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HomeMy WebLinkAbout0 NUTMEG RD N MISC DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Applicati BUILDING DEPARTMENT (,- 2 D 1540 SULLIVAN AVENUE Bldg.Permit# _0 C, 644-2511 ext. 230 Date BtlYing Inspector Application must be printed or typed FEE SCHEDULE Location of Job: c IL c $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT n ,� kf C� APPLICANT ADDRESS 1"r(a �0 APPLICANT PHONE .3# �! j 3 3.1 O W N S,c OWNER /- /q ONE Ci /err-Ci/J/4*y - -- - OWNER/ADDRESS 4A/5Cr C • OWNER PHONE S,3— O t - C ill = ESTIMATED COST$ dc>i c"� x IS THIS A CONTRACT COST? _Yes _No FEE ENCLOSED$ 3 y� TYPE OF JOB: LSD R C O� New Installation teration/Addition/Repair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A ❑RESIDENTIAL BUILDING PERMIT APPLICATION? ElYES ❑NO �.� �,Q 1 ❑BUSINESS CURRENT USE AND OCCUPANCY © 'tom<ce/C��/K I ❑ASSEMBLY ❑MERCANTILE❑EDUCATIONAL FUTURE USE AND OCCUPANCY ❑INSTITUTIONAL ❑FACTORY ENGINEER'S NAME PHONE ❑STORAGE ❑GARAGE ADDRESS ❑MIXED USE (Other Please specify) CITY STATE ZIP 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 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. CONTRACTORS LICENSE NO. TYPE STATE �/ SIGNATURE OF APPLICANT DATE l v G DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT TOWN OF SOUTH WINDSOR PERMIT# Application is he BUILDING DEPARTMENT / 0 PR 1540 SULLIVAN AVENUE Bldg.Permit# 644-2511 ext. 230 a . Dat 2 -N Building Inspector -- Application must be printed or typed FEE SCHEDULE Location of Job: $0-$1,000=$15.00 Street No. Street Lot No. Over$1,000= $15.00 per$1,000 or any fraction thereof Tenant Designation Apt.No. APPLICANT t APPLICANT ADDRESS 3o,-, 4, i,,, 3 �✓t�.,.r� .�s �. C f �60�o APPLICANT PHONE# 8t<-O' O W N S F,q OWNER OWNER ADDRESS L�, QJ3 ,/. e 4 O OWNER PHONE- Y82- 9 Z g 1 ESTIMATED COST$ -7L01 0 d x IS THIS A CONTRACT COST'? _Yes _No FEE ENCLOSED$ S • . O,� TYPE OF JOB: �R C V New Installation V"�Alteration/Addi tion/Repair Revised 4/01//2002 APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side) TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A 0 RESIDENTIAL BUILDING PERMIT APPLICATION? ElYES ElNO MWJSINESS CURRENT USE AND OCCUPANCY ❑ASSEMBLY ❑MERCANTILE❑EDUCATIONAL FUTURE USE AND OCCUPANCY 4�� � ✓` ❑INSTITUTIONAL O FACTORY ENGINEER'S NAME f'r n /VL►�-sue, .. PHONE cPt�o-E 3 Z- 70J$ EI STORAGE 0 -7� GARAGE ADDRESS 3c� ❑MIXED USE CITY C.rn r►�wt�� STATE L'f • ZEp (Jbl �I (Other please specify) TYPE OF INSTALLATION/WHUNG METHOD rt le com yv1 Cam.T t%+ SIZE OF SERVICE /l-�T SIZE OF MAIN CONDUCTORS y� NUMBER OF METERS y/l NUMBER OF DISCONNECTS AND RATINGS 4414 NUMBER OF PANELS It.-A REMOTE DISCONNECT REQUIRED? 0 YES U NO NUMBER OF LIGHT CIRCUITS /I/4 NUMBER OF POWER CIRCUITS NUMBER OF SWITCHES/VS} NUMBER OF OUTLETS /hi NUMBER OF LIGHT FIXTURES 11-A NUMBER OF HEAT CIRCUITS NUMBER OF A/C CIRCUITS /Y/1 SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. )� J 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. 88Z 3 y - CONTRACTORS LICENS E STATE SIGNATURE OF APPLICANT j DATE �6 -0s—