HomeMy WebLinkAbout2010 JOHN FITCH BLVD DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Applicatio
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
APP OVED 1540 SULLIVAN AVENUE
�ZJ Bldg.Permit#
644-2511 ext. 230
Date B ing Inspector
Application must be printed or typed
Loca on of Job:
FEE SCHEDULE Z Q/a /� �z zrz J�
$0-$1,000=$15.00 Street No. h Street T Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �(,� � 1
APPLICANT ADDRESS
E o t uj 1p�nAf o f c T C)(0 ��0
APPLICANT PHON # d (D l3
Ow N S F OWNER ! Q I r
44 OWNER ADDRESS Z 0 r O - XID'I, v
u UJ • �.- _
OOWNER PHONE to 0 - 73 Gd
C ESTIMATED COST$ O V. O J
IS THIS A CONTRAC COST? _Yes l.�o
�l �G FEE ENCLOSED .
TYPE OF JOB:
SOR.CO New Installation
_1.,A4t!Lcr'ation/Addition/Repair
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OEJ13ULLDING 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
❑ 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
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.
/ 'R o a y
CONTRACTORS LICENSE N TYPE ISTATEN
SIGNATURE OF APPLICANT DATE d —Z Z —� �p
Electric # APPLICATION FOR BUILD NG PERMIT
Plumbing# 2010 John Fitch Blvd. Date:
HVAC #
Sprinkler# 32784
FINAL R i— _- ----- -- —i Estimated Cost $
l t o� Permit Fee
Buildin $
g ` COMPLETE RED BOXED AREAS Occupancy Fee $
Enidavit nee n
Affidavit TYPE OR PRINT ONLY Eng. Insp. Fee $
► SIGN ON REVERSE SIDE
Appr. for CO. 1 Total Fee $�C,/),
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR, CT (Additional Cost) $
The and i ed here y a plies to do work according to the following:
Applicant Location of Work,-,']-?to Lot No.
Applicant's Address I <--r l3M Tel.# o-G qc^?f4
Town t/ Cg- Zip Qloolo(. Lic.#
Owner '72WA-Y Architect
Owner's Address Q Jp Architect's Address
Zip Zip
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permif 4?,e cf-21 rX..
City Water❑ Well❑ Septic System❑ Sewer❑
Ins: HO SP Cert. Area Basement Garage
Approved by Date 'd4 Use Grou nstruction Types-1
Revised 6102
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 disc ce from all street lines,side yard lines,and required
distances from all other zones and is located allowed
Signed
I hereby apply for a Certificate of Occupancy for the rk descri in this application for the permit.
Signed
DO NOT WRITE BELOW THIS LINE
INSPECTION COMMENTS
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TOWN OF SOUT H WI NDSO
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PLAN SHOVING LAND TO BE ACQUIRED FROM
JOHN P. MALIN
>FIGIAL Br
1 HEREBY CERTIrY THAT THIS MAP
15 SUB,—,TANTIALLY COR=•ECT TO THE
. TOWN CLERKS OFFICE . TowN ivo._
132 BEST OF MY KNOWLEDGE AND BELIEF. THE STATE OF CONNECTICUT
F PROJECT No 34 -a��� t� ✓�x� EAST HARTFORD—SPRINGFIE D ROAD
DRAWER NO.- ..-..-... SCALE t "-ao` # MQrc� /94 0
SERIAL NO
2 TiTLE��q����r o�D�s ROUTE U.S. 5
MAP NO.^ wl�iam ,/. Cox
SHEET_ OF DATE March i940
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