HomeMy WebLinkAbout105 Gorski Drive (2)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR 3BUILDINGDEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
M 644-2511 ext. 230 2 9 3 3o-z- ^
Date Buil i Inspector
Application must be printed or typed
Location ofJob:
FEE SCHEDULE
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT J i4y$uA2C l/P E.-
APPLICANT ADDRESS /D.S 61-o fesk k
xnt WlwDfc72 Cam' CG o7c
APPLICANT PHONE#
W N S OWNER 1
F
q OWNER ADDRESS
OOWNER PHONE
ESTIMATED COST$ SOOtG
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ IS'
TYPE OF JOB:
OR-Co New Installation
Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? $YES NO
6 RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE
FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD C C
SIZE OF SERVICE o 1'i-s,P SIZE OF MAIN CONDUCTORS 1^,0%
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS — f'
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? YES NO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS ?
NUMBER OF SWITCHES G NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES / 9 NUMBER OF HEAT CIRCUITS
NUMBER OF A/C CIRCUITS C7
SEPARATE 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 CONNECTICUT BUILDING CODES IN THE
PERFORMANCE OF SUCH WORK.
Z&YI e0aj"i FV
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE %//Z0131—