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APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR BUILDING DEPARTMENT
1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074(PHONE) 860-644-2511 EXT. 230
DEPARTMENT DECISION P T NUMBER:
APPLICATION IS HEREBY:
APPROVED: BLDG.PERMIT NUMBER:
DATE INSPECTOR �
LOCATION OF WORK:
APPLICANT: OWNER: TYPE OF STRUCTURE:
❑NEW BUILDING
NAME: C NAME: A� lj��r1/ 2-¢ -rZ_ o ADDITION
PHONE NUMBER: PHONE NUMBER: U(p J - L ; iJ 1 - STING BUILDING
ADDRESS: �i� 0 Y(�'G ADDRESS: -
� � TYPE OF USE:
SIDENTMI. ❑COMMERCIAL
ELECTRICAL INFORMATION: n FURTHER DESCRIPTION OF WORK:
TYPE OF INSTALLATION: L �-C PC�i C�sL(c'u �F-P(-A-t-- !Q+lyE L
SIZE OF SERVICE: lV +,A,10 t / 7-7+- U JyC T-1f m 2
SIZE OF MAIN SERVICE: l%l) cP Cir 26-L' I � AW 0
NUMBER OF METERS: f- �
NUMBER OF PANELS: 1
D c%
NUMBER OF LIGHT CIRCUITS: ESTIMATED COST:S /Z
NUMBER OF SWITCHES:
NUMBER OF LIGHT FIXTURES: FEE ENCLOSED:S
NUMBER OF A/C CIRCUITS:
FEE SCHEDULE:$18 PER S1,000 OF THE ESTIMATED COST.
NUMBER OF POWER CIRCUITS: ROUND UP TO THE NEXT THOUSAND ONCE THE PROJECT
IS SLOO OVER (.26 CENT EDUCATIONAL FEE INCLUDED AS
NUMBER OF OUTLETS: PART OF THE PERMIT FEE)
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 PERFOMANCE OF SUCH WORK.
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CONTRACTORS LICENSE NO.: I TYPE:� STATE:
SIGNATURE OF APPLICANT: L)VI, DATE:
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SIG.:
1800263 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER ELECTRICAL PERMIT
DATE: 08/03/2018
GIS ID:20700018 FEE: 36.00
MUNIS APPLICATION# 201801379 BUILDING DESCRIPTION:
APPLICANT. LOCATION
NAME: ACKERT ELECTRIC ADDRESS: 18 CLEARVIEW DRIVE
ADDRESS: P.O. BOX 406 OWNER: GONZALEZ JUBENAL W&MICHELLE M
__. 18 CLEARVIEW DRIVE
COVENTRY,CT 06238
DESCRIPTION OF WORK: REPLACE EXISTING PANEL WITH ONE WITH MORE CIRCUITS
AND AN INTERLOCK FOR A GENERATOR
SPECIAL CONDITIONS:
ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVE THE BT DEPARTMENT.
CONSTRUCTION TYPE:
OCCUPANCY GROUP: BUILDfNG OFFICIAL
8/3120I8 2:52 PM THE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CT STATE EDUCATION SURCHARGE