HomeMy WebLinkAbout20 Abar Lane (9)DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMTT#
Applicati n is er V
TOWN OF SOUTH WINDSOR 17/16i3UILDDIOE.EPARTMENT
PROVED 1540 SULLIVAN AVENUE Bldg.Permit#
Z (
644-2511 ext. 230
Date Buil 13 inspector
App"L icstion must be printed or typed
Location ofJob:
FEE SCHEDULE rFStreetAIna.- F 01
0-$1,000=$13.00 StreetLot No.
Over$1,OG; _
13.00 per$1,000
or any fraction thereof nation Apt.No.
APPLICANT 6
n 14 11- 14 e J:n 1..Skn:e S
A?PLICAN7F twi.R,:SS 10 4
APPLICANT PHONE# G z
Ovi N $OWNER A e Ca.
OWNERADDRESS q0 ( 11 a —r-4 a SF/G E `•f 'Z00
0) ` *OWNER PHONE H - 4 y- L 00 d
C ESTIMATED COST$
IS THIS A CONTRACT COE. 0 Yes Z No
FEE ENCLOSED$ J
TYPE OF JOB:'
Co 0 New Instailation
M Alteration/Addition Repair
APPLICATION FOR ELECTRICAL PE104IT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
RESIDENTIAL
BUILDING PERMIT APPLICATION? 0 YES ElNO
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
0 MERCANTILE FUTURE USE AND OCCUPANCY AN'—
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS AL
GARAGE
MIXED USE CITY STATE
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE NIA SIZE OF MAIPr CONDUCTORS
NUMBER OF METERS NUMBER C f DISCONNECT: ^Tm RATINGS
OF PANELS IV(b REMOTE DISCONNECT REQUIRED? 13 YES Q NO
NUMBER.OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES N IA NUMBER 01'OU P ETS
NU,+ZBER OF LIGHT FIX71,T tES NUMBER Of FIF.AT CTP"t MrS'
NUMBER OF A/C CIRCUITS_
SEPARATE BEAT LOSS AND A/C CALCTJT,ATION;MUST BE SUBMITTED.
DESCRIPTION OF WORK
Zoil
T—
rr e / A /1 r C4 0''!4 ST
THE UNDERSIGNED HEREBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO
COMPLY WITH..—f L LOCAL ORDINANCES AND STATE OF CONNECT IC TT 13T71LDLNG CODFS IN THE
PERFORMANCE,OF SUCH WORK.
Ia11 '17 cT
CONTRACTORS LICENSE NO,/ PE l STATE
SIGNATURE OF APPLICANT DATE----3 a le