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APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT
1540 SULLIVAN AVENUE SOUTH WINDSOR,CT 06074 (PHONE) 860-644-2511 EXT. 230
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DEPARTMENT DECISION PERMIT NUMBER:
APPLICATION IS HEREBY:
APPROVED: BLDG.PERMIT NUMBER:
G ems•1� M �
DATE INSPECTOR
LOCATION OF WORK: P`.�`� 3 �)(o Ll 1 v W v�-,� «-
f Pirl �2yc��r�9q
APPLICANT: OWNER: TYPE OF STRUCTURE:
I r T e k5&BUILDING
NAME: F t%Aker:u6,� NAME: 1�+ D c.. � ' r� C ❑ADDITION
PHONE NUMBER: �1(o n 1oI�7- Z`�,� PHONE NUMBER: b0I' S ' 3 l ❑EXISTING BUILDING
ADDRESS: 3 b V6 L r ADDRESS:_ y `�re.n Ay•�
TYPE OF USE:
RESIDENTIAL ❑COMMERCIAL
ELECTRICAL INFORMATION: nn FURTHER DESCRIPTION OF WORK:
TYPE OF INSTALLATION:
SIZE OF SERVICE: y l
SIZE OF MAIN SERVICE: Anne _ lTtl,..ram r�. -4w/ V: I
NUMBER OF METERS:
NUMBER OF PANELS: I
NUMBER OF LIGHT CIRCUITS: ESTIMATED COST:S
NUMBER OF SWITCHES: Y/�r -
NUMBER OF LIGHT FDCTURES: FEE ENCLOSED:S ✓ v G`�
NUMBER OF A/C CIRCUITS: CP
NUMBER OF POWER CIRCUITS: FEE SCHEDULE:$18 PER SI,000 OF THE ESTIMATED COST.
ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT
IS$1.00 OVER. (.26 CENT EDUCATIONAL FEE INCLUDED AS
NUMBER OF OUTLETS: PART OF THE PERMIT FEE)
THE UNDERSIGNED HEARBY APPLIES FOR A PERMIT TO PERFORM THE WORK DESCRIBED AND IS TO COMPLY WITH ALL LOCAL
ORDINANCES AND STATE OF CONNECTICUT BUILD O E. PERFOMANCE OF SUCH WORK.
CONTRACTORS LICENSE NO.: E - E:j — STATE:--cr
SIGNATURE OF APPLICANT: DATE: