HomeMy WebLinkAbout1735 Ellington Road (13) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
TOWN OF SOUTH WINDSOR
Application'
BUILDING DEPARTMENT
PROVE 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date Build' g Ispector
Application must be printed or typed
Location of Job:
FEE SCHEDULEI / fr.1 ,- 0
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT
APPLICANT ADDRESS AB Arl 6,0
M C c 1-� s i 17 AG D V-6—
APPLICANT PHONE# (n
OWNER
001�O* SFq w
OWNER ADDRESS
S
OWNER PHONE L� L/
ESTIMATED COST$ -9,1
Pal
IS THIS A CONTRACT COST? Yes �No
f� FEE ENCLOSED$ -TO,
TYPE OF JOB:
�sOR•C�� New Installation
7XAlteration/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
XBUSINESS 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 specify)
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. TYPE STATE
SIGNATURE OF APPLICANT --{ `-�--- DATE
Shirley Wilhelm - CRS Approval Confirmation: Request Not. 236639 Page 1
From: <clpsvc@nu.com>
To: <W ILHEL@SOUTHW INDSOR.ORG>
Date: 11/28/02 4:16AM
Subject: CRS Approval Confirmation: Request No. 236639
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 236639
House No: 1735
Lot No:
Street Name: ELLINGTON AVE
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Nov 27, 2002