HomeMy WebLinkAbout26A-26J Amato Drive (17)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PEFA%IIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Permit#
APPROVED 1540 SULLIVAN AVENUE 43 3P 1
644-2511 ext.230
Date sing Inspector Application must be printed or typed
Location ofjob
Z T 7c,V e-
Street No. Street Lot No.
FEE SCHEDULE
Floor Apt. No.
0 - $1,000 - $12.00
Over $LOW
12.00 per$1,000 OWNER VktK-eu- k(A)CLA"
or any fraction thereof
ADDRESS Z4 —3 lyi'klle
S .C-T C)G C)
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OWNERS PHONE# 51?C)
APPLICANT A),-4*K-P- LQ
SAN< ADDRESS
ESTIMATED COST$
IS THIS A CONTRACT COST?
U YES NO
FEE ENCLOSED $
TYPE OF JOB:0 CO Original Installation
K-Alteration/Addition Repair
Revised 11/95
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING
IS THIS APPLICATION ASSOCIATEH A
RESIDENTIAL BUILDING PERMIT APPLICATION YES NO
BUSINESS
ASSEMBLY CURRENT USE AND OCCUPANCY bZcl vao
MERCANTILE
rrEDUCATIONALFUTUREUSEANDOCCUPANCY
INSTITUTIONAL
FACTORY
STORAGE 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 I NUMBER OF DISCONNECTS AND RATINGS Q
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED 7 YES
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES —2- NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES I
NUMBER OF HEAT CIRCUITS 0 NUMBER OF A/C CIRCUITS
SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
d
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS
TO COMPLY WITH ALL LOCAL ORDINANCES AND STATE OF CO .BUILDING C DES IN THE
PERFORMANCE OF SUCH WORK
NAME STATE LICENSE NO. TYPE SIGNATUrP APPVtANT
PHONE NO. &0-(,I(((-S- 7 DATE 2