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DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR
PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
Location of Job:
FEE SCHEDULE ff
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 vc.• 1i J 2ec
APPLICANT ADDRESS
Vp,i?,Ajas CT
APPLICANT PHONE# 0 71 -a ' '
0000011OWN S OWNER v /y t? v eP,-4 . LL r
OWNER ADDRESS -c 1',, 19 6?, L ez
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0 OWNER PHONE
C ESTIMATED COST$$J /c7 0
U
IS THIS A CONTRACT COST? 0,Yes 0 No
FEE ENCLOSED$ o 6 c,
OR-CO
TYPE OF JOB:
X.New Installation
13 Alteration/Addition/Repair Revised 8/99
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? 0 YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY , ,v i : •%'i F=
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCY
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD A./e
SIZE OF SERVICE r t SIZE OF MAIN CONDUCTORS
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
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
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i 6! /• % / o rL, 5 f-rI b J L cl/lam 2 9 A
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.
C-101AS_-7Ag 5 /
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE a -
INSPECTOR DATE_c--,2 TIME 02M
LOCATION
INSPECTION: CODE: RESULT(E/A) :
BUILDING:
ftFtF
ELECTRICAL:
PLUMBING:
OTHER: