HomeMy WebLinkAbout1175 Ellington Road DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
Appl• TOWN OF SOUTH WINDSOR PERMIT#
BUILDING DEPARTMENT f?�0�
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
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Date Bui ng or
Application must be printed or typed
FEE SCHEDULE n Location of Job:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation ► Apt.No.
APPLICANT
APPLICANT ADDRESS
APPLICANT PHONE#
O w N S F OWNER . O `��T G� �Y •
q� OWNER ADDRESS
OWNER PHONE
ESTIMATED COST$
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IS THIS A CONTRACT COST? Yes No
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FEE ENCLOSED$ to Q,b,�f
O�� TYPE OF JOB:
R J
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New Installation
Addition/Repair 1
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4
Revised 4/01//2002
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,
❑FACTORY ENGINEER'S NAME PHONE
❑STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please spec,tfy)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS
NUMBER OF METERS NUMBER OF DISCONNECTS AND RATINGS
NUMBER OF PANELS REMOTE DISCONNECT REQUIRED? ❑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.
CONTRACTORS LICENSE NO. E STATE
SIGNATURE OF APPLICANT '� DATE