HomeMy WebLinkAbout17 PINE KNOB DR DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Application is hereby: TOWN OF SOUTH WINDSOR PERMIT#
4
BUILDING DEPARTMENT —
APPROV D 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Dat6 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$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT ,
APPLICANT ADDRESS �Q
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APPLICANT PHONE#
SOWN 3�� OWNER ti %aN�( !� ex—
� OWNER ADDRESS �,(>(°
a#. OWNER PHONE G
C ;D ESTIMATED COST$
x IS THIS A CONTRACT COST? _Cl/Yes _No
FEE ENCLOSED$
1��SOR•CO�y� TYPE OF JOB: q
_New Installation 77
�teration/Addition/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? O YES ElNO
0 BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE❑ EDUCATIONAL FUTURE USE AND OCCUPANCY
❑ INSTITUTIONAL
O FACTORY ENGINEER'S NAME PHONE
OSTORAGE
❑GARAGE ADDRESS
❑MIXED USE
(Other please specify) CITY STATE ZIP
TYPE OF INSTALLATION/WIRING METHOD Jac-eWeg r
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES &J�O
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 o
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SEPARATE �`'HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED. �, 1397 7 770
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
PERFORIy1ANCE OF SUCH WORK. r
CONTRAC ORS LICENSE NO. —� E STATE
SIGNATURE OF APPLICANT DATE /-0-
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1 inch = 40 feet