HomeMy WebLinkAbout1739 Ellington Road (29) DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT
TOWN OF SOUTH WINDSOR PERMIT#
Application is hereby:
BUILDING DEPARTMENT
APPROVED 1540 SULLIVAN AVENUE Bldg.Permit#
644-2511 ext. 230
ate Building Inspector
Application must be printed or typed
FEE SCHEDULE Location of Job:
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$0-$1,000=$15.00 Street No. Street Lot No.
Over$1,000=
$15.00 per$1,000
or any fraction thereof Tenant Designation Apt.No.
APPLICANT -3 O S ('s-L OYv E
APPLICANT ADDRESS 00-n1 SPA) 2
N3 0Yt-7"— ELAnIAVAJ , G 0 6 K?3
APPLICANT PHONE# k Jf 14Y
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N S F OWNER Pr -7 il-(o t'4-,c A-� r)-% Sy s-z&eC6 4', r.
q� nt OWNER ADDRESS 2 ai
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OWNER PHONE '7 1 3 2—J
C ESTIMATED COST$ 411 O 0
4w IS THIS A CONTRACT COST? Yes No
FEE ENCLOSED$ c2YO.
TYPE OF JOB:
�SOR- _IZ� ew 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
USINESS 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
Fir&a n
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 LICENSE N TYP STATE
Z
SIGNATURE OF APPLICANT DATE 0ct ���-[ -1C>�—
Shirley Wilhelm -CRS Approval Confirmation: Request No. 221236 Page 1
From: <clpsvc@nu.com>
To: <W ILHEL@SOUTHW INDSOR.ORG>
Date: 9/11/02 12:42PM
Subject: CRS Approval Confirmation: Request No. 221236
Your approval of the following CRS Request has been successfully processed.
CRS Work Request#: 221236
House No: 1739
Lot No:
Street Name: ELLINGTON RD
Town Name: SOUTH WINDSOR, CT
Inspector: JOHN COLLINS
Approval Date: Sep 11, 2002