HomeMy WebLinkAbout16 TROY RD DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
TOWN OF SOUTH WINDSOR
Application ' reby:
BUILDING DEPARTMENT
ED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
ate B n nspector
-�
Application must be printed or typed
FEE SCHEDULE Location of Job:
/4 TROY
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt. No.
APPLICANT y N pl E(3,KZ E ��.. Sok4 L_L_C
APPLICANT ADDRESS -0("7` 0 VZ 0
Lk)I jAiD.%i&_Lnr hL5 , Cr 06496
APPLICANT PHONE# Q O 6S- 1
0 W N Se OWNER Lui C U► l T'-4 Q
OWNER ADDRESS
�Oc,1`rt� (V l'4 VI
0 OWNER PHONE — 62 Z SS�
C ESTIMATED COST$ Z(200
06
r
IS THIS A CONTRACT COST? Yes _No
a r-'^���.► FEE ENCLOSED$ 3O C' j� ll
�✓' TYPE OF JOB:
SOR.CO New Installation
A Alteration/Addition/Repair
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? ❑ YES)(NO
RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑ MERCANTILE FUTURE USE AND OCCUPANCY
❑ EDUCATIONAL
❑ INSTITUTIONAL
❑ FACTORY ENGINEER'S NAME PHONE
El STORAGE
❑GARAGE ADDRESS
❑ MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD i?Lg-
SIZE OF SERVICE 2.00 A SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS / REMOTE DISCONNECT REQUIRED? ❑YES XNO
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.
I02986 (_I r'_?"
CONTRACTORS LICENSE NO. ��TYPE STATE
SIGNATURE OF APPLICANT DATE /,f
Electric# APPLICATION FOR BUILDING PERMIT
Plumbing# 16 roy Paad Date: H( ✓Z Cc 07
HVAC # -
Spri t_ 731282
F Y -S --- - - - - _ - --- - --- -- Estimated Cost $ ,li)
Building COMPLETE RED BOXED AREAS Permit Fee $ 7.� -
Engineering I Occupancy Fee $
En
g g TYPE OR PRINT ONLY i Eng. Insp. Fee $
Affidavit
C SIGN ON REVERSE SIDE Total Fee
- - - - -
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant Lo1J4
on Work - �G -. Cot No.
Applicant's ddress Ao I O ' W CI O Tel # —
Town n Zip Lic.#
Owner Architect
Owner's Address Architect's Address
Zip Zip
Sq. Ft. New Area: 1 st FI. 2nd FI. n 3rd FI. Total New Area
Purpose of this permit t
v L_) 1
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO SP a Area Basement Garage
Approved by Use Group Construction Type
Revised 6/02 I
I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of
South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this
permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required
distances from all other zones and is located in which this building and its use is allowed.
Signed
I hereby apply for a Certificate of Occupancy for the work described in this application for the permit.
Signed
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
PERMIT CLOSEn
PA- 17-176
AND
rGS 22,393