HomeMy WebLinkAbout1024 MAIN ST DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APPRO D 1540 SULLIVAN AVENUE Bldg.Permit#
�a 644-2511 ext. 230
Date Building Inspect
Application must be printed or typed
FEE SCHEDULE Location of Job:
$0-$1,000=$15.00 Street 7No�. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS ?' e°4�L/
APPLICANT PHONE#
O W N $F,q OWNER
OWNER ADDRESS �
S7N
OF, OWNER PHONE ,�-
C ;D ESTIMATED COST$
IS THIS A CONTRACT COST? _Yes _ o
FEE ENCLOSED$ D
TYPE OF JOB: �I
SpR-CD New Installation'-'—
nstallation
tion/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF -DING IS THIS APPLICATION ASSOCIATED WITH A
TIDE
BUILDING PERNIIT APPLICATION? ❑YES❑NO
NTIAL
U BUSINESS CENT USE AND OCCUPANCY
O ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑STORAGE
❑GARAGE ADDRESS
0 MIXED USE
CITY 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 WORK
100,
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.Z2Q/
coNTAAcroRs LICENSE NO. STATE
SIGNATURE OF APPLICANT DATE //��
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