HomeMy WebLinkAbout214 LONG HILL RD DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Applicati TOWN OF SOUTH WINDSOR PERMI
BUILDING DEPARTMENT -1
Wl-
1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULElocation of Job:
FTenantDesignation
`$0-$1,000=$15.00 Street Lot No.
Over$1,000$15.00 per$1,000
or any fraction thereof Apt.No.
APPLICANT / f GL' ,Ll-
APPLICANT ADDRESS
APPLICANT PHONE#
O W N S Fq OWNER Qi e
OWNER ADDRESS
OWNER PHONE lyzt),
ESTIMATED COST$ 9 S^O
+� IS THIS A CONTRACT COST? x Yes _No
L� o 0 FEE ENCLOSED$ �S
SO. O�4 TYPE OF JOB:
R.C _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
RESIDENTIAL BUILDING PERMIT APPLICATION? 0 YES 0 NO
❑BUSINESS CURRENT USE AND OCCUPANCYr>��—{
0 ASSEMBLY
❑MEREDUCATTILE
IONAL
EDU 0 CATION FUTURE USE AND OCCUPANCY
U INSTITUTIONAL
U FACTORY ENGINEER'S NAME PHONE
❑STORAGE
O GARAGE ADDRESS
❑MIXED USE
(Other Please specify) CITY STATE ZIP
TYPE OF INSTALLATION/WHUNG METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS 9C
NUMBER OF METERS / NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? U 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."o�c>>?/! Z—'(/
Z�
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE
P & M ELECTRIC, L.L.C.
P.O. Box 337 (860)241-1573
Marlborough, CT 06447 Lic.#E 1-100919
Public Act No. 91-95: An act concerning the requirement that tensed contractors as defined in Section
20-330 of the Connecticut General Statutes,must personally sign each building permit application.
DATE: iol5la►oc)S
Toww o k- W-to4tc r
Building Department
Attention: Building Official
RE: Application for: ELECTRICAL PERMIT
To whom it may concern:
In accordance with Public Act 91-95, this letter authorizes the below named agent to sign the above-
referenced permit application.
1. Project Name: P.Ak" Max Ai%\-O
2. Location: cl VA Lena jcikk 'V,04XA
3. Starting Date: t0 I S acr�5
4. Licensed Contractor's Name: Salvatore Formica
5. Licensed Contractor's Trade License No. 100919
6. Name of Agent: Subby Magro
Jennifer L. Magro
Sincerely,
Signature of Company Officia
S e of Lice ontractor
Req ' lic Act 91-9