HomeMy WebLinkAbout28 Abar LaneLDEPARTMENT
DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
plication is hereby:TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT 3
PR]03>1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 2306
Building Inspector
Application must be printed or typed
Location of Job:
Z!FEE SCHEDULE
e Oft-6-
0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT 6' •
APPLICANT ADDRESS
APPLICANT PHONE#
OWNER J
OWNER ADDRESS
OWNER PHONE
C ESTIMATED COST$ c
U
IS THIS A CONTRACT COST? Yes
FEE ENCLOSED$
TYPE OF JOB: dSOR'C New Installation
teration/AdditionlRepair
Revised 4/01//2002
AP ICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYP BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES NO
RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
ASSEMBLY
MERCANTILE FUTURE USE AND OCCUPANCYEDUCATIONAL
INSTITUTIONAL
FACTORY ENGINEER'S NAME PHONE
STORAGE
GARAGE ADDRESS
MIXED USE
CI'ry STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
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
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WO
CZ e-
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.
7
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE