HomeMy WebLinkAbout1735 Ellington Road (9) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH WINDSOR K Y3
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
16& 14111— 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
FEE SCHEDULE f e Location of ob:
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000= ,.r
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$15.00 per$1,000A �t n
r 'on thereof Tenant Designation Apt.No.
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APPLICANT L::S4 wx- S
APPLICANT ADDRESS 9
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APPLICANT PHONE# Q
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OWNER
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< OWNER ADDRESS
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ESTIMATED COST$ E>
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IS THIS A CONTRACT COST? Yes )�(No
FEE ENCLOSED$
TYPE OF JOB:
New Installation
2Alteration/Addition/Repair
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 V�c
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD
SIZE OF SERVICE SIZE OF MAIN CONDUCTORS 2-
-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.
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CONTRACTORS LIC NSE NO. T(�- ---YPE STATE
SIGNATURE OF APPLICANT DATE 1 c7 Z'7 p Y
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