HomeMy WebLinkAbout1571 Ellington Road DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMI
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Application is hereby: TOWN CF SOUTH WINDSOR PERMIT#
BUILDJNG DEPARTMENT
APPRov 1540 SULLIVAN AVENUE
644-2511 ext. 230 Bldg.Permit#
ate Building Inspector
Ajpplication must be printed or typed
FEE SCHEDULE Location of Job:
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$0-$1,000=$13.00 Street No. Street Lot No.
Over$1,000=
$13.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANTrrev
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APPLICANT ADDRESS
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APPLICANT PHONE# —
OWN $ OWNER rr&% 4- 1 i
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OWNER ADDRESS �
71 ���• a
E'' OWNER PHONE Aby ,
ESTIMATED COST$ _ Q
"S+ IS THIS A CONTRACT^OST?
des 0 No 3
FEE ENCLOSED$
dSOR.CO� TYPE OF JOB:
O Original Installation j
4y
Alteration/Addition/Repair Revised 8/99
9
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APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING 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 ENGINEER'-S NAME PHONE
❑FACTORY
❑ STORAGE ADDRESS
❑ GARAGE
❑MIXED USE CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF MAIN FEEDERS AND RATING OF WIRE USEDL
NUMBER OF METERS ' NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS t REMOTE DISCONNECT REQUIRED? ❑YES ltJ NO
NUMBER OF LIGHT CikCUfrS 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 SUBNHTTED.
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.
P — l'oo C--- 1 CT
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT DATE 0
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