HomeMy WebLinkAbout1739 Ellington Road (26) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby: o�p
_�_..., BUILDING DEPARTMENT
APPRO 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230 �
0
'bate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
1739 Ellington Rd.
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000= peoples Bank in Stop & Shop
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT Silverstone Electric Co. Inc.
APPLICANT ADDRESS 762 Garfield Ave.
Bridq=rt, Ct 06606
APPLICANT PHONE# 203-335-5582
W N S OWNER Richard S. Kelley
4� OWNER ADDRESS 1744 Ellington Rd.
South Windsor, Ct. 06074
OWNER PHONE
8,000.00
ESTTMATED COST$
IS THIS A CONTRACT COST? X Yes No
FEE ENCLOSED$ 120.00
TYPE OF JOB:
OR C X New Installation
Alteration/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
fg 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
�e C, (2 1 L< i�L4
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.
4102355 E1 CT
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT �l .�.,,2 i (,,,.�.,�,L DATE