HomeMy WebLinkAbout1739 Ellington Road (27) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Applica. ' ere BUILDING DEPARTMENT �
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
Date B ing Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
1932 'E ' w'L'?
$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT ® �� � - — `c�`HC1�r►t
APPLICANT ADDRESS 2 0 tF Ise. ftkcY . 5ec-
'
PA i IJ k4aw o. 06 57
APPLICANT PHONE# (960)
W N S OWNER �b �f- Seto
�q IV4 I-
� OWNER ADDRESS I-&A A,-
O _ OWNER PHONE
ESTIMATED COST$ ---. ,3 • r—
14WIS THIS A CONTRACT COST? XG Yes No
FEE ENCLOSED$ 6 6
11`r� TYPE OF JOB:
SOR'CD 'New Installation
Alteration/Addition/Repair
Revised 4/01//2002
S
APPLICATION FOR ELECTRICAL PERMIT (Continued from reverse side)
TYPE OF BUILDING IS THIS APPLICATION ASSOCIATED WITH A
BUILDING PERMIT APPLICATION? 2 YES ❑NO
❑RESIDENTIAL
BUSINESS CURRENT USE AND OCCUPANCY
❑ASSEMBLY
❑MERCANTILE FUTURE USE AND OCCUPANCY �"Sf'1v G"CtrzA
❑EDUCATIONAL
❑INSTITUTIONAL
❑FACTORY ENGINEER'S NAME PHONE
❑ STORAGE
❑GARAGE ADDRESS
❑MIXED USE
CITY STATE ZIP
(Other please specify)
TYPE OF INSTALLATION/WIRING METHOD U 1 P 0VrE-6bx,-f S Fba ok 19k,K- c AA>L�
uTp C-j"-C-&o(Ly3 R fo-tY «19�
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
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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.
� F246 I Z T/ c-
CONTRACTORS LICENSE NO. TYPE STATE
SIGNATURE OF APPLICANT / DATE / 0 2