HomeMy WebLinkAbout25 PINE TREE LN DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPRO D 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
s'-•�$ • C f2 c
Date Building Inspect j
Application must be printed or typed
FEE SCHEDULE FTenant
Location of Job:
+I`c-_ � Clr$0-$1,000=$15.00 Street Lot No.
Over$1,000$15.00 per$1,000
or any fraction thereof gnation Apt.No.
APPLICANT1C9
APPLICANT ADDRESS -7 (j--Z)c�—x- r v-
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APPLICANT PHONE# -7 a 3 G
O W N S F,q OWNER C' in r T n
OWNER ADDRESS _ T P,do Q»
Qj, �Y, CfZ�
co� r: i� OWNER PHONE y y a a a a
O
C! ►7 ESTIMATED COST$ / o`Z 00 00
.� � IS THIS A CONTRACT COST? 1C Yes _No
tG O (" G FEE ENCLOSED$ 30
TYPE OF JOB: *1 411�
�SO R•CO _New Installation
Alteration/Addition/Repair
Revised 4/01//2002
I
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? 0 YES ❑NO
❑RESIDENTIAL
❑BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
0 INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
0 STORAGE
0 GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD O 0 1~V i L G � 0,
SIZE OF SERVICE /0 O SIZE OF MAIN CONDUCTORS 4? -
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS 00
NUMBER OF PANELS_� REMOTE DISCONNECT REQUIRED? ❑YES *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
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
/D D
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./ d -'3 -.57- i d , con"
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANTC.-.20 DATE AV to
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