HomeMy WebLinkAbout1765 Ellington Road (2) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
PERMIT#
Application is hereby: TOWN OF SOUTH VaNDSOR �� �?
-, BUILDING DEPARTMENT
C APPROVED 1540 SULLIVAN AVENUE
Bldg.Permit#
/6,0 ,z- 40 644-2511 ext. 230
Date Building Inspector
Application must be printed or typed
EE SCHEDULE Location of Job:
7 G S 15 ,,v��
Fao
-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
15.00 per$1,000 c, e��N�stN
nyy fraction thereof Tenant Designation Apt.No.
APPLICANT C h aq^y/Ce
APPLICANT ADDRESS -7/ 11JAu C A
A lug C T
APPLICANT PHONE# 61 -Zoo - 7 ,?3 - ®73 I
O N S£ OWNER �o y e�?e
q� OWNER ADDRESS
M. OWNER PHONE
0
C ESTIMATED COST$ L? a a . �G ` 2 0
IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$
TYPE OF JOB: '
OR-C� New Installation
7AIteration/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
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY
❑EDUCATIONAL
❑INSTITUTIONAL PHONE
❑FACTORY ENGINEER'S NAME
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD ue
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
/iV
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.
104-1 0 /6, /_� /C � 7�
CONTRACTORS LICENSE NO. YPE STATE
SIGNATURE OF APPLICANT DATE % �� `�