HomeMy WebLinkAbout220 Burnham StreetDEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT PERMIT#
Application is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
PRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
Fo
EE SCHEDULE
Location of Job:
1,000=$13.00 Street No. Street Lot No.
Over$1,000=
13.00 per$1,000
ny fraction thereof Tenant Designation Apt.No.
APPLICANT l Qv E1$G]=i GQ j Cj • Zh G
APPLICANT ADDRESS ' J 3. t ry±i,, f4--::-
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APPLICANT PHONE# Y/ -
00110"001111111111111111111111111111111111illillilillilIOWN S OWNER mp 4e,—r-Gl 4.6
OWNER ADDRESS 42
N
OWNER PHONE
ESTIMATED COST$ S rp p . D D
taw IS THIS A CONTRACT COST? ®'ems 0 No
FEE ENCLOSED$ af
l TYPE OF JOB:s R.CO
M'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? YES Wr4O
RESIDENTIAL
WTUSINESS CURRENT USE AND OCCUPANCY
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 / ( j
SIZE OF SERVICE o DO Q Zl t f SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS oZ 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
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.
1 k.;L.R g 3 e- c7"*
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE