HomeMy WebLinkAbout109 SCANTIC MEADOW RD DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby:
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT bw
APPROV -,w 1540 SULLIVAN AVENUE Bldg.Permit#
A. 644-2511 ext. 230
�P
Date Building Ingpd6or
Application must be printed or typed
FEE SCHEDULE Q 1 Location of Job:
---
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000 _
or any fraction thereof Tenant Designation Apt. No.
APPLICANT Y
APPLICANT ADDRESS S N1�J I C �Cil
APPLICANT PHONE# �• Co �l f Z Z�
O W N Se-4
e-4 OWNER
OWNER ADDRESS O g C!-,� �Ic c a�cc✓ ��
S d y Lj t ti.A3 r r �J —
+� OWNER PHONECC
ESTIMATED COST$ _j fZ U
IS THIS A CONTRACT COST? Yes _No
l� o o � �G FEE ENCLOSED$
f�Y TYPE OF JOB: D I L l
60SO R-COS _New Installation
<Alteration/Addition/Repair
Revised 4/01//2002
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
m4tEgIDENTIAL BUILDING PERMIT APPLICATION? ❑ YES ❑NO
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑STORAGE
❑GARAGE ADDRESS
❑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
k6 14 x-,,a Servl<C,
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 TYPE STATE l
SIGNATURE OF APPLICANT DATE I ! d
S ,
- 1 01.0 'S'
f 144 143
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AN 1 ,'-- MEADOW ROAD
Lot numbers refer to map entitled,
"Subdivision Map, Farnham Estates,
Property of I. R. Stich Associates,
Inc., Rye Street, South Windsor, Conn.,
Scale lit - 401, Sept. 19, 1957, Sheet
#5, Certified Substantially Correct,
Morton S. Fine, C.E. & L.S." �g LON�f
PROPOSED LAYOUT
FARNHAM ESTATES
SCA.NTIC 1Il:ADOW ROAD
I hereby certify that this f�`/' SOUTH WINDSOR, CONN.
map is substantially cor-
rect and no zoning regula- o SCALE 1" a 401 OCT. 3 1955
tions have been violated . us+ MORTON S. FiNE, C.E.-L.S.
�� HARTFORD, CONN.