HomeMy WebLinkAbout26 THOMAS ST DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENTtdg
APPRO D 1540 SULLIVAN AVENUE
Bldg.Permit#
644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
a b i�\nry\a
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000 _
or any fraction thereof Tenant Designation Apt.No.
APPLICANT �2 rt�Q �1(LO c�V�Q►'1►10.V21- _ _
APPLICANT ADDRESS
APPLICANT PHONE# I O
OW Ni SFq OWNER yCwT� Sv �' t �/ O'n
OWNER ADDRESS (d
5oytln W;n�Sod' G-f'
OWNER PHONE 8(00 -
C ESTIMATED COST$ /aQy
.� IS THIS A CONTRACT COST? _Yes _No
lL o "_ �CJ FEE ENCLOSED$ oo O v
1� TYPE OF JOB: 14-3
�SO R CO New Installation
2<,Alteration/Addition/Repair 6
516
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? ElYES 09 NO
❑BUSINESS CURRENT USE AND OCCUPANCY Anryyz
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY M Q_
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD Se c,Ce
SIZE OF SERVICE 4C SIZE OF MAIN CONDUCTORS_
NUMBER OF METERS�_ NUMBER OF DISCONNECTS AND RATINGS to
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑YES kNO
NUMBER OF LIGHT CIRCUITS NUMBER OF POWER CIRCUITS
NUMBER OF SWITCHES NUMBER OF OUTLETS
NUMBER OF LIGHT FIXTURES NUMBER OF HEAT CIRCUITS 0
NUMBER OF A/C CIRCUITS I—
SEPARATE HEAT LOSS AND A/C CALCULATIONS MUST BE SUBMITTED.
DESCRIPTION OF WORK
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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.
y\ 980Q9
CONTRACTORS LICENSE NO. T STATE
SIGNATURE OF APPLIC DATE_T�`;\ a3 /aco$
6/1/23, 11:01 AM Print Map
Town of South Windsor
Geographic Information System (GIS) �► �/
Date Printed: 6/1/2023
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MAP DISCLAIMER - NOTICE OF LIABILITY Approximate Scale: 1 inch=40 feet
This map is for assessment purposes only. It is not for legal description W E
or conveyances.All information is subject to verification by any user. 0 40
The Town of South Windsor and its mapping contractors assume no Feet
legal responsibility for the information contained herein. S
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