raE 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(140
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES , iZ NUMBER OF OUTLETS ,
w NUMBER OF LIGHT FIXTURES
4 NUMBER OF HEAT CIRCUITS` NUMBER OF A/C CIRCUITS
SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
c_ lJc'ru. G'v'C-ce
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CONN.BUIL ING CO THE
PERFORMANCE OF SUCH WORK.
NAME STATE LICENSE NO. TYPE SIGNATURE 0F ,`I
PHONE NO. t'y'`J` ATE I