HomeMy WebLinkAbout26A-26J Amato Drive (13)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT
Application is hereby: TOWN of SOUTH WINDSOR
BUILDING DEPARTMENT Bldg Pem-d #
APPROVED 1540 SULLIVAN AVENUE
644-2511 ext. 230
Date Building Inspector Application must be printed or typed
Location ofjob
G 577
Street N . Street Lot No.
FEE SCHEDULE Zh
Floor Apt. No.
0 - $1,000 - $12.00
Over $1,000
12.00 per$1,000 OWNER Ple- -A / 4 t—J 9-4h 4N
or any fraction thereof n
ADDRESS + Al&7
OWNERS PHONE#
APPLICANT
Ow f ADDRESS
Cn ESTIMATED COST$ 7.0-a
44
C IS THIS A CONTRACT COST?
3 U YES NO
G FEE ENCLOSED $ `Z
l
OSUR.C0 TYPE OF JOB:
r
Original Installation
Alteration/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)
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?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
SEPERATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DES/C/RIPTION 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.
E- / /2,5 y 9- r-.,-.
NAME STATE LICENSE NO. TYPE SIGNATURE OFAPPLICANT
C
PHONE NO. G — / e2z DATE