HomeMy WebLinkAbout0 ST MARC CIR BLDG 23 APPLICATION FOR ELECTRICAL PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: BUILDING DEPARTMENT
30.P 0 r6
APPROVED 1540 SULLIVAN AVENUE / #
513 -'
644-2511 ext. 230 Bldg.Permit
Date
Application must be printed or typed
FEE SCHEDULE Location of Job:
$041,000=$15.00 FStre�it
/? �'S' �i.� Ply Pi; P// P/
Over$1,000= Street PG Lot No.
$15.00 per$1,000 51,410
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Apxh 116lS6-x 7
APPLICANT ADDRESS '51V c, c.; -re,. RD
_<0V'T!1,- L-/i, o s G A C-r OKO 7 t( -- .
APPLICANT'S PHONE# £r60 5'X-`r 32y/
OWNER
oW N S£q< OWNER ADDRESS 44st�
OWNER PHONE
ESTIMATED COST$_ 3C%
..� < (� IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ /S
TYPE OF JOB: /2y6
SOR-CO� New Installation
e Alteration/Addition/Repair
�or �nDr32
Revised 03/05/10
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑ YES U NO
�b RESIDENTIAL CURRENT USE AND OCCUPANCY
❑ BUSINESS
❑ ASSEMBLY 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 ROh•6.t DC-y 4--O/j
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBERS OF METERS NUMBERS OF DISCONNECTS AND RATINGS
NUMBERS OF PANELS NUMBERS OF DISCONNECTS REQUIRED? ❑ YES ❑ NO
NUMBERS 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
104-re+C Ty'&
IN /�,��� �,✓/2 ep �v b�o�cc�•-�
THE UNDERSIGNED HEARBY 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 PERFOR-
MANCE OF SUCH WORK
0/9 �04 3 C sy C i
CONTRACTORS LICENSE NO. TYPE
/ TYPE STATE
SIGNATURE OF APPLICANT �Y�l DATE E$ Z - V,0