HomeMy WebLinkAbout0 BENEDICT DRAPPLICATION FOR ELECTRICAL PERMIT
DEPARTMENT DECISION TOWN OF SOUTH WINDSOR PERMIT#
Ap ClYy:
BUILDING DEPARTMENT 000`3l
1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg. Permit#
Date ding Inspector
Application must be printed or typed
oe heck k C'f ' k V`-- cation of Job:FEE SCHEDULE pp p
0-$1,000= $15.00 r G"r o P h Q,94 U LX2 t` a
Over$1,000= I Street No. Street Lot No.
15.00 per$1,000
or any fraction thereof Tenant Designation Apt. No.
APPLICANT co s s E Ce
APPLICANT ADDRESS r `( kI n ti J T
E--, 4:ct d 0100 y L,
APPLICANT'S PHONE # e&,) 335-1
OWNER CT- W aT 1Zte- Co.
oW N S fqC OWNER ADDRESS 5— 1Vqrjk 9-b
OWNER PHONE 0
ESTIMATED COST$ A S(1'D- 0t
U IS THIS A CONTRACT COST?Yes No
A* FEE ENCLOSED$ S l a a 15 k5
G
r TYPE OF JOB: j 5` 0-1
S •co New Installation
Alteration/Addition/Repair
Revised 03/05/10
APPLICATION FOR ELECTRICAL PERMIT(Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? YES C -56
RESIDENTIAL CURRENT USE AND OCCUPANCY
BUSINESS
ASSEMBLY FUTURE USE AND OCCUPANCY N A.
EDUCATIONAL
INSTITUTIONAL ENGINEER'S NAME PHONE
FACTORY
STORAGE ADDRESS
GARAGE
MIXED USE CITY STATE ZIP
Other please specify)
TYPE OF INSTALLATION/WIRING METHODt+S
SIZE OF SERVICE I CID SIZE OF MAIN CONDUCTORS -?
NUMBERS OF METERS NUMBERS OF DISCONNECTS AND RATINGS
NUMBERS OF PANELS NUMBERS OF DISCONNECTS REQUIRED? YES NO
NUMBERS 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
fe](i dJ cc._ 9r dJ q TV-4 4L.0 l A)ap s
THE UNDERSIGNED NEARBY 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 PERFOR-
MANCE OF SUCH WORK
CONTRACTORS LICENSE NO TYPE STATE
SIGNATURE OF APPLICANT DATE I Z/aarl a